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NURS 572 Pharm Ch 50

Pharm - angina pectoris

types of angina (not unstable which requires hospitalization) chronic stable/most common=exertional ----variant/Prinzmetal's = vasospastic/idiosyncrastic
what goes wrong in angina too little 02 supply ---too much 02 demand
class of drugs that treat angina nitrates---beta blockers---calcium channel blockers---stand alone ranolazine
what types of angina do nitrates treat stable and variant treated by this class
MOA of nitrates ECF nitrate ---VSM nitrate ---converted to nitric oxide by sulfonyl group enzymes (which must not be depleted)---NO is a vasoDIL which leads to venous dilation(dec preload)---and---arterial dilation (dec preload, dec coronary vasospasm)
nitrates are poster boy for this drug response tachyphylaxis - sudden, immediate decrease in drug response
ADRs nitrates HA bwo vasodil---ORTHOSTATIC hypoTN---reflex tachy (to compensate for vasodil)---usually concurrent admin of BB or CCB to blunt this effect
nitrate patch must be removed for 6-8 hours. why so we don't deplete the sulfonyl group enzymes which could lead to tolerance to efficacy
nitrates CONTRAINDICATED for this class PDE-5 inhibitors, which are potent vasoDIL = sildenafil, tadalafil, vardenafil
quick-short nitrate sublingual tab, sublingual spray
quick-long nitrate transmucosal tab
slow-long nitrate patch MUST BE REMOVED 6-8h to preserve sulfonyl groups on enzyme----ointment, ISMN tab
quick-long ISDN = isosorbide DInitrate---sublingual, chewable, tab/cap
Beta blockers treat what type of angina only treat exertional/stable. they have no vasoDIL effects----work to decrease 02 demand bwo ---dec HR, CO & afterload
what do we need to watch for with BBs and asthma pts watch for asthmatic effect if BB is non-selective (propanolol, naldolol, timolol)
what type of angina does CCBs treat both stable/chronic---variant---decreases 02 demands AND vasodilates
examples of CCBs verapamil/diltiazem-----amlodipine & all dipine's in class
both CCBs and BBs have similar SEs which are cardiac effects = dec HR, AV block, dec contractility, dec bp, reflex tachy
what is one stand alone drug whose MOA is opposit of digoxin ranolazine ----MOA is to decrease late Na current, keeping Ca from getting too high in cell---> decreased cardiac work--->improve supply/demand balance
ranolazine ADRs prodysrhythmic/TdeP---dizz/HA/c/n
what drug lease likely to need 8 hour free period? any short acting nitrate (any non-patch, really)
what drug least likely to help Prinzmetals/variant angina BBs because they do not vasodilate
what drug least likely to be 1st line drug ranolazine - prevention, too new with prodysrhythmic ADR
standard order of drug admin for angina is nitrate---BB---CCB---long acting nitrate. what if pt is asthmatic? then we would use CCB as 2nd agent
Created by: lorrelaws