Antianginal Drugs Flashcards
What causes angina pectoris?
Decreased supply of oxygen to the heart resulting in the “aching” of the heart
What is ischemia, ischemic heart disease and MI?
I: Poor blood supply to an organ
IHD: Poor blood supply to the heart
MI: Necrosis of cardiac tissue
What are the 5 different kinds of angina and what are the two most common ?
Most common:
Stable, unstable
Others:
Variant, atypical, microvascular
What are the signs and symptoms of angina?
Pain in middle chest that radiates to L arm, back neck and jaw
Pressure, tightness or squeezing in arms and chest
Persistent indigestion
Numbness in arms, shoulders or wrists
What is a stable angina?
It occurs when the heart as to work harder than normal. (i.e exercise)
It has a regular pattern and usually subsides once activity is stopeed or medication is taken
What are the characteristics of a stable angina?
Feels the same each time it happens
Usually lasts <5 mins and stops after rest or medication
Might feel like indigestion
What is an unstable angina?
Often an indicator of an incoming heart attack
There is no predictable pattern, it can occur at any time
It should always be treated as an emergency
Increased risk for heart attacks, cardiac arrest or arrhythmias
What are the characteristics of an unstable angina?
Often happens during sleep or rest
May last >30 mins
Cannot be relieved with rest or meds
What is the relation between angina and women?
The type of pain is different: Usually stabbing, pulsating or sharp pain.
They’re also more likely to experience SOB, nausea, and abdominal pain
What are the 3 classes of angina drugs?
Nitrates and nitrites
Beta blockers
Calcium channel blockers
What is the overall goal of drug therapy?
Increase blood flow to ischemic myocardium and decrease myocardial o2 demand
What are the forms of nitrates and nitrites (N/N) that we need to know?
IV solutions, trandermal patches and translingual sprays
What is the MOA of N/N?
Vasodilation via relaxation of smooth muscles resulting in increased oxygen to ischemic myocardial tissue
What are the uses of rapid and long acting forms of N/N?
R: treatment of acute anginal attacks
L: Prevention of anginal episodes
Name a N/N
Nitroglycerin
What is the IV form of nitroglycerin used for?
Control of BP in periop HTN, HF, Ischemic pain, pulmonary edema and hypertensive emergencies
What are the adverse effects of nitroglycerin?
Headaches
Reflex tachycardia
Postural hypotension
Tolerance may develop
How can nitroglycerin tolerance be prevented and give an example
Allowing a regular nitrate-free period to allow enzyme pathways to replenish
Ex: Transdermal forms may be removed at bedtime and re-applied in the morning
Name 2 antianginal beta blockers
Atenolol
Metoprolol
What are the contraindications of nitrates?
Severe anemia
Closed-angle glaucoma
Hypotension
Severe head injury
Use of ED drugs
What is the MOA of beta blockers?
Block beta receptors in the heart
Decrease HR, resulting in decreased O2 demand
Decrease contractility resulting in decreased demand and conserved energy
How do beta blockers prevent further complications after a MI?
After a MI, a high level of catecholamines irritate the heart causing imbalances in supply and demand and leading to dysrhythmias
Beta blockers block the effects of catecholamines, improving survival after a MI
What are the indications of beta blockers?
Angina
HTN
Dysrhythmias
MI
What are the contraindications of beta blockers?
Systolic HF
Diabetes mellitus
Peripheral vascular disease
Use caution in bronchial asthma
