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Pharm1 Chapter23
| Question | Answer |
|---|---|
| Which type of antianginal medication is most effective for coronary artery spasms? | Calcium Channel Blockers |
| A PT has recently been prescribed an antianginal med--and now they are "tired and depressed" and have been having "nightmares"--what med do you suspect? | Beta blocker |
| Besides nitroglycerian, what type of antianginal med is good at treating exertional angina? | Beta blocker |
| What is preload? | The volume of blood in the heart |
| Besides nitroglycerian, what type of antianginal med is good at treating exertional angina? | Flushing, Headache, hypotension |
| What is afterload? | The pressure that the heart pumps against |
| Before administering isosorbide mononitrate (Imdur), what would be a priority assessment? | taking the PTs blood pressure |
| Where is the best place to apply nitroglyceride patch or ointment? | Nonfatty, non-hairy part of skin, proximal of elbows and knees preferrably on the upper torso |
| What should be monitored with IV nitroglycerine? | BP, HR, and chest pain |
| It is most important to instruct a person on nitroglycering to avoid what medication? | Erectile dysfunction meds which can cause acute exacerbation of nitrate related hypotension |
| Is IV nitroglycerine administered as a bolus? | NO, only in a continuous infusion only! |
| Can Calcium channel blockers (like diltiazem(Cardizem)) be used to treat acute anginal attacks? | No, calcium channel blockers are only used to prevent angina |
| What is chronic stable angina? | Chest pain that has as its primary cause atherosclerosis, which results in a long-term but relatively stable level of obstruction in one or more coronary arteries. AKA classic angina, effort angina and exertional angina. |
| What is unstable angina? | Is usually the early stages of progressive CAD; often culminates in MI later in life. AKA preinfarction angina, and crescendo angina b/c the pain increases in severity and frequency of attacks. |
| Vasospastic angina? | results from the spasms of the layer of smooth muscle that surrounds atherosclerotic coronary arteries. This often happens at rest without any preceipitating cause. AKA Prinzmetal's Angina or Variant Angina. |
| What are the contraindications for the use of nitrates? | Sever anemia (drug-induced hypotensive episode can further comprimise already reduced tissue oxygenation), closed-angle glaucoma, and severe head injury. |
| When taken with what drugs will nitrates produce additive hypotensive effects? | alcohol, beta-blockers, CCBs, phenothiazines (largest group of antipsychotic drugs), and erectile-dysfunction drugs like sildenafil (Viagra) |
| Beta-blockers have become a "mainstay" in ther tx for which cardiovascular diseases? | angina, MI, dyrhythmias, and hypetension |
| A normal heart spends 60-70% of its time in diastole (at rest), what happens as the heart spends more time in a systolic state? | The heart needs more oxygen (due to increased muscle contraction), and it's receiving less blood to support that demand. The harder the heart is working the more ischemic it gets (less blood it receives). |
| What is used to stop the irritating effects of the catecholamines after MI? | Beta blocker |
| What is the rule of thumb with Nitro administration? | 1 subling. Tablet every 5 minutes up to 3 tablets |
| What are some common beta blockers? | atenolol (Tenormin) Metoprolol (Lopressor) Propranolol (Inderal) and Nadolol (Corgard) |
| Unless strongly contraindicated, what should be given to all pt's post- MI? | Beta blocker |
| What is Renin? | A potent vasoconstrictor released by the kidneys. Beta blockers suppress the activity of Renin. |
| Beta-blockers are most effective against typical exertional angina--what might bring on this type of angina in an elderly pt? | Performing regular ADLs |
| What are the contraindications for the use of beta-blockers? | Systolic HF, serious conduction disturbances, bronchial asthma. Relative contraindications include diabetes mellitis (BBs can cause both hyper- and hypoglycemia), reduced mental alerness, and peripheral vascular disease |
| Which BB is indicated for the tx of congestive heart failure, essential hypertension, and less for angina? | Carvedilol |
| What are considered to be the first line drugs for angina, hypertensionm and supraventricular tachycardia? | Calcium Channel Blockers |
| Which type of drugs are particularly useful for prinzmetal's angina? | Calcium Channel Blockers |
| Which CCB is indicated solely for the use of cerebral artery spasms? | dihydropyridine CCB nimodipine |
| What are the contraindications of CCBs? | acute MI, 3rd degree atroventricular block (unless the pt has a pacemaker), and hypotension |
| Grapefruit juice reduces the metabolism of which drug? | Calcium Channel Blockers |
| What is the newest antianginal drug, that also raises digoxin levels enough to require that adjustments to the digoxin dose be made? | Ranolazine |
| How do the nitrates help angina? | by decreasing venous return and systemic vascular resistance (preload and afterload) |
| How do the Beta-blockers help angina? | by slowing the HR, and decreasing the contractility--which decreases the oxygen demand of the heart |
| What are drugs that end with -afil used for? | Erectile dysfunction meds which can cause acute exacerbation of nitrate related hypotension |
Created by:
cspearsall
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