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Pharmacology Exam 1
Angina
| Question | Answer |
|---|---|
| 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
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