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Kol- Pharm 323 Spring > Angina > Flashcards

Angina Flashcards

1
Q

2 ways Anti-Angina drugs work?

A
  • Decrease O2 demands of ♥: decrease HR, contractility, preload/afterload
    • Increase O2 supply : improve myocardial blood flow
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2
Q

4 classes of Anti-Angina drugs?

A
  1. Organic nitrates
  2. Beta Blockers
  3. Calcium Channel Blockers
  4. Ranolazine (Ranexa)
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3
Q

When does angina Occur?

A

Angina occurs when there is not enough O2 –> lactic acid build up –> pain

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4
Q

Angina is a ______, not a disease itself

A

symptom

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5
Q

3 types od Angina

A
  1. stable
  2. variant
  3. unstable
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6
Q

generally speaking, how do we treat stable angina?

A

decrease oxygen demand

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7
Q

stable angina is triggered by

A

activity

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8
Q

what is the underlying cause of stable angina?

A

CAD

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9
Q

variant angina is triggered….

A

anytime!

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10
Q

underlying cause of variant angina

A

coronary artery vasospasm

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11
Q

treatment for variant angina (generally speaking)

A

increase oxygen supply with vasodilation of coronary arteries

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12
Q

how do we treat unstable angina?

A

treat as if MI until proven otherwise!

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13
Q

drug of choice for acute angina attacks?

A

nitroglycerin (organic nitrate)

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14
Q

How does nitroglycerin work in stable angina? how does it work in variant angina?

A

(organic nitrate)

  1. Causes vasodilation of vessels in stable angina decreasing oxygen demand –> decreases preload/ventricular filling –> decrease demands on heart
  2. Increase oxygen supply in variant angina by relaxing coronary artery vasospasm
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15
Q

route for nitroglycerin?

A

(organic nitrate)

  • oral
  • sublingual
  • IV
  • buccal
  • patch/paste/ointment
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16
Q

oral nitroglycerin effectiveness and duration?

A

(organic nitrate)
-1st pass effect = nothing left

-comes in long acting and short acting

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17
Q

what is most common nitroglycerin route at home?

A

(organic nitrate)

sublingual

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18
Q

How is IV nitroglycerin given?

A

(organic nitrate)
given through continuous infusion
-delivered in glass bottle
-special tubing (interaction)

19
Q

how is topical nitroglycerin given?

A

(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
20
Q

How do we store nitroglycerin?

A

(organic nitrate)

  • dark packaging
  • prevent moisture (hands/bathroom)
  • -> inactivates it
21
Q

onset/half life/duration in body of nitroglycerin?

A

(organic nitrate)

  • Peak plasma within 4 minutes
  • half life of 5-7 minutes
  • persists in body for 1 hour
22
Q

how is sublingual nitroglycerin administered AT HOME

A
  • 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)
23
Q

how is sublingual nitroglycerin administered in hospital

A
  • 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
24
Q

alcohol + nitroglycerin =

A

severe hypotension!

patient teaching: abstain from alcohol

25
Q

Common side effects of nitroglycerin

A
  • headache
  • Hypotension, orthostatic hypotension
  • tachycardia
26
Q

considerations for topical nitroglycerin and cardiac arrest?

A

-Wipe paste off skin before applying “defib” pads to skin –> can burn pt

27
Q

life threatening hypotension/cv collapse interactions b/w nitroglycerin and

A

sildenafil (Viagra)
tadalafil (Cialis)
vardenafil (Levitra)

28
Q

drug of choice to treat CHRONIC STABLE angina?

A

metoprolol (Lopressor, Topol XL)

Beta Blockers for Angina

29
Q

how does metoprolol (Lopressor, Topol XL) treat angina?

A

Reduce cardiac oxygen demand of ♥ by slowing HR and reducing contractility

(Beta Blockers)

30
Q

administration considerations for metoprolol (Lopressor, Topol XL)

A
  • Check pulse (hold if <60 bpm, 50 bpm???)
  • Check BP
  • Monitor for brady and AV block
31
Q

can you stop metoprolol (Lopressor, Topol XL) abruptly?

A

no!

32
Q

teaching for diabetics with metoprolol?

A

can mask s/s of hypoglycemia

33
Q

metoprolol is contraindicated in which patient population?

A

Asthma/COPD

34
Q

prototype for calcium channel blockers?

A

diltiazem (Cardiazem)

35
Q

How does diltiazem (Cardiazem) fxn?

A

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
36
Q

side effects of diltiazem (Cardiazem)

A

hypotension, reflex tachycardia

Calcium Channel Blockers

37
Q

considerations for diltiazem (Cardiazem)

A
  • 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)
38
Q

newest anti-angina drug?

A

ranolazine (Ranexa)

39
Q

how does ranolazine (Ranexa) fxn?

A

Decreases incidence of angina and increases exercise tolerance
—>Don’t really know how it works

40
Q

interaction with ranolazine (Ranexa)?

A

CYP450 metabolism pathway-drug interactions –> no grapefruit juice!

—> protease inhibitor, macrolides, azoles, most Ca Channel blockers except Amlodipine

41
Q

adverse effects of ranolazine (Ranexa)?

A
  • Increase QT interval

- constipation, dizziness, nausea and headache

42
Q

do we use ranolazine (Ranexa) as monotherapy?

A

usually used as first line therapy used in addition to nitrate/beta blocker/ Ca Channel Blocker Amlodipine

43
Q

2 anti angina drugs no go grapefruit?

A

ranolazine (Ranexa)

diltiazem (Cardiazem)(Calcium Channel Blocker)

Kol- Pharm 323 Spring (41 decks)

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