Antianginal

Question 1

Role of coronary arteries

Answer 1

deliver oxygen to the heart muscle

Question 2

what is myocardial ischemia?

Answer 2

damaged heart tissue from inadequate oxygen supply

Question 3

What is angina pectoris?

Answer 3

chest pain as a result of ischemia

Question 4

What is MI?

Answer 4

Necrosis of the myocardium. also known as a heart attack

Question 5

What are the different types of angina?

Answer 5

• Chronic stable angina
• Unstable angina
• Varient or vasospastic or Prinzmetal’s angina

Question 6

Chronic stable angina
Classic angina
Effort angina

Answer 6

triggered by exertion or other stress (e.g. cold, emotions)

Question 7

Unstable angina

Answer 7

Usually the early stage of progressive coronary artery disease. Often ends in MI

Question 8

Varient angina
Vasospastic angina
Prinzmetal angina

Answer 8

Spasms in the layer of smooth muscle that surrounds coronary arteries

Question 9

Describe the development of atherosclerosis

Answer 9

the build up of fatty plaque deposits in artery walls

Question 10

Controller drugs

Answer 10

Beta- blockers, CCB, and long-acting nitrates provide baseline prophylaxis or protection against acute angina attacks

Question 11

Rescue Drugs

Answer 11

SL, translingual spray, and IV nitroglycerin is used to treat acute anginal pain

Question 12

Nitroglycerin tolerance

Answer 12

• Occurs in pts taking nitrates around the clock or with long-acting forms
• Prevented by allowing regular nitrate-free period to allow enzyme pathways to replenish allow at least 8 hrs.

Question 13

Nitroglycerin MOA

Answer 13

In angina due to atherosclerosis, NTG dilates veins which reduces venous return (decrease preload). This decreases the workload of the heart. In variant angina, NTG dilates coronary arteries which improves blood flow through coronary vasculature.

Question 14

Drug Effect of Nitroglycerin

Answer 14

Decreased cardiac oxygen demand and increased cardiac oxygen supply

Question 15

Indications for Nitroglycerin

Answer 15

Stable, unstable and variant angina

Question 16

Contraindications for Nitroglycerin

Answer 16

Hypotension, erectile dysfunction drugs (Viagra, Levitra, or Cialis)

Question 17

Adverse effects of Nitroglycerin

Answer 17

Headache, orthostatic hypotension, reflex tachycardia, tolerance

Question 18

Nursing Implications

Answer 18

• Identify risk factors for CAD
• Obtain baseline data regarding frequency, intensity, duration,location, and precipitating factors of attacks
• Assess V/S and EKG

Question 19

Pt Ed

Answer 19

• Instruct pt proper technique for administering SL, transdermal, ointment, or oral routes
• Manage headache with acetaminophen
• Instruct men not to take erectile dysfunction drugs (lethal combo)

Question 20

Beta Blockers MOA

Answer 20

Prevent stimulation of beta receptors in the heart which decreases HR and contractility. Also prevents release of renin

Question 21

Drug effects of Beta Blockers

Answer 21

Decreased myocardial oxygen demand

Question 22

Examples of beta blockers

Answer 22

propranolol (Inderal)

metroprolol (Lopressor)

Question 23

Indications for beta blockers

Answer 23

Prevention/ prophylaxis of stable angina

Question 24

Contraindications of Beta blockers

Answer 24

Bradycardia, AV block, asthma

Question 25

Adverse effects of beta blockers

Answer 25

Dizziness, bradycardia, heart block, mask S/S of hypoglycemia, bronchoconstriction, constipation

Question 26

Nursing Implications of beta blockers

Answer 26

- Assess for contraindications | - Assess V/S- hold and notify MD if HR less than 60

Question 27

Pt ED

Answer 27

- Inform pt they are for long-term prevention, not immediate relief - change positions slowly, avoid hot tubs, saunas which result in vasodilation - Monitor glucose closely if diabetic - do not abruptly stop

Question 28

CCB MOA

Answer 28

Prevents influx of calcium ions across cell membrane of vascular smooth muscle Dilation of peripheral and coronary arteries

Question 29

Drug effects of CCB

Answer 29

Decreased after load decreases workload of the heart and therefore myocardial oxygen demand

Question 30

Examples of CCB

Answer 30

diltiazem (Cardizem) | verapamil (Calan)

Question 31

Indication for CCB

Answer 31

Prevention/ prophylaxis of stable, variant angina

Question 32

Adverse effect of CCB

Answer 32

dizziness, hypotension, constipation, peripheral edema

Question 33

Nursing implications for CCB

Answer 33

monitor VS

Question 34

Pt ED for CCB

Answer 34

- Avoid hazardous activities while dizzy - change positions slowly - increase fluid and fiber intake to prevent constipation unless otherwise instructed by MD