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Patient education: Medicines for angina (chest pain) (The Basics)

Patient education: Medicines for angina (chest pain) (The Basics)

What is angina? — Angina is the medical term for chest pain caused by a condition called "coronary heart disease" or "coronary artery disease." In this disease, the blood vessels that supply the heart with blood get narrower and narrower because fatty deposits build up on the inside walls. When the vessels get too narrow, the heart muscle does not get enough blood. This causes chest pain, especially during physical activity.

What do medicines for angina do? — Medicines for angina help prevent or ease chest pain (figure 1). They can:

Relax blood vessels going to the heart muscle – This lets more blood flow to the heart.

Reduce the amount of work the heart muscle has to do

What medicines might I need? — Your doctor will decide which medicine is best for you. Some people take just 1 medicine for angina. But the first medicine you try might not help enough. If that happens, tell your doctor or nurse. People sometimes need to try a few different medicines before they find the treatment that works for them. And some people take 2 or 3 of the medicines together.

There are 4 types of medicines that doctors use to treat angina (table 1). These are listed below.

Nitrates — These medicines come in many different forms, including:

Pills or powder that go under your tongue

Sprays that go on or under your tongue

Pills that you swallow

Patches that you wear on your skin

Ointment that you put on your skin

Your doctor will decide which form of nitrate is best for you. It depends on how often you get angina, how long it usually lasts, and what kinds of situations cause you to get it. You should sit down if you are taking nitroglycerin to relieve chest pain. Sometimes, doctors tell people to take under-the-tongue nitrates before they exercise. This can prevent angina. Keep nitroglycerin tablets in the bottle they came in with the cap on tightly.

If you take nitrates, you should know:

Call for an ambulance if your chest pain lasts – Your doctor might tell you to take 2 to 3 doses of under-the-tongue or spray nitroglycerin spaced 5 minutes apart when you get angina. But if your chest pain lasts more than 5 minutes after you take your last dose, call for an ambulance right away (in the US and Canada, call 9-1-1). You might be having a heart attack.

Beware of the side effects – The side effects of nitrates include a fast heart rate, a headache, feeling lightheaded, fainting, and "flushing." Flushing is when your skin gets red and feels hot, especially on your face. You should sit down when you take under-the-tongue or spray nitroglycerin to lower your risk of fainting. Older people are more likely to get lightheaded than younger people, especially in hot weather. Drinking alcohol can make nitrate side effects worse, so be very careful when taking these medicines.

Avoid erection medicines – If you take nitrates, do not take medicines to help you get or keep an erection. These medicines include sildenafil (brand name: Viagra), vardenafil (brand name: Levitra), and tadalafil (brand name: Cialis). Taking these medicines with nitrates is very dangerous.

Beta blockers — These medicines are usually taken 1 or 2 times a day to prevent angina. There are many different types of beta blockers. Your doctor will choose the best one for you based on your age and any other health problems you might have.

When you first start taking beta blockers, they might make you feel tired. That is just while the body gets used to the medicine. You might have other side effects, such as breathing problems or trouble getting an erection. You might need to try many different beta blockers to find the one that causes the fewest side effects and works best for you.

Calcium channel blockers — Doctors usually only give these medicines to people who:

Can't take beta blockers because of side effects or because of other health problems

Still have angina even though they take nitrates and beta blockers

Side effects from calcium channel blockers include:

Flushing

Dizziness and lightheadedness

Headache

Swelling of the feet and ankles

Constipation

The side effects will depend on the kind of calcium channel blocker you take. You might need to try many different kinds to find the one that causes the fewest side effects and works best for you.

Ranolazine — This is the latest medicine (brand name: Ranexa) for treating angina. Doctors give this to people who still have angina even while taking a combination of beta blockers, calcium channel blockers, or nitrates. The side effects include:

Feeling dizzy

Headache

Upset stomach

Constipation

For more detailed information about your medicines, ask your doctor or nurse for the patient handout from Lexicomp available through UpToDate. It explains how to use each medicine, describes its possible side effects, and lists other medicines or foods that can affect how it works.

More on this topic

Patient education: Chest pain (The Basics)
Patient education: Coronary artery disease (The Basics)
Patient education: Heart attack (The Basics)
Patient education: Medicines after a heart attack (The Basics)

Patient education: Medications for angina (Beyond the Basics)
Patient education: Angina treatment — medical versus interventional therapy (Beyond the Basics)

This topic retrieved from UpToDate on: Feb 02, 2024.
Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or medication information. It is not meant to be comprehensive and should be used as a tool to help the user understand and/or assess potential diagnostic and treatment options. It does NOT include all information about conditions, treatments, medications, side effects, or risks that may apply to a specific patient. It is not intended to be medical advice or a substitute for the medical advice, diagnosis, or treatment of a health care provider based on the health care provider's examination and assessment of a patient's specific and unique circumstances. Patients must speak with a health care provider for complete information about their health, medical questions, and treatment options, including any risks or benefits regarding use of medications. This information does not endorse any treatments or medications as safe, effective, or approved for treating a specific patient. UpToDate, Inc. and its affiliates disclaim any warranty or liability relating to this information or the use thereof. The use of this information is governed by the Terms of Use, available at https://www.wolterskluwer.com/en/know/clinical-effectiveness-terms. 2024© UpToDate, Inc. and its affiliates and/or licensors. All rights reserved.
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