Tanya Sklierenko (Markland Wood Pharmacy) for NP-UN, Toronto.
Angina is the term for episodes of chest pain or discomfort caused by partial blockage of the heart’s blood vessels. Often times, the chest pain will present as a squeezing, suffocating or burning feeling. The pain may spread to the left arm, neck, back, throat or jaw. Angina is usually brought on by physical activity, stress or extreme cold or hot temperatures. Usually angina only lasts a few minutes.
Although angina is not a heart attack, it is a sign of increased risk of certain heart diseases. For this reason, management of angina by making lifestyle changes and taking medications is essential.
Lifestyle changes include: staying physically active (for angina, the type and duration of exercise should be specifically approved by a doctor), eating a healthy diet (such as restricting salt intake and following the DASH diet – more info here), avoiding cigarette smoking and decreasing alcohol intake. In addition, managing other medical conditions such as high blood pressure, high cholesterol and diabetes can be very helpful.
There are many medications to help prevent and relieve symptoms of angina. Nitrates are a common class of medication used for this purpose. They are available in short-acting and long-acting formulations and are prescribed for a various reasons. See the charts below for more information & important tips to remember with regards to these medications.
Short‐Acting Nitrates
Purpose:
These formulations act quickly to deliver the medication and provide relief.
They take effect within 2-5 minutes. For this reason, they are most commonly prescribed for the treatment of sudden attacks of chest pain.
Examples:
Available as a sublingual spray (Nitrolingual Pumpspray) and sublingual tablets (Nitrostat) that are used under the tongue.
Important tips:
- Always make sure that the medication you carry is not expired.
- Keep the spray or sublingual tablets with you at all times and in an easy-to-reach place (such as a purse, pocket or glove compartment).
- The spray and sublingual tablets are available both with and without a prescription. This ensures that the medication is readily available for anyone experiencing an attack of severe chest pain.
- These medications often cause quite a bit of light-headedness so they are best administered when sitting down.
- It is important to be familiar with the process of how to administer these medications in the event of sudden chest pain. For a reminder on how to best use them, feel free to come into the pharmacy – we are more than happy to review with you!
Long‐Acting Nitrates
Purpose:
These formulations provide consistent levels of medication throughout the day. They often take effect within 30 minutes. For this reason, they are most commonly prescribed for the prevention of sudden attacks of chest pain.
Examples:
Available as a patch (Trinipatch, Nitro-Dur) and oral tablets (ISMN).
Important tips:
- It is common for short-acting and long-acting formulations of nitrates to be used in combination.
- These medications are only available with a prescription.
- The effectiveness of these medications can diminish with constant use. Therefore, if you have been prescribed the patch, it is important that it be removed for at least 12 hours of the day. Since most individuals have angina during periods of activity, it is recommended to apply the patch at 8am and remove it at 8pm.
- Medication may still remain in the patch upon disposal. To properly discard the patch, fold it in half with the adhesive side inwards. Throw it away safely out of the reach of children and pets.
- Contact with water (such as bathing, swimming, showering, etc.) or physical activity will not affect the patch
Share on Social Media
