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Antianginal Drugs
Ch. 24 Pharm
| Question | Answer |
|---|---|
| Oxygen is delivered to the heart muscle by means of the | coronary arteries |
| what is angina pectoris or chest pain? | when the heart doesn't get enough O2 and energy rich nutrients |
| What is the primary cause of ischemic heart disease, or disease of cornonary arteries | atherosclerosis (fatty plaque deposits in the arterial walls) |
| What is CAD and what can be a result of it? | coronary artery disease- supply of O2 and energy rich nutrients decr. MI, myocardial infarction, heart attack |
| What are the two main classes of antiangina drugs | beta blockers and CCB's (calcium channel blockers) |
| What do antiangina drugs do? | correct imbalance b/n myocardial O2 supply and demand by decr heart rate and contractility |
| Angina is heart pain stimulated by what main acid | lactic acid |
| What are the three classic types of chest pain? | chronic stable angina unstable angina vasospastic angina |
| What is chronic stable angina | atherosclerosis is primary cause. Triggered by exertion/stress. Pain intense, but subsides in 15 min with rest or drugs |
| What is unstable angina | early stages of CAD, known as preinfarction angina or crescendo angina. Pain incr in severity and freq. of attacks. Can occur while at rest |
| What is vasopastic angina | spasms in layer of smooth muscle that surround atherosclerotic coronary arteries. Pain occurs at rest, reg. pattern, same time q day. Known as prinzmetal angina or variant angina |
| What are the three main classes of drugs to treat angina pxts | nitrates, nitrites, beta-blockers, CCB's |
| Three main therapueutic objectives | 1.min. freq attacks and decr intensity of pain 2.improve pxt funx capacity 3.prevent/delay worst possible outcomes, MI |
| What is the overall goal for antianginal drug therapy | incr blood flow to ischemic myocardium, decr myocardial O2 demand or both |
| What forms are nitrates available in | subl, chewable/oral tabs, caps, ointments, patches, translingual spray, IV |
| Name rapid(R)&/or long(L) acting nitrates | amyl nitrate(R), nitroglycerin(R/L), isosorbide(R/L), isosorbide mononitrate(L) |
| What is the mechanism of action for nitrates | dilate all blood vessels, predominantly venous vascular beds, but have arterial vasodilator effect, and coronary aa, decr preload and afterload |
| How do nitrates reduce venous return | reduce left ventricular end-diastolic vol(preload), results in lower lft ventricular pressure, thus lower left vent pressure and myocardial O2 demand |
| Long-acting dosage forms used to treat prevention or acute anginal attacks? Rapid acting? | prevention acute attacks |
| What are some contraindications of nitrates? | severe anemia, closed-angle glaucoma, hypotension, severe head injury, erectile dysfunction |
| Adverse effects of nitrates | headache, diminishes |
| what is reflex tachycardia? | if nitrate induced vasodilation occurs too rapidly, incr HR. Lg shift in blood vol to systemic venous circ. |
| How do you prevent tolerance for nitrates? | Have a regular nitrate-free period, remove patches at night for 8 hrs. |
| Beta blockers help with what cardiovascular diseases? | angina, MI, dysrhythmias, hypertension |
| Name 4 beta blocker drugs | atenolol, metoprolol, nadolol, propranolol |
| What does nitroglycerin have that prevents oral forms from being effective? | Lg. first pass effect |
| What do beta blockers prevent? | epi & norepi from the heart to contract more strongly. |
| During excercise or stress, the heart spends more time in diastole or systole? | systole |
| Beta blockers have a negative: inotropic, chronotropic, dromotropic) | inotropic, chronotropic, reduce myocardial O2 demand |
| What hormone does beta blockers inhibit? | renin(vasoconstrictor released by kidneys), Reduce BP |
| Beta blockers are most effective in treatment of? | exertional angina(caused by excercise) Also, MI, hypertension, cardiac dysrhythmias, essential tremor |
| Beta 2 receptors can cause what complications if blocked by beta blockers? | caution in pxts with bronchial asthma |
| How is a beta blocker cardioprotective? | blocks epi, norepi, dopamine harmful effects after MI |
| What adverse effect should a person on a beta blocker be aware of regards to blood glucose | may drop sugar and not feel physical affects of it and not know it. Specifically mask tachycardia of hyperglycemia |
| What are 4 calcum channel blockers? | verapamil(Calan,Isoptin), diltiazem(Cardizem), nifedipine(Procardia), amlodipine(Norvasc) |
| What role does calcium play in the heart? | role in excitation-contraction coupling process that occurs in heart and vascular smooth muscle cells. Prevent Ca promotes muscle relaxation, coronoary aa dilate, incr blood to heart, incr. O2, decr afterload, reduce myocardial O2 demand |
| CCB's are first line drugs for treatment of what heart conditions b/c adverse effects are acceptable? | angina, hypertension, supraventricular tachycardia, coronary artery spasms |
| What are CCB's not as effective in treating? | exercise-induced elevations in HR/BP |
| What other things do CCB's treat? | Raynaud's disease(type of peripheral vascular disease), migraine, afib/flutter |
| Onset of IV infusion is within? subQ extended release topical transdermal patch | 1-2 min 2-3 min 20-45 min 15-60 min 30-60 min |
| Acute rapid onset would use which method? maintenance therapy? | IV, subQ, tanslingual spray patch, extended release |
| What systolic BP should be reported before antianginal drugs given? Pulse rate? | < 90mm Hg <60b/min |
| what precautions should nurse follow in giving for heart drugs | extended not crushed/chewed, nitrates not exposed to light, moisture, plastic, ointment not applied with fingers, not below knees, covered wtih plastic cover, IV only for emergencies, non-PVC tubes, |
| Overall therapeutic effects of antianginals | decr BP, incr CO and tissue perfusion, decr in angina, incr activity/performance of ADL's |
| First sign of chest pain, how should you give nitroglycerin? | subQ first sign of angina, pxt lie down, if angina not relieved after 5 min, call 911. Take second tab, then third 5 min later if needed, but no more than 3 tabs total. |
| Burning nitro pills means what? | they are good and not expired. Potenet only for 3-6 months |
| decr venous dilation means decr blood return to heart also known as decreased what? | preload |
| In arterial dilation, decr of peripheral resistance or decr force against which the left vent must pump is known as decr what? | afterload |
| Beta Blockers essentially do what? | relieve angina, decr HR, reduce workload on heart, decr O2 demands |
Created by:
palmerag
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