Angina Flashcards
2 ways Anti-Angina drugs work?
- Decrease O2 demands of ♥: decrease HR, contractility, preload/afterload
- Increase O2 supply : improve myocardial blood flow
4 classes of Anti-Angina drugs?
- Organic nitrates
- Beta Blockers
- Calcium Channel Blockers
- Ranolazine (Ranexa)
When does angina Occur?
Angina occurs when there is not enough O2 –> lactic acid build up –> pain
Angina is a ______, not a disease itself
symptom
3 types od Angina
- stable
- variant
- unstable
generally speaking, how do we treat stable angina?
decrease oxygen demand
stable angina is triggered by
activity
what is the underlying cause of stable angina?
CAD
variant angina is triggered….
anytime!
underlying cause of variant angina
coronary artery vasospasm
treatment for variant angina (generally speaking)
increase oxygen supply with vasodilation of coronary arteries
how do we treat unstable angina?
treat as if MI until proven otherwise!
drug of choice for acute angina attacks?
nitroglycerin (organic nitrate)
How does nitroglycerin work in stable angina? how does it work in variant angina?
(organic nitrate)
- Causes vasodilation of vessels in stable angina decreasing oxygen demand –> decreases preload/ventricular filling –> decrease demands on heart
- Increase oxygen supply in variant angina by relaxing coronary artery vasospasm
route for nitroglycerin?
(organic nitrate)
- oral
- sublingual
- IV
- buccal
- patch/paste/ointment
oral nitroglycerin effectiveness and duration?
(organic nitrate)
-1st pass effect = nothing left
-comes in long acting and short acting
what is most common nitroglycerin route at home?
(organic nitrate)
sublingual
How is IV nitroglycerin given?
(organic nitrate)
given through continuous infusion
-delivered in glass bottle
-special tubing (interaction)
how is topical nitroglycerin given?
(organic nitrate)
1 inch topically QID, squirt ointment onto paper measurement, fold in half, to spread around and attach to pt skin
- wear gloves!
- change location
- prevent tachphylaxsis
How do we store nitroglycerin?
(organic nitrate)
- dark packaging
- prevent moisture (hands/bathroom)
- -> inactivates it
onset/half life/duration in body of nitroglycerin?
(organic nitrate)
- Peak plasma within 4 minutes
- half life of 5-7 minutes
- persists in body for 1 hour
how is sublingual nitroglycerin administered AT HOME
- Sublingual = do not chew or swallow
- Administer at onset of chest pain
- Administer 1 SL tablet every 5 min X 3.
- If no relief after 1st dose, then call EMS (if out of hospital)
how is sublingual nitroglycerin administered in hospital
- check BP/pulse
- Administer SL, wait 5 minutes and reassess
- If still chest pain- check BP/pulse, administer 2nd dose, wait 5 minutes, reassess
- If chest pain -check BP/pulse, administer 3rd dose then follow protocol
alcohol + nitroglycerin =
severe hypotension!
patient teaching: abstain from alcohol
Common side effects of nitroglycerin
- headache
- Hypotension, orthostatic hypotension
- tachycardia
considerations for topical nitroglycerin and cardiac arrest?
-Wipe paste off skin before applying “defib” pads to skin –> can burn pt
life threatening hypotension/cv collapse interactions b/w nitroglycerin and
sildenafil (Viagra)
tadalafil (Cialis)
vardenafil (Levitra)
drug of choice to treat CHRONIC STABLE angina?
metoprolol (Lopressor, Topol XL)
Beta Blockers for Angina
how does metoprolol (Lopressor, Topol XL) treat angina?
Reduce cardiac oxygen demand of ♥ by slowing HR and reducing contractility
(Beta Blockers)
administration considerations for metoprolol (Lopressor, Topol XL)
- Check pulse (hold if <60 bpm, 50 bpm???)
- Check BP
- Monitor for brady and AV block
can you stop metoprolol (Lopressor, Topol XL) abruptly?
no!
teaching for diabetics with metoprolol?
can mask s/s of hypoglycemia
metoprolol is contraindicated in which patient population?
Asthma/COPD
prototype for calcium channel blockers?
diltiazem (Cardiazem)
How does diltiazem (Cardiazem) fxn?
Calcium Channel Blockers
work by inhibiting the influx of Ca into cells, preventing muscular contraction —> Vasodilation occurs
- Cause arteriolar smooth muscle relaxation –> dec BP (afterload) –dec myocardial oxygen demand
- Can relax coronary vasospasm to increase oxygen delivery
side effects of diltiazem (Cardiazem)
hypotension, reflex tachycardia
Calcium Channel Blockers
considerations for diltiazem (Cardiazem)
- S/S of HF (diltiazem, verapamil)
- Daily weights (fluid retention)
- Do not crush extended release
- NO grapefruit juice–> toxicity
- Watch for brady, AV block (diltiazem, verapamil)
newest anti-angina drug?
ranolazine (Ranexa)
how does ranolazine (Ranexa) fxn?
Decreases incidence of angina and increases exercise tolerance
—>Don’t really know how it works
interaction with ranolazine (Ranexa)?
CYP450 metabolism pathway-drug interactions –> no grapefruit juice!
—> protease inhibitor, macrolides, azoles, most Ca Channel blockers except Amlodipine
adverse effects of ranolazine (Ranexa)?
- Increase QT interval
- constipation, dizziness, nausea and headache
do we use ranolazine (Ranexa) as monotherapy?
usually used as first line therapy used in addition to nitrate/beta blocker/ Ca Channel Blocker Amlodipine
2 anti angina drugs no go grapefruit?
ranolazine (Ranexa)
diltiazem (Cardiazem)(Calcium Channel Blocker)
