antianginal: chapter 24 Flashcards
what are 2 main differences between chronic stable angina and unstable angina
chronic stable angina has a predictable pattern and is usually triggered by exertion. unstable angina does not have a predictable pattern and can occur at any time
what are 3 classes of antianginal drugs
nitrates, beta blockers, calcium channel blockers
mechanism of action of nitrates (2)
vasodilation, relax vascular smooth muscle cells
4 contraindications for nitrates
severe anemia, closed angle glaucoma, hypotension, severe head injury
3 adverse effects of nitrates
dizziness, orthostatic hypotension, rapid administration can lead to reflex tachycardia
what is a key nitrate
nitroglycerin
how is nitroglycerin metabolized when taken po. does it have a high or a low first pass effect
metabolized by the liver, high first pass effect
what routes of administration are used for acute onset of angina
sublingual or sprays
mechanism of action of beta blockers (3)
block b1 receptors and b2 receptors, block epinephrine and norepinephrine after and mi, suppress renin
how does blocking b1 and b2 receptors have an effect on the body
decrease hr, reduce heart workload
why would a beta blocker be given after an mi
to prevent an increase in hr, increases the survival rate
how does the suppression of renin have an effect on the body
prevents vasoconstriction which reduces blood pressure
4 contraindications of beta blockers
acute heart failure, asthma due to bronchoconstriction, diabetes, peripheral vascular disease
4 adverse effects of beta blockers
- decrease hr, co, and cardiac contractility
- increased airway resistance
2 key beta blockers
atenolol, metoprolol
what are atenolol and metoprolol used for
b1 receptor blockers used for prophylaxtic treatment
what are the 3 classes of calcium channel blockers
phenylalkyamines, benzothiazepines, dihydropyridines
mechanism of action of calcium channel blockers
prevent muscle contraction, allow arteries to dilate, decrease conduction of sa and av nodes
what antianginal drugs are used as first line therapy for angina, hypertension, and supraventricular tachycardia
calcium channel blockers
3 contraindications for calcium channel blockers
acute mi, second or third degree heart block, hypotension
3 adverse effects of calcium channel blockers
hypotension, dizziness, peripheral edema
what interacts calcium channel blockers
grapefruit juice
what are 2 key calcium channel blockers
diltiazem, amlodipine
what class of diltiazem
benzothiazepine
what drug class is amlodipine
dihydropyridine
what 4 things should be avoided due to vasodilation
alcohol, saunas, hot tubs/showers, hot weather
when should nitroglycerin be taken
at the first sign of chest pain
the patient is asking the nurse what he should do at the first sign of chest pain and what to do if the chest pain does not stop after the first dose of nitroglycerin. what does the nurse tell the patient
take a dose at the first sign of chest pain and sit or lie down due to possible hypotension. if symptoms are not relieved in 5min, take another dose and call 911. if symptoms are not relieved in another 5min, take another dose. do not take more than 3 doses
the patient has asked the nurse how he will know if his nitroglycerin has expired. what will the nurse tell the patient
if the medication still burns upon taking it then it is still potent and will have an effect
what 3 things can indicate an overdose of nitroglycerin
blurred vision, dry mouth, severe headaches
what may the doctor order to decrease the chances of tolerance to nitroglycerin patches
removal of the patches at specific times for 8hrs
