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Pharm - Ch. 50, 45
Drugs for Angina Pectoris, Vasodilators
| Question | Answer |
|---|---|
| Cardiac oxygen demand is determined by... | Heart rate, contractility, preload, and afterload |
| Cardiac oxygen supply is determined by... | Myocardial blood flow |
| Coronary blood flow increases __ times over resting flow rate during exertion | 4-5X |
| What is the underlying cause of stable angina? | Coronary artery atherosclerosis |
| Exertional angina is also known as | Chronic stable angina |
| The type of angina that is the result of decreased O2 supply is called | Variant angina (Prinzmetal's) |
| The type of angina that is the result of increased O2 demand is called | Chronic stable/exertional angina |
| What are the three families of antianginal agents? | Organic nitrates, beta blockers (NOT for variant angina), calcium channel blockers |
| Beta blockers are used for which type of angina? | Exertional angina |
| Calcium channel blockers can help with angina by doing what? | Restoring O2 supply in blood vessels |
| True or false: verapamil and nidefipine are both effective against angina pectoris | True since CCBs help restore O2 supply |
| Nitroglycerin does what to blood vessels? | Vasodilators vascular smooth muscles |
| List the adverse effects of nitroglycerin | Headache, orthostatic hypotension, reflex tachycardia |
| Explain the nursing implications of nitroglycerin tolerance | Drug can become less responsive as body adjusts to its actions. Since nitroglycerin is used in emergent situations, becoming tolerant of the drug is an issue for certain patients who rely on it. |
| Nitroglycerin paired with beta blockers can result in what? | Antagonization of reflex tachycardia. With excessive hypotension, body may not be able to respond to changes in BP adequately. |
| Nitroglycerin paired with CCBs can result in what? | Too much vasodilation |
| Nitroglycerin paired with sildenafil can result in what? | Profound hypotension |
| True or false: nitroglycerin is administered through the following routes - sublingual, oral sustained-release, transdermal, translingual spray, uncoated PO, buccal, IV, topical | False! Cannot be given as uncoated PO. |
| When giving nitroglycerin in emergent situations, what is the preferred route of administration? | Sublingual or spray for RAPID vasodilation. Workers faster than IV. Sublingual administration NOT a scheduled method. |
| When nitroglycerin is ordered on a daily schedule, what is the preferred route of administration? | Transdermal. Apply once daily to a hairless area of skin. Patch-free for 10-12 hrs reced. NOT for aborting ongoing attack but for prophylaxis. |
| How do beta blockers help treat angina pectoris? | Decrease cardiac oxygen DEMAND. |
| True or false: propanolol is effective against variant angina | False. Variant angina caused by insufficent oxygen supply. |
| List some CCB used for angina pectoris | Verapamil, diltiazem, nifedipine |
| True or false: CCB are used to treat both stable and variant angina | True |
| True or false: Reflex tachycardia is a SE of verapmil | True |
| True or false: Tachycardia is a SE of nifedipine | False. It is bradycardia |
| List the principal indications of vasodilators. (5) | Essential HTN, hypertensive crisis, angina pectoris, HF, MI |
| List the principal adverse effects of vasodilators (3) | Postural hypotension, reflex tachycardia, expansion of blood volume (RAAS, renal filtration) |
| True or false: hydralazine causes direct dilation of arterioles | True |
| True or false: one of the adverse effects of hydralazine is systemic lupus erythematosus-like syndrome | True |
| True or false: postural hypotension is a problem with hydralazine | False. Minimal postural hypotension |
| When is hydralazine commonly prescribed? | When other anti-HTN don't work |
| Minoxidil causes what therapeutic effects? | Direct dilation of arterioles, increase of contractility |
| What is minoxidil's onset? | Rapid |
| When is minoxidil used? | To Tx severe HTN is unresponsive to safer drugs |
| What are the adverse effects of minoxidil? | Reflex tachycardia, Na-H2O retention, hypertrichosis |
| True or false: sodium nitroprusside acts faster than nitroglycerin | True |
| True or false: sodium nitroprusside causes minimal reflex tachycardia | True |
| What kind of vasodilator is sodium nitroprusside? | A potent venous AND arterial vasodilator |
| What is the route of administration for sodium nitroprusside? | IV |
| What are the adverse effects of sodium nitroprusside? | Thiocyanate toxicity after prolonged admin, cyanide poisoning if given too rapidly, excessive hypotension is given too rapidly |
| What are the three unique vasodilator drugs covered in this chapter? | Sodium nitroprusside, minoxidil, hydralazine |
| List some other vasodilators | ACE inhibitors, ARBs, organic nitrates, CCBs, sympatholytics |
| True or false: for stable angina, there is much we can do to increase cardiac oxygen supply | False. Due to occlusion of coronary arteries, main treatment focuses on decreasing cardiac oxygen demand |
| Stable angina can be treated with what three main types of drugs? | Organic nitrates, beta blockers, CCBs |
| What sort of factors can precipitate angina? | Overexertion, heavy meals, emotional stress, cold exposure |
| True or false: variant angina can cause pain any time even during rest and sleep | True |
| True or false: drugs relieve variant angina by decreasing oxygen demand | False. Increase cardiac oxygen supply |
| Vasospatic angina is treated with which two groups of drugs? | CCBs and organic nitrates, which relax coronary artery spasm |
| Unstable angina is a medical emergency. Symptoms may include... | 1) angina at rest, 2) new onset of exterional angina, 3) intensification of existing angina |
| What sort of drugs can be used to treat unstable angina? | Nitroglycerin, beta blockers, O2, IV morphine, ACE inhibitors, antiplatelet therapy, aspirin |
| How can one reduce the risk of nitroglycerin tolerance? | Use at lowest efefctive dosage, long-acting formulations used at intermittent schedule (At least 8 drug-free hours per day) |
| True or false: nitroglycerin is lipid soluble | True! Hence can be absorbed through skin and oral mucosa |
| Explain how nitroglycerin relieves stable angina | By dilating veins, decreases venous return, which decreases preload, which decreases oxygen demand |
| True or false: beta blockers are administered PRN for angina | False. Need to be on fixed schedule |
| Why should beta blockers not be withdrawn abruptly? | Can increase incidence and intensity of anginal attacks or precipitate MI. |
| When CCB is combined with a beta blocker, which of the following drugs is preferred? Nifedipine, verapmil, diltiazem | Nifedipine because verapmil/diltiazem intensify cardiosuppression caused by beta blocker, but nifedipine/dihydropyridine won't |
| In patients with asthma, which drugs are preferred? Beta blockers or CCBs? | CCBs |
| Patients with established CAD are often recommended what kind of inhibitor? | ACE inhibitor |
| Treatment of stable angina has two objects: 1) prevention of MI and death, 2) reduction of cardiac ischemia and anginal pain. Which is more important? | Prevention of MI and death |
| Drugs that dilate arterioles cause a _____ in cardiac ______ | Decrease, afterload |
| Drugs that dilate veins ______ the force of blood returning to the heart, which decreases cardiac ______ | reduce; preload |
Created by:
choel
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