antianginal: chapter 24

Question 1

what are 2 main differences between chronic stable angina and unstable angina

Answer 1

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

Question 2

what are 3 classes of antianginal drugs

Answer 2

nitrates, beta blockers, calcium channel blockers

Question 3

mechanism of action of nitrates (2)

Answer 3

vasodilation, relax vascular smooth muscle cells

Question 4

4 contraindications for nitrates

Answer 4

severe anemia, closed angle glaucoma, hypotension, severe head injury

Question 5

3 adverse effects of nitrates

Answer 5

dizziness, orthostatic hypotension, rapid administration can lead to reflex tachycardia

Question 6

what is a key nitrate

Answer 6

nitroglycerin

Question 7

how is nitroglycerin metabolized when taken po. does it have a high or a low first pass effect

Answer 7

metabolized by the liver, high first pass effect

Question 8

what routes of administration are used for acute onset of angina

Answer 8

sublingual or sprays

Question 9

mechanism of action of beta blockers (3)

Answer 9

block b1 receptors and b2 receptors, block epinephrine and norepinephrine after and mi, suppress renin

Question 10

how does blocking b1 and b2 receptors have an effect on the body

Answer 10

decrease hr, reduce heart workload

Question 11

why would a beta blocker be given after an mi

Answer 11

to prevent an increase in hr, increases the survival rate

Question 12

how does the suppression of renin have an effect on the body

Answer 12

prevents vasoconstriction which reduces blood pressure

Question 13

4 contraindications of beta blockers

Answer 13

acute heart failure, asthma due to bronchoconstriction, diabetes, peripheral vascular disease

Question 14

4 adverse effects of beta blockers

Answer 14

• decrease hr, co, and cardiac contractility

- increased airway resistance

Question 15

2 key beta blockers

Answer 15

atenolol, metoprolol

Question 16

what are atenolol and metoprolol used for

Answer 16

b1 receptor blockers used for prophylaxtic treatment

Question 17

what are the 3 classes of calcium channel blockers

Answer 17

phenylalkyamines, benzothiazepines, dihydropyridines

Question 18

mechanism of action of calcium channel blockers

Answer 18

prevent muscle contraction, allow arteries to dilate, decrease conduction of sa and av nodes

Question 19

what antianginal drugs are used as first line therapy for angina, hypertension, and supraventricular tachycardia

Answer 19

calcium channel blockers

Question 20

3 contraindications for calcium channel blockers

Answer 20

acute mi, second or third degree heart block, hypotension

Question 21

3 adverse effects of calcium channel blockers

Answer 21

hypotension, dizziness, peripheral edema

Question 22

what interacts calcium channel blockers

Answer 22

grapefruit juice

Question 23

what are 2 key calcium channel blockers

Answer 23

diltiazem, amlodipine

Question 24

what class of diltiazem

Answer 24

benzothiazepine

Question 25

what drug class is amlodipine

Answer 25

dihydropyridine

Question 26

what 4 things should be avoided due to vasodilation

Answer 26

alcohol, saunas, hot tubs/showers, hot weather

Question 27

when should nitroglycerin be taken

Answer 27

at the first sign of chest pain

Question 28

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

Answer 28

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

Question 29

the patient has asked the nurse how he will know if his nitroglycerin has expired. what will the nurse tell the patient

Answer 29

if the medication still burns upon taking it then it is still potent and will have an effect

Question 30

what 3 things can indicate an overdose of nitroglycerin

Answer 30

blurred vision, dry mouth, severe headaches

Question 31

what may the doctor order to decrease the chances of tolerance to nitroglycerin patches

Answer 31

removal of the patches at specific times for 8hrs