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Pharmacology Exam 1

Angina

QuestionAnswer
Angina Pectoris Is sudden pain beneath the sternum, often radiating to the LEFT shoulder and arm.
Angina Pectoris CAUSED by...DISEASE OR SYMPTOM? By 02 supply not meeting the 02 demands of the heart. Anemia may cause this also. Angina Pectoris is a symptom not a disease!
When having angina Pectoris what is the 1st intervention? Put patient on 02 1st.
Drug therapy has 2 GOALS for ANGINA PECTORIS 1) PREVENTION OF MI and DEATH 2) PREVENTION OF MYOCARDIAL ISCHEMIA & ANGINAL PAIN.
If the heart is not getting enough 02 the EKG will show Reserved T waves.
02 demand is determined by... 4 factors 1) Heart rate, 2) contractility, 3)Preload, & 4)Afterload. Drugs that reduce these factors reduce 02 demand.
What are the 3 types of antianginal families of drugs? 1) Beta blockers, 2)Calcium Channel Blockers, 3) Organic NITRATES
What is CARDIAC 02 supply determined by and how is it accommodated? BLOOD FLOW To accommodate an increase in cardiac 02 demand must increase BLOOD FLOW.
When does Myocardial perfusion occur? Only during Diastole (when the heart relaxes).
What triggers Chronic Stable angina known as EXERTIONAL ANGINA Triggered most often by an increase in physical activity (also emotional excitement, large meals, & cold exposure)
GOAL of antianginal therapy is to... To reduce the intensity and frequency of angina attacks.
How does antianginal therapy work by... (organic nitrates, BB, CCBs) Decrease cardiac 02 demand by DECREASING HEART RATE, CONTRACTILITY, AFTERLOAD, AND PRELOAD.
What is Variant angina (Prinzmetal's angina, Vasopastic angina) caused by... Caused by Coronary Artery spasm which restricts blood flow to the myocardium.
When does Variant angina (Prinzmetal's angina, Vasopastic angina) OCCUR? Can occur at any time including REST and SLEEP
GOAL of VARIANT ANGINA To reduce the intensity & severity of attacks
How do you treat VARIANT ANGINA? TX. increasing cardiac 02 supply (VASODILATORS). Drugs used: NITRATES, CCBs
What is UNSTABLE ANGINA? IT IS AN EMERGENCY. May present with either symptoms of angina at rest, new-onset exertional angina, & Intensification of existing angina.
RISK OF UNSTABLE ANGINA THAN STABLE? Much GREATER RISK OF DEATH THAN STABLE, but SMALLER RISK OF DEATH than MI.
Treatment for UNSTABLE ANGINA CONSISTS OF? Anti-ischemic therapy (NTG, BB, 02, ACE1) Anti-platelet therapy (ASA, PLAVIS) Anti-coagulant therapy (HEPARIN)
ORGANIC NITRATES-OPENS VEINS 8 QUESTIONS NITROGLYCERIN
What is the oldest 1879 drug & most frequently used?? NITROGLYCERIN
What is Drug of choice for ACUTE ANGINA attacks? Nitroglycerin
Nitroglycerin ACTION Causing VASODILATION on vascular smooth muscle (VSM).
Nitroglycerin act on veins or arteries? At usual doses, ACTS ON VEINS, dilation of arterioles is MODEST.
In the biochemical event of NITROGLYCERIN what is the most important ASPECT. Is the conversion of NITRATE to its ACTIVE FORM--NITRIC OXIDE-- in the presence of a SULFHYDRYL source.
HOW does Nitroglycerin work in STABLE ANGINA? Works by decreasing cardiac 02 demand (decreases VENOUS return to the heart-----DECREASING VENTRICULAR filling) This decrease in wall tension (preload) decreases 02 demand).
Does nitroglycerin in STABLE ANGINA increase blood flow to ischemic area of the heart? It DOES NOT, (does not dilate atherosclerotic arteries). Does not RELIEVE PAIN, pain relief from effects on peripheral blood flow.
How does NITROGLYCERIN work in VARIANT ANGINA? NTG relaxes or prevents spasm (decreases spasms) in coronary arteries-thus increasing 02 supply.
What is the pharmacokinetics for NITROGLYCERIN? Is HIGHLY LIPID SOLUBLE & CROSSES MEMBRANES EASILY. Has rapid inactivation by HEPATIC ENZYMES in 1st pass-HALF LIFE 5-7 minutes.- goes under tongue.
What are the adverse effects NITROGLYCERIN & TX.? 1) HA--- (use ASA & tylenol) 2) Orthostatic hypotension from relaxation of VSM resulting in pooling of blood in veins when standing- (sit or lie down if occurs, elevating feet helps promote venous return)
Cont. of adverse effects NITROGLYCERIN & TX.? 3) Reflex Tachycardia can occur form low BP (baroreceptor response to increase HR), & negate benefits of therapy--- PRETREATMENT with a CCB or BB can prevent sympathetic stimulation of the heart.
What are drug interactions with NITROGLYCERIN? CAN INTENSIFY the effects of HYPOTENSIVE drugs (BB, CCB, & OTHERS). Use with PHOSPHODIESTERASE type 5 inhibitors (VIAGRA, CIALIS, LEVITRA) INTENSIFY NTG effects---LIFE THREATENING HYPOTENSTION can occur---**CONTRAINDICATED WITH THESE DRUGS.
What drugs are CONTRAINDICATED WITH nitroglycerin? PHOSPHODIESTERASE TYPE 5 INHIBITORS (VIAGRA, CIALIS, LEVITRA) INTENSIFY NTG effects--- LIFE THREATENING hypotension can occur.
How FAST can TOLERANCE occur for NITROGLYCERIN? Occurs rapidly (OVER 1 DAY) FROM depletion of SULFHYDRYL groups in VSM.
Do those who develop (tolerance to nitroglycerin) show a cross-tolerance to all other nitrates? YES
When does tolerance to nitroglycerin most occur? Most occurring with HIGH-DOSE uninterrupted therapy.
To prevent Tolerance to nitroglycerin it is best use in? Use in lowest effective dose, Try to allow 8 drug free hours a day usually at NIGHT. **CAN add BB OR CCB if angina is experienced during drug free time. --reason to off the patch to prevent tolerance.
What PREPARATIONS & ROUTES OF ADMINISTRATION DOES NITROGLYCERIN come in? Sublingual Sustained-release oral capsules Transdermal delivery system Translingual spray Transmucosal (buccal) tablets Topical ointment IV infusion
Sublingual Nitroglycerin works by... Absorbed directly through oral mucosa into blood stream (BYPASSES the liver).
Sublingual nitroglycerin is used in high or low doses? Used in very low doses.
How rapid are sublingual nitroglycerin? Effects rapid (1-3min) & lasts up to 1hour.
What is SUBLINGUAL NITROGLYCERIN used for? Used for terminating ongoing attack & shorterm prophylaxis when EXERTION is anticipated.
Morphine is given for chest pain why? Not as much affect on BP, dilates heart blood vessels, & calms patient.
When should you replace nitroglycerin? When the tablet loses the tingle.
What would you want to teach patients with sublingual nitro with chest pain? If pain not relieved in 5mins, CALL 911; can take 2nd or third every 5 mins up to 3.
How should teach patient on nitroglycerin about storage of sublingual tablets? Store in closed, dark container. After opening can keep for up to 24 months. ***Teach not to carry in pocket, will get hot that will inactive it.
What form of nitroglycerin is used for long-term prophylaxis only? Sustained-Release oral capsules.
What is sustained-release oral nitroglycerin capsules used for long-term prophylaxis only? Can it cause tolerance? How do you take this medication? Cannot act fast enough for acute attack. Can cause Tolerance Take once or twice a day.
What preparation and route is nitroglycerin that comes in a patch, absorbed through the skin then to blood? Transdermal Delivery System
How does the Transdermal Delivery System nitro work by? Is its release constant? When does it begin to work, & last up to how long? It works by releasing constant beginning in 30-60 min, & lasting up to 14 hours.
When is the patient tolerant to Transdermal Delivery System nitro? What is the patch free-time? Is this used for acute attacks? Tolerance if 24Hours. Patch free time 10-12 hrs helps (on in am & removed in at pm). NOT FOR ACUTE ATTACK.
What type of nitro is delivered to the oral mucosa in a metered dose spray device? How do you teach pt. to use it? Translingual spray nitro Use like sublingual. DO NOT INHALE SPRAY. spray on tongue
How is Transmucosal (buccal) tablets nitro used (put where)? How long does this tablet take to dissolve? Where is it absorbed at? Between upper lip and gum or between cheek and gum. Dissolves in 3-5 hours. Absorbed through oral mucosa into blood.
What kind of onset does Transmucosal (buccal) tablets nitro have? Are these used for Acute Attack? They have a rapid onset (CAN BE USED FOR ACUTE ATTACK).
If it is in paste form, how should the nurse administrator it? If it is paste form, wear gloves to give to prevent HA.
Topical nitro ointment is a ... sustained protection!
What areas can you place nitro ointment? Chest, back, abdomen, or anterior high.
When does effect of topical nitro ointment begin? How long does it last? Topical ointment begins in 20-60mins and last up to 12 hours.
Do do you dispense topical ointment nitro from tube? Usually 1-2inches every 4-8 hours.
How much does 1in of nitro ointment equal in mg? 15mg of NTG.
How do you spread topical nitro ointment on patient? Spread to 2.5-3.5 inch and cover with plastic wrap.
Is IV infusion nitro rare to use? Yes, rare for angina except with failure to respond to other medications.
When is IV infusion nitro used? In MI, CHF, & production of controlled hypotension for surgery.
What is the duration for IV infusion nitro? VERY SHORT duration of action.
How does IV infusion nitro come packaged? In a glass bottle with special tubing.
How do you discontinue nitroglycerin? Slowly to avoid vasospasm.
What type of nitroglycerin comes in ampules, broken and inhaled? Amyl nitrate
Amyl nitrate effects in how long, and terminates when? What can this medication Intensify? Effects in 30 sec, and terminates 3-5 min. Intensifies SEXUAL ORGASM, and has been abused for that purpose.
Beta Blockers are important for what type of angina? And are not effective for? Important for stable angina (not effective for vasospastic)
What kind of schedule should you take Beta Blockers of chest pain? On a fixed schedule
Why should you take beta blockers on a fixed schedule? Provides protection against effort-induced angina, exercise tolerance is increased and the frequency and intensity of attacks are lowered.
What do ALL BB equally effective at? Decreasing risk of death especially in those with prior MI.
How does BB work on the heart with chest pain? Works decreasing 02 demand by blockade of beta 1 in the heart (reduced rate & contractility) & modest reduction in arterial pressure (afterload). Helps increase 02 supply by slowing rate & increasing diastole (myocardial perfusion).
What are adverse side effects of BB? Bradycardia, Decreased AV conduction, reduced contractility (NOT USED in SICK sinus syndrome) Insominia Depression Bazaar dreams Sexual dysfunction.-if non-selective bronchospasm.
What three CCBs are most frequently used? Verapamil (kalen) Diltiazem (cardizem) Nifedipine (Procardia)
How do these three CCB work? All 3 block calcium channels in VSM, primarly in arterioles (reduction in peripheral resistance (afterload)) and can relax coronary vasospasm.
Which two CCB block calcium channels in the heart (decrease rate, AV conduction, contractility)? Verapamil (kalen) & Diltiazem (cardizem)
Verapamil & Diltiazem treat which types of angina? Stable and Variant angina.
How does CCB work in variant angina? Produces relaxation of coronary spasm thus increasing 02 supply.
How does CCB work in stable angina? Produce relaxation of peripheral arterioles thus reducing afterload (Reduces 02 demand).
How does Verapamil & Diltiazem further reduce 02 demand by? Reducing heart rate and contractility.
What are the drugs to prevent Myocardial Infarction and Death? Antiplatelet drugs Cholesterol-lowering drugs ACE inhibitors
How do antiplatelet drugs prevent myocardial infaraction? Decrease platelet aggregation thus decrease risk of thrombus formation in coronary arteries.
How do cholesterol-lowering drugs prevent myocardial infaraction? Can slow progression of CAD, stabilize artherosclerotic plaques and even cause plaque reduction.
How do ACE Inhibitors drugs prevent myocardial infaraction? May greatly reduce the incidence of adverse outcomes in those with CAD. Great po-MI with BB.
Created by: thomas_kn