Pharm exam 3: vasodilators
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| define angina pectoris | chest pain caused by lack of oxygenated blood to heart muscles
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| etiology of angina pectoris | narrowing of arteries, hypotension, vasoconstriction, SNS or drugs
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| precipitating factors of angina pectoris | exercise, anxiety, cold, heavy meals, smoking
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| symptoms of angina pectoris | chest pain persisting for 3-5 minutes; dissipates upon rest
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| ECG changes seen in angina pectoris | S-T changes
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| management of angina pectoris | education; vasodilating drugs
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| effect of vasodilating drugs | cause dilation of blood vessels and tend to lower blood pressure
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| Vasodilators are used to treat... | hypertension, coronary disease (angina) or peripheral vascular disease
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| where do nitrates act? | directly on smooth muscles of peripheral and coronary vascular bed
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| effect of nitrates | peripheral vasodilatation
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| how do nitrates decrease preload | venous dilation
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| how do nitrates decrease afterload | arterial dilation
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| what do nitrates reduce? | work of heart and oxygen requirement
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| What do nitrates dilate | large normal coronary artery, not lined with plaque
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| Drug of choice of angina | nitrates
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| side effects of angina | tachycardia, flushing, severe headache, nausea/vomiting, hypotension, vertigo
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| tolerance occurs to what nitrates | long acting; not usually to nitroglycerin (NTG)
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| What interacts with nitrates? | alcohol, antihypertensive drugs, aspirin
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| Nitrate kinetics | sublingual (Nitrostat) NTG tabletss
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| normal dosage for NTG tablets | 0.15-0.6 mg; usually 0.4mg
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| How often can nitrates be given | repeated several times a day
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| how often do you take nitrates for chest pain | 5 minute intervals x 3
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| Dynamics of nitrates | effect in 2 minutes; peak in 4 minutes; disappears in 10-30 minutes
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| can nitrates be taken before exertion? | yes; as prophylaxis
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| NTG is inactivated by what? | light, heat, air, moisture, and time
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| How often should patients get a fresh supply of nitrates? | every 3-6 months
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| Education of storage of NTG | airtight, dark container; avoid keeping close to body; don't store in bathroom
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| What should patient do before taking NTG? | sit or lie down
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| What does NTG cause besides desired effect? | flushing or headaches - if not; medication is not good
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| What to take for headaches with NTG? | Tylenol
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| describe NTG spray | metered dose; oral spray; take seated or lying down; do not inhale
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| describe NTG sustained release (Nitro-bid) | take on empty stomach with full glass of water, do not cut or chew
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| Effect and duration of NTG sustained release | effect 24-45 minutes; duration 4-8 hours
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| Onset and duration of NTG patches | onset 30-60 minutes; duration 18-24 hours
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| Education for NTG patches | wear gloves to apply; rotate site and wash skin; remove old patch when replacing new
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| When to remove NTG patch | from 8-12 hr/day; before defibrillation; when replacing old patch
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| When to use NTG IV | acute situation with unrelieved angina
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| NTG IV onset | immediate
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| Use what monitoring devices with NTG IV | pump and cardiac, blood pressure monitor
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| Beta-adrenergic Blocker prototype | propranolol (Inderal)
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| Where does propranolol (inderal) act? | heart receptors
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| effect of propranolol (inderal) | decreased HR; decreased force of contraction, decreased myocardial oxygen demand
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| adverse effects of propranolol (inderal) | slowed heart rate; lowers BP; contributes to impotence
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| calcium channel blocker prototype | verapamil (Calan)
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| action of verapamil (Calan) | inhibit release of intracellular calcium
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| effect of verapamil (Calan) | decrease force of myocardial contraction = decrease heart oxygen demand; dilate coronary artery to increase oxygen supply
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| use of verapamil (Calan) | long term prevention of angina
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| side effects of verapamil (Calan) | hypotension, arrhythmias, heart failure
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