Antianginal Agents Flashcards
What is an atheroma?
Fatty tumor in the intimate of the heart vessels
What is atherosclerosis?
Narrowing of the heart vessels
How is angina pectoris described?
Suffocation of the chest
What occurs during a myocardial infarction?
Cells in the myocardium become necrotic and die
How is stable angina described?
No damage to the heart muscle
Basic reflexes surrounding the pain restore blood flow
How is unstable angina described?
Episodes of ischemia occur even when at rest
How is Prinzmetal’s Angina described?
Caused by spasm of the blood vessels, not just by vessel narrowing
What causes the chest pain associated with angina pectoris?
Factor P is released during ischemia affecting the nerve fibers around the chest. Due to lack of nerve fibers in the heart.
What occurs during an acute myocardial infarction?
A coronary vessel becomes occluded and is unable to deliver blood to the cardiac muscle. This causes ischemia and ultimately necrotic cardiac tissue.
When a patient is experiencing an acute myocardial infarction what are their symptoms?
Excruciating pain
Nausea
Severe sympathetic stress reaction
What are the actions of antianginal drugs?
- Improve blood delivery to the heart muscle by dilating blood vessels
- Improve blood delivery to the heart muscle by decreasing the work of the heart
How does antianginal drug increase the supply of oxygen?
By improving blood delivery to the heart muscle by dilating blood vessels
How does abtianginal drugs decrease the demand for oxygen?
By improving blood delivery to the heart muscle by decreasing the work of the heart
What classifications of drugs affect increased heart rate?
Beta blockers and calcium channel blockers
What classifications of drugs affect increased blood volume (preload)?
Beta blockers, calcium channel blockers, nitrates
What classifications of drugs affect increased blood pressure (after load)?
Beta blockers, nitrates, calcium channel blockers
What classifications of drugs affect increased muscle contractility?
Beta blockers and calcium channel blockers
What are the three types of antianginal drugs?
Nitrates
Beta-Adrenergic Blockers
Calcium Channel Blockers
What do nitrates do?
Help restore the appropriate supply and demand ratio in oxygen delivery to the myocardium when rest is not enough
Where do nitrates act on?
Act directly on smooth muscle to cause relaxation and depress muscle tone
When are nitrates indicated for use?
When a patient needs to prevent or treat attacks of angina pectoris?
What are the contraindications for nitrates?
Severe anemia
Head trauma
Cerebral hemorrhage
Pregnancy and lactation
When should you use caution for the prescription of nitrates?
Hepatic or renal disease
Hypotension
Hypovolemia
Conditions that limit cardiac output
What are the adverse effects of nitrates?
Related to vasodilation and decreased in blood flow.
Headache, dizziness, weakness, nausea, vomiting, hypertension, flushing, pallor,
increased perspiration
What are the two drugs that interact with nitrates?
Ergot derivatives and heparin
What is the prototype for nitrates?
Nitroglycerin
How often can you administer nitroglycerin to a patient experiencing angina pectoris?
0.4 mg every 5 minutes x 3
The patient asks the nurse to explain the type of angina he is experiencing. The nurse explains that pain is due to the imbalance of myocardial supply and demand. What type of angina does this described? A. Unstable B. Prinzmetal's C. Stable D. Ischemic
C. Stable
What do beta blockers do?
Block the stimulatory effects of the sympathetic nervous system
What are the contraindications for beta blockers?
- Bradycardia
- Heart block
- Cardiogenic shock
- Asthma or COPD
- Pregnancy and lactation
When do you use caution when prescribing beta blockers?
Diabetes Mellitus
PVD
Thyrotoxicosis
What drug interacts with beta blockers?
Clonidine
What are the adverse effects for beta blockers?
Dizziness, fatigue, emotional depression, nausea, vomiting, colitis, CHF, decreased cardiac output, arrhythmia, bronchospasm, dyspnea, and cough
What is the prototype for beta blockers?
Metoprolol
What does Metoprolol treat?
Stable angina pectoris
What do calcium channel blockers do?
Inhibit the movement of calcium ions across the membranes of myocardial and arterial muscle cells
When is calcium channel blockers indicated to be used?
Prinzmetal’s angina
What are the contraindications when prescribing calcium channel blockers?
- Heart Block
- Sick sinus syndrome
- Renal or hepatic dysfunction
- Pregnancy or lactation
What are the adverse effects of calcium channel blockers?
Hypotension Cardiac arrhythmias GI upset Skin reactions Headache
What is the prototype for calcium channel blockers?
Diltiazem
True or False:
Older adults are more likely to develop adverse effects associated with the use of antianginal drugs- dysrhythmias, hypertension, and congestive heart disease.
False:
Arrhythmias, hypotension, and congestive heart disease are likely to develop
Why do you need to use caution in patients with diabetes and prescribing anti-anginals?
It may hide symptoms of hypoglycemia
