anti-anginal Flashcards
what is ischemia?
poor blood supply to an organ
what is ischemic heart disease?
poor blood supply to the heart muscle **(means in red)
atherosclerosis
CAD
what is myocardial infarction?
necrosis, or death of cardiac tissue ***
disabling or fatal
clinical syndrome char b y episodes of chest pain occur with ____ produce ___ most often caused by ____ MAY be caused by
occurs with mocardiac o2 deficit
produces myocardial ischemia
most often caused by atherosclerotic plaque in coronary arteries
may be caused by coronary vasospasm
what is CAD?
development, progression of atherosclerotic plaque
continuum progresses from angina to MI
what are the 3 types of angina?
classic, variant, and unstable
what is stable angina?
results from coronary artery obstr by atheromatous plaque
triggered by 4 Es: exercise, emotion, cold and eating
pain lasts for 1-15 min builds gradually to max. intensity: relieved by rest/ administration of nitro
what is variant angina? (prinzmetal angina)
occurs at rest. nitro relieves pain
ca channel blockers- main form of treatment to reduce the incidence of acute events
what is unstable angina?
result of atherosclerotic progression. high chance of getting MI. precipitated by the factors for angina. it occurs at rest (or with minimal exertion) lasting for more than 20 minutes
substernal chest pain symp? might be mistaken for? (I think relating to just angina)
constriction, squeezing, suffocating
may radiate to the jaw, neck, shoulder, both arms, back
may be mistaken for arthritis, ingestion
N/V, dizziness, diaphoresis, SOB, or fear or impeding doom may be associated
do males and females experience same type of pain?
no quality changes and women dent always experience classic arm pain but feel unusual fatigue, sweating and SOB, beck/jaw/back pain “i thought i had the flu”
how does acute coronary syndrome occur?
Acute coronary syndrome (any condition brought on by sudden, reduced blood flow to the heart) may be seen when the fibrous cap raptures, exposing thrombogenic material, producing a thrombus within the lumen. At this point, the intraluminal thrombi can occlude arteries outright or will detach, move into the circulation, and eventually occlude smaller, distal branches of the coronary artery causing thromboembolism and likely an acute MI or ST-segment elevation MI.
what are some lifestyle changes, for CAD?
-obesity, stop smoking
-elevated triglycerides, cholesterold
elevated BP, fasting glucose
-dietary changes” dec in salt, sugar, trans fat
other non-pharmacological management of CAD?
Patient education
Revascularization, interventional procedures
what are some pharmacological management of CAD?
nitrates and nitrites beta-adnergic blocking agents calcium channel blocking agents -reduce myocardial oxygen deman -inc myocardial blood supply
what are some available forms of nitrates and nitrites?
does it bypass the liver?
sublingual (bypass) chewable tablets oral capsules/tablets IV (bypass) transdermal patches (bypass) translingual (bypass)
are nitrates long term or short term?
long term- used for prevention
MOA of nitrates or nitrites?
- causes vasodilation bc of relaxation of smooth muscles
- potent dilating effect on coronary arteries
- result: oxygen to ischemic myocardial tissue
- used for prevention and treatments of angina ***
what are rapid acting forms of nitrates and nitrites?
used to treat acute anginal attacks
sublingual tablets or spray; IV infusion
what are some long acting forms of nitrates and nitrites used for?
what are short acting forms of nitrates and nitrites used for?
used to prevent anginal episodes (long acting) **
used to treat anginal attacks Sublingual tablets or spray; IV infusion
short term
rapid or long acting? isosorbide dinitrate
both
rapid or long acting? isosorbide mononitrate
primarily long acting
nitroglycerin -what kind of nitrate? used for? what form?
Prototypical nitrate
Large first-pass effect with oral forms
Used for symptomatic treatment of ischemic heart conditions (angina)
Intravenous form used for control of blood pressure in perioperative hypertension, treatment of heart failure, ischemic pain, pulmonary edema associated with acute myocardial infarction, and hypertensive emergencies (malignant hypertension = >180/120)*****
what are some adverse effects of nitrates?
**headaches (usually diminish in intensity and freq with cont use)
reflex tach
postural hypotension
tolerance may develop
when does tolerance occur in nitrates and how can it be prevented?
occurs in patients taking nitrates around the lock or with long-acting forms
prevented by allowing a regular nitrate free period to allow enzyme pathways to replenish
what might you instruct your patient with a transdermal form of nitrate to do? in reg: tolerance
may be instructed to remove patch at bedtime for 8 hours, then apply a new patch in the morning
what are some contraindications of nitrates?
known drug alergy severe anemia closed-angle glaucoma hypotension severe head injury *use of erectile dysfunction drugs
when are beta blocker s used?
mainstay in the treatment of cardiovascular diseases
- angina
- MI
- hypertension
- dysrhythmias
what are some abtianginal beta blockers?
atenolol
metoprolol
propranolol hydrcoholride
nadolol (napm)
MOA of beta blockers?
block beta 1 receptors on the heart
**dec HR, resulting in dec myocardial oxygen demand and inc oxygen delivery to the heart
dec myocardial contractility, helping to conserve energy or dec deman
what is the result of catecholamines on the heart after an MI
there is an increase of catecholamines in the heart following an MI which irritate the heart causing an imbalance in supply and demand ratio and even lead to life threatening dysrhythmias
what is the effect of beta blockers on catecholamines?
block the harmful effects of catecholamines and improve survival after an MI
indications for beta blockers?
angina, HTN, cardiac dysrhythmias, MI, some used for migraine headaches, essential tremors and stage fright
contraindications for beta blockers?
systolic heart failure, serious conduction disturbances
caution: bronchial asthma because any level of blockage of beta 2 receptors can promote bronchoconstriction
diabetes mellitus: can mask hypoglycaemia-induced tachy
peripheral vascular disease: may further compromise cerebral or peripheral blood flow
adverse effects for beta blockers on cardiovascular?
bradycardia, hypotension, AV block
adverse effects for beta blockers on metabolic system?
hyperglycaemia, hypoglycaemia, hyperlipiedmia
adverse effects on CNS for beta blockers?
dizziness, fatigue, depression, lethargy
other AE for beta blockers?
erectile dysfunction, wheezing, dyspnea
what are some adjunctive antianginal drugs?
aspirin (antithrombotic effects)
antiipidemics (reduce serum cholesterol)
antihypertensives
what are the goals of therapy for abtianginal drugs?
Relieve acute anginal pain
Reduce number and severity of acute anginal attacks
Improve exercise tolerance and life quality
Delay progression of CAD
Prevent MI and sudden cardiac death
preventing tolerance strategies with atianginal drugs?
administer lowest effective dose and avoid long acting forms of nitrates
only use long acting forms during waking hours
what are some ca channel blockers for chronic stable angina?
amlodipine
diltiazem
nifedipine
verapamil hydrochloride
(andV)
MOA of ca channel blockers?
causes coronary artery vasodilation
cause peripheral arterial vasodilation, this dec systemic vascular resistance
reduce the workload of the heart
result: dec myocardial oxygen demand
are ca channel blockers first line treatments?
yes with beta blockers
indications for ca channel blockers?
- Angina
- Hypertension
- Supraventricular tachycardia
- **Coronary artery spasms (Prinzmetal angina)
- Short-term management of atrial fibrillation and flutter
- Migraine headaches
- Raynaud’s disease
- dihydropyridine nimodipine: cerebral artery spasms associated with aneurysm rupture
contraindications for calcium channel blockers?
-known drug allergy
-acute myocardial infaraction
-second or third degree AV block (unless the patient has a pacemaker)
hypotension
adverse effects for calcium channel blockers?
limited
primarily relate to overexpression of they therapeutic effects
-May cause hypotension, palpitations, tachy, or brady, constipation, nausea, dyspnea, other adverse effects
what is the proper way to take nitro? or the improper way? ***
** instruct pt to never chew or swallow the sublingual form and if there is a burning sensation felt with sublingual forms indicates that the drug is still potent
how long is potency good for for nitro?
3-6 months. instruct pt to keep a fresh supply of sublingual med on hand
how can you preserve potency for nitro ?
**meds should be stored in an airtight, dark glass bottle with a metal cap and no cotton filler
at what point of anginal pain should you take nitro?
**take as needed nitrates at the first hint of anginal pain
if the patient is experiencing chest pain the patient taking sublingual nitro should do what?
*should lie down o prevent or decrease sissiness and fainéant that may occur because of hypotension
patients taking beta blockers should monitor ____
***their pulse rates daily and report rates lower than 60 beats/min or symp relative bradycardia
isntruct pt to report dizziness or fainting
can patients stop beta blockers if they feel they need to?
**no tell them they cannot abruptly discontinue b-blockers
are beta blockers used for immediate relief?
no just long-term prevention angina
what is a serious problem with ca channel blockers (side effect i guess?)
*** constipation so instruct pt fluids, fibre
general adverse effects for antianaginal drugs?
allergic reactions, headaches, lightheadedness, hypotension, dizziness
