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Pharm 323 Spring 22 > Angina <3 > Flashcards

Angina <3 Flashcards

1
Q

angina is caused by what?

A

lack of O2 to heart –> anaerobic metabolism –> lactic acid buildup

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2
Q

angina drugs do which 2 things? (broad)

A
  1. decrease O2 demands of heart

2. increase O2 supply

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3
Q

3 main families + other for angina drugs

A
  1. organic nitrates
  2. Beta blockers
  3. calcium channel blockers
  4. other: ranolazine
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4
Q

prototype for organic nitrates

A

nitroglycerin

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5
Q

MOA of nitroglycerin

-in stable angina
+
-vasospasm

A

in stable angina: decrease O2 demand by VASODILATION

in vasospasm: increase O2 supply by relaxing coronary arteries

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6
Q

forms of nitroglycerin

A
  • oral (1st pass effect)
  • sublingual
  • buccal
  • patch
  • IV
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7
Q

what is the short acting nitroglycerin?

A

isosorbide dinitrate

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8
Q

what is the long acting nitroglycerin?

A

isosorbide mononitrate

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9
Q

patient teaching/considerations for SL nitroglycerin

A
  • don’t pour into hands
  • don’t store in bathroom (b/c of humidity)
  • keep in dark package
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10
Q

what is half life of nitroglycerin?

A

5-7 minutes (hence why we administer q5mins)

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11
Q

how long does nitroglycerin last?

A

up to 1 hour

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12
Q

what drug-drug interaction can cause life-threatening hypotension and CV collapse?

A

nitroglycerin + erectile dysfunction drugs

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13
Q

when should SL nitroglycerin be taken?

A

ONSET of chest pain

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14
Q

protocol for SL nitroglycerin administration at home

A

1 tablet at onset of chest pain
wait 5 mins
still have chest pain? call 911 + take 2nd dose
wait 5 minutes
still have chest pain? take 3rd dose + hope that EMS is almost there :)

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15
Q

protocol for SL nitroglycerin administration in hospital

A 
check BP + HR + assess 
give 1 tablet
wait 5 minutes
still have chest pain? check BP + HR + assess
give 2nd tablet
wait 5 minutes
still have chest pain? check BP + HR + assess 
give 3rd dose

difference is checking BP/HR + assessing before administering doses

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16
Q

pt education for nitroglycerin

A
  1. no ETOH - severe hypotension
  2. rotate patch site - avoid irritation
  3. have “drug free” periods - avoid tolerance + tachyphylaxis (@ night is good time)
17
Q

common SE of nitroglycerin

A
  • HA (usually improves)
  • hypotension
  • orthostatic hypotension
  • tachycardia
18
Q

nursing considerations for nitroglycerin

A
  • wear gloves (patch or paste)

- wipe off skin before applying defib pads (can burn)

19
Q

prototype for beta blockers for angina

A

metoprolol

20
Q

MOA of beta blockers for angina

A

reduce O2 cardiac demand by decreasing HR, contractility + contraction

21
Q

what is 1st line tx for chronic stable angina?

A

beta blockers

“betas are the BEST!”

(Reduces death risk post MI)

22
Q

what should you know as a nurse with beta blockers?

A
  • take BP + HR (apical)
  • avoid with asthma + COPD
  • diabetics: close BG monitoring
  • don’t stop suddenly
  • monitor for bradycardia + AV block
23
Q

prototype for calcium channel blockers for angina

A

diltiazem (acting on heart and vessels)

24
Q

MOA of diltiazem for angina

A

relaxes smooth muscles –> vasodilation

+ works on heart: decreased HR, conduction, contractility

25
Q

what drugs work very well for vasospasm?

A

diltiazem (CCB)

26
Q

SE of diltiazem

A
  • hypotension

- bradycardia

27
Q

things to monitor for with CCB

A
  • HF (w/ verapamil + diltiazem b/c working on the heart)
  • daily weights
  • edema
  • AV block + bradycardia (w/ verapamil + diltiazem b/c working on heart)
28
Q

drug-food interactions with calcium channel blockers

A

grapefruit

29
Q

what is the prototype of our “other” drug for angina

A

ranolazine

30
Q

drug-food / drug-drug interactions with ranolazine

A
  1. grapefruit

2. CCB (Except amlodipine)

31
Q

AE of ranolazine

A
  • increased QT interval
  • constipation, dizziness, nausea, HA

“rano is LAZY and everything slows down to a dangerous level”

Pharm 323 Spring 22 (18 decks)

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