Anti-Angina Flashcards
stable angina
consistent presentation, effort induced
relieved by rest/nitroglycerin
cause/mechanism of stable angina
caused by reduction in blood flow from coronary atherosclerosis
increasing demand causes ischemia, demand increased by emotion or physical activity increasing cardiac workload
unstable angina
Increasing frequency/inconsistent onset of chest pain, less effort to precipitate symptoms
Not relieved by rest/nitroglycerin
cause/mechanism of unstable angina
caused by blockage of coronary arteries by blood clots
Prinzmetal angina
+what eases symptoms
angina due to coronary artery spasm
Unrelated to activity/BP/HR, chest pain at rest
Eased with vasodilators, nitroglycerin, Ca channel blockers
list organic nitrates
nitroglycerin
isosorbide dinitrate
isosorbide mononitrate
list beta blockers for angina
cardio selective
metoprolol
atenolol
list calcium channel blockers for angina
verapamil
nifedipine
diltiazem
list sodium channel blocker for angina
ranolazine
MOA of organic nitrates
release nitric oxide –> increase CGMP –> relax vascular smooth muscle
acts to reduce myocardial oxygen demand for angina by relaxing arteries and veins
MOA of beta blockers
inhibit beta 1 adrenergic receptors to decrease HR and contractility
MOA of calcium channel blockers
stop calcium transport across the membrane to shut down processes demanding oxygen and creating ischemia
results in arterial dilation and lower BP
MOA of sodium channel blockers
inhibit sodium current to improve O2 supply, blocks Na to relax the heart and modulate Ca levels
side effects of organic nitrates
Headache
OH
Hypotension
Facial flushing
Tachycardia
nausea
side effects of beta blockers
At high doses act on pulmonary system Beta 2 receptors - bronchospasm
Fatigue
Bradycardua
hypotension
blunted HR response to exercise
side effects of calcium channel blockers
Constipation
Reflex tachycardia
Worsen HF w increased contractility
Edema
Flushing
Headache
Dizziness
side effects of sodium channel blockers
Dizziness
Headache
Constipation
QT interval prolonged
PT considerations for angina medications
- monitor BP for OH
- monitor angina symptoms
- regular aerobic exercise to reduce angina symptoms
- recognize side effects
- pt education on taking meds
risk factors for angina
age
family hx
smoking
sedentary
meds
stress
HTN
DM
kidney disease
obesity
dyslipidemia
nitrates pharmacokinetics
metabolized significant portion in first pass metabolism at liver
taken sublingually/transdermal to avoid GI system for fast acting
