In most instances, drugs are recommended for the treatment of angina before surgery is considered. The major classes of drugs used to treat angina include the following:
Nitrates. These come in several forms: nitroglycerine tablets to be slipped under the tongue during or in anticipation of an attack; ointment to be absorbed through the skin; long-acting medicated skin discs; or long-acting tablets. The latter three forms are used mostly to prevent rather than relieve attacks. The nitrates work by reducing the oxygen requirements of the heart muscle.
Beta-blocking Drugs. These agents act by blocking the effect of the sympathetic nervous system on the heart, slowing heart rate, decreasing blood pressure, and thereby, reducing the oxygen demand of the heart. Recent studies have found that these drugs also can reduce the chances of dying or suffering a recurrent heart attack if they are started shortly after suffering a heart attack and continued for two years.
Calcium-channel Blocking Drugs. These drugs are prescribed to treat angina that is thought to be caused by coronary artery spasm. They can also be effective for stable angina associated with exercise. All muscles need varying amounts of calcium in order to contract. By reducing the amount of calcium that enters the muscle cells in the coronary artery walls, the spasms can be prevented. Some calcium-channel blocking drugs also decrease the workload of the heart and some lower the heart rate as well.
Use of Nitroglycerin
Nitroglycerin is usually effective in relieving anginal chest discomfort. It also can be used to prevent anginal pain. It is usually taken in tiny tablets which are placed under the tongue to dissolve, but may also be prescribed as an oral spray. The nitroglycerin tablets are inexpensive and quick-acting. Keep a fresh, sealed supply of the tablets on hand at all times. As a general rule, avoid transferring your nitroglycerin tablets out of the original, dark glass bottle, since the tablets are sensitive to heat, light and air. Do not keep cotton in the bottle because it will absorb the nitroglycerin.
Always use the medicine as directed by your doctor. Be sure to carry the nitroglycerin with you at all times. Take a tablet just before starting an activity you know is likely to cause anginal discomfort. Also, take a tablet when the discomfort does not subside within a minute or two after you have stopped the activity, or if it occurs when you are not physically active. Let your doctor know what usually causes your angina so that he can advise you about preventing attacks. It may take several tablets a day to control your symptoms.
Nitroglycerin is safe and not habit forming, so don't be afraid to take it. Ask your doctor what to do if nitroglycerin is not effective in relieving your angina completely or if the pain begins to increase in frequency or severity.
In some people, nitroglycerin causes a short headache or a feeling of fullness in the head. Often these symptoms will disappear after you have taken nitroglycerin several times. If not, your doctor may want to reduce the dosage in each tablet.
If your angina is not relieved after taking three (3) tablets within a 10-minute period, seek medical attention promptly. If your doctor is not immediately available, go to your local hospital Emergency Room.
Ask your doctor about refilling your nitroglycerin prescription at six-month intervals, since old tablets can lose their strength; tables that are effective should cause stinging or burning under the tongue.
Your doctor may also prescribe longer-acting nitroglycerin compounds which are taken by mouth or applied to the skin as an ointment or skin patch.
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