antianginal drugs

Question 1

angina pectoris

Answer 1

insufficient o2 and nutrient supply to the heart causing pain

Question 2

ischemia

Answer 2

poor blood supply to an organ

Question 3

ischemic heart disease

Answer 3

poor blood supply to heart muscle, atherosclerosis, coronary artery disease

Question 4

preload and afterload

Answer 4

preload: filling and stretching (end of diastole)
afterload: pressure to pump against (systole)

Question 5

myocardial infarction

Answer 5

necrosis or death of cardiac tissue
disabling or fatal

Question 6

5 types of angina

Answer 6

• stable angina (classic/effort angina)
• unstable angina ( pre-infarction angina)
• variant (vasosparatic/ Prinzmetal)
• atypical
• microvascular

Question 7

symptoms of angina

Answer 7

• usually after heavy exercise or emotional stress
• pain in middle of chest, spreads to L arm, back, neck or jaw (dull)
• pressure or squeezing in chest or arms

Question 8

stable angina

Answer 8

when the heart works harder than normal
- regular pattern
- stops after rest or medication (nitroglycerin) within a few mins
- feels the same each time it happens
- less than 5 mins
- might feel like indigestion

Question 9

unstable angina

Answer 9

• sign of possible heart attack
• no predicted pattern
• should be treated as an emergency
• increased risk of cardiac arrest or arrhythmias

Question 10

unstable angina characteristics

Answer 10

• pain happens when resting or sleeping
• last as long as 30 mins and may become worse
• not relieved by rest or meds
• might be a sign of a possible heart attach

Question 11

women and angina

Answer 11

• stabbing, pulsating or sharp pain
• more likely to have nausea, SOB, abd pain

Question 12

therapeutic objectives of antiangina meds

Answer 12

• minimize frequency of attacks
• increase blood flow to ischemic myocardium and decrease myocardiac 02 demand .
• improve functioning
• prevent or delay MI

Question 13

nitrates and nitrite forms

Answer 13

• IV sol
• transdermal patches
• translingual sprays
  bypasses the liver and first pass effect

Question 14

MOA of nitrates

Answer 14

vasodilation from relaxation
dilating effect on coronary arteries
results in o2 to ischemic myocardial tissue
decreases preload and afterload

Question 15

rapid acting nitates and nitrites

Answer 15

treat acute anginal attacks
sublingual tablets or spray; IV infusion

Question 16

long acting nitrates

Answer 16

used to prevent anginal episodes

Question 17

nitroglycerin

Answer 17

rapid and long acting
most important for symptomatic treatment of ischemic heart conditions
PO, SL, metered-dose aerosol, IV, topical

Question 18

nitroglycerin IV indications and storage

Answer 18

treatment of HF, ischemic pain, hypertensive emergencies.
- given with non polyvinyl chloride tubing and bags

Question 19

nitrates adverse effects

Answer 19

• headaches (most common)
• reflex tachycardia
• postural hypotension
• tolerance may develop

Question 20

how to prevent tolerance with nitrates

Answer 20

-allow a regular nitrate free period to allow enzyme pathways to replenish.
- remove transdermal patch at bedtime for 8 hrs and then apply new patch

Question 21

nitrate contraindications

Answer 21

anemia, glaucoma, hypotension, severe head energy, erectile dysfunction drugs

Question 22

beta blockers

Answer 22

mainstay in the treatment in cardiovascular disease
(angina, MI, hypertension, dysrhythmias)

Question 23

antianginal beta blockers

Answer 23

atenolol and metoprolol

Question 24

beta blocker MOAs

Answer 24

-decreases HR= decreased oxygen demands= increased delivery of oxygen to the heart
- decrease myocardial contractility, helping to conserve energy or decrease demand
-blocks effects of catecholamines improving survival of MI

Question 25

beta blocker indications

Answer 25

angina, hypertension, cardiac dysrhythmias, MI, migraine, essential tremors, stage fright

Question 26

beta blocker contraindications

Answer 26

systolic HF, serious conduction disturbances, asthma, diabetes, PVD

Question 27

caution with beta blockers in

Answer 27

-bronchial asthma (can cause bronchoconstriction) - diabetes mellitus (can mask hypoglycemia-induced tachycardia) - PVD (can compromise blood flow)

Question 28

beta blocker adverse effects

Answer 28

CV: bradycardia, hyoptension, atrioventricular shock Metabolic: hyperglycemia, hypoglycemia, hyperlipidemia CNS: dizziness, fatigue, depression, lethargy Other: erectile dysfunction, wheezing, dyspnea

Question 29

atenolol

Answer 29

- B1 receptor blocker - prophylactic treatment of angina - use of atenolol after myocardial infarction can decrease mortality -PO

Question 30

metroprolol tartrate

Answer 30

- B1 beta blocker - prophylactic treatment of angina - reduces mortality rate after MI - PO and injectable

Question 31

IV metropolol

Answer 31

after MI and is used for treatment of hypertension in pts unable to take oral meds

Question 32

Ca channel blockers for chronic unstable angina

Answer 32

- amlodipine and diltiazem

Question 33

Ca channel blocker MOA

Answer 33

- vasodilation - reduces workload of heart - decreased myocardial o2 demand - depression of conduction through SA and AV node for dysrhythmias

Question 34

Ca channel blocker indications

Answer 34

- angina - hypertension - tachycardia - coronary artery spasms - short term a-fib management - migraine - raynaud's

Question 35

Ca channel blocker contraindications

Answer 35

- acute MI. allergy, 2-3rd degree AV block, hypotension

Question 36

Ca channel blocker adverse effects

Answer 36

- overexpression of therapeutic effects - hypotension, palpitations, tachycardia, bradycardia, constipation, nausea, dyspnea

Question 37

diltiazem hcl

Answer 37

- treats angina and hypertension - treatment of a fib and along tachycardia

Question 38

amlodipine besylate

Answer 38

most popular ca channel blocker of dihydropyridine subclass angina and hypertension PO only

Question 39

pts should limit ____ intake

Answer 39

caffeine

Question 40

pts should report

Answer 40

blurred vision, persistent headache, dry mouth, edema, fainting, weight gain, pulse rate < 60 BPM, dyspnea

Question 41

t or f you can swallow sublingual nitroglycerin forms

Answer 41

false. never chew or swallow the sublingual form

Question 42

what indicates sublingual nitroglycerin is potent

Answer 42

burning sensation potency is good for 3-6 months

Question 43

how to store nitroglyc

Answer 43

airtight, dark glass bottle with metal cap, no cotton filter

Question 44

how to take nitro with chest pain

Answer 44

lay down to prevent dizziness or fainting

Question 45

what to do with anginal pain

Answer 45

- stop activity - take sublingual tab - call 911 and take 2nd tab if theres no relief in 5 mins - 3rd tab if no relief after 5 mins - dont drive to hospital

Question 46

common problem with calcium channel blockers

Answer 46

constipation