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Pharmacology > Antianginal Drugs (54) > Flashcards

Antianginal Drugs (54) Flashcards

1
Q

Angina

A

Chest pain

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2
Q

Angina is caused by

A

Insufficient supply of oxygen and nutrients in the blood, to meet demands of the heart

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3
Q

Where is the topical distribution of angina (referred pain)

A

Left sided pain, neck, arm, down to hand

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4
Q

Stable angina

A

Predictable
-exercise, excitement

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5
Q

Unstable angina

A

Occurs without activity

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6
Q

Variant angina

A

Coronary artery vasospasm

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7
Q

Micro vascular angina

A

Spasms in smallest coronary arteries
-longer lasting pain

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8
Q

Micro vascular angina is more common in

A

Women

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9
Q

How long does micro vascular angina last

A

10 to 30 minutes

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10
Q

Angina pectoris

A

Stable angina

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11
Q

Prinzmetals angina

A

Variant angina

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12
Q

Therapeutic goals of angina

A

-relieve the pain of a current attack
-prevention/limiting

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13
Q

Broad treatment goals of antianginal drugs

A
  1. Improve blood flow in coronary circulation
  2. Reduce heart muscle metabolic demands
  3. Or both
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14
Q

Four types of antianginal drugs

A

-organic nitrates
-beta blockers
-calcium channel blockers
-ranolazine

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15
Q

Combination therapies for antianginal drugs

A

-nitrates and ccbs
-nitrates and B blockers
-ccbs and b blockers
-nitrates and ccbs and b blockers

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16
Q

Organic nitrates mechanism of actions

A
  1. Combine with S-nitrosonthiol and sodium nitroprusside
  2. Creates GC which makes GTP into cGMP
  3. Relaxation
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17
Q

Organic nitrates cause

A

Vasodilation
-relaxation of vascular smooth muscles

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18
Q

How do organic nitrates cause vasodilation

A
  1. Dilate coronary arteries
  2. Reduce cardiac preload, and afterload
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19
Q

Preload vs afterload

A

Preload - relax veins

Afterload - relax systemic arteries

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20
Q

Preload physiology

A

Stress on ventricular wall before systole
-volume of blood in ventricles at the end of diastole/before systole

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21
Q

Preload relates to what law

A

Frank starling law

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22
Q

afterload physiology

A

Resistance heart has to pump against

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23
Q

Afterload is determined by

A

Arteriolar pressure

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24
Q

Organic nitrates decrease..

A

Preload and afterload

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25
Q

Decreased preload =

A

Dilate veins

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26
Q

Dilated veins

A

Decreases stroke volume, cardiac output, blood pressure

And cardiac work

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27
Q

Decreased afterload =

A

Arteriolar vasodilator and blood pressure

Decreased cardiac work

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28
Q

Nitroglycerin first pass effect

A

Large first pass effect

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29
Q

Nitroglycerin is a

A

Organic nitrates

30
Q

How is organic nitrates given

A

SL for symptomatic treatment
-not PO

31
Q

How is organic nitrates given when symptoms need to be treated

A

SL

32
Q

Nitroglycerin is given ___ for prevention of angina

A

Patch/PO

33
Q

When is nitroglycerin given IV

A

For BP control in perioperative hypertension, HF, ischemic pain, pulmonary edema associated with acute MI, hypertensive emergencies

34
Q

Isosorbide mononitrate helps with, and is give…

A

Prolonged action for prophylaxis
-orallyyyyy

35
Q

Nitrates are used for (3)

A

-acute relief
-prophylaxis in situations that may provoke
-long term prophylaxis

36
Q

Acute relief of angina

A

Few minutes, last around an hour
-SL, tablet, or spray

37
Q

Prophylaxis in situations that may provoke angina

A

Such as exercise
-SL and oral

38
Q

Long term pyophylaxis of angina

A

-transdermal patches
-oral

39
Q

Transdermal patches vs oral

A

Transdermal- nitroglycerin

Oral- nitroglycerin and isosorbide mononitrate

40
Q

Adverse effects of organic nitrates

A

-headache
-postural hypotension
-reflex tachycardia

41
Q

Adverse effects of organic nitrates: headache

A

Classic and predictable in almost all patients
-usually diminish in intensity and frequency with continued use

42
Q

Adverse effects of organic nitrates: postural hypotension

A

Some peripheral edema due to pooling of blood in venous system

43
Q

Adverse effects of organic nitrates: reflex tachycardia

A

Partially offsets beneficial effects
-may combine with b blocker

44
Q

Organic nitrates can build up a ___ to the drug

A

Tolerance
-over a signal day

45
Q

How do you avoid the tolerance of organic nitrates

A
46
Q

Nitroglycerin NEVER do what

A

Chew or swallow SL form

47
Q

Nitrate topical ointments and transdermal forms: client implications

A

-site rotations
-removal of old medications

48
Q

Removal of old nitrlgycerin patches reduces

A

Tolerance by removing topical forms at bedtime, and apply new doses in the morning
-allowing for a nitrate free period

49
Q

Beta blockers: B and Reno Peter antagonists

A

-atenolol
-metoprolol
-propranolol

50
Q

Mechanisms of action of beta blockers

A

-decreases HR
-decreases myocardial contraction lite

51
Q

Decrease in HR =

A

Decrease cardiac work and myocardial oxygen demand

52
Q

Decrease myocardial contractility =

A

Decrease cardiac work and myocardial oxygen demand

53
Q

Beta blockers are

A

Long term prevention of angina

54
Q

Beta blockers are NOT for

A

Acute exacerbations of angina

55
Q

Indications of beta blockers

A

-angina
-anthypertensive
-cardioprotective effects
-migraine headaches

56
Q

Which beta blocker is used for migraine headaches

A

Propranolol

57
Q

Adverse effects of beta blockers: cardiovascular effects

A

-bradycardia
-hypotension
-second or third degree heart block
-HF

58
Q

Adverse effects of beta blockers: metabolism

A

-altered glucose
-lipid metabolism

59
Q

Adverse effects of beta blockers: CNS

A

-dizziness
-fatigue
-mental depression
-lethargy
-drowsiness
-unusual dreams

60
Q

Adverse effects of beta blockers: other

A

-impotence
-wheezing
-dyspnea

61
Q

Client implications of beta blockers

A

Monitor pulse rate daily and report any lower than 60 beats per minute

62
Q

Beta blockers should never be

A

Abruptly discontinued
-physical dependence

63
Q

Three calcium channel blockers

A

-diltiazem
-verapamil
-nifedipine

64
Q

CCBs mechanism of action

A

-Reduce myocardial contractility
-peripheral arterial vasodilation
-decreased myocardial oxygen demand

65
Q

Which of the CCBs reduce myocardial contractility

A

Verapamil and diltiazem

66
Q

Which of the CCBs cause peripheral arterial vasodilation

A

All of them

67
Q

Indications of CCBs

A

First line agents
-angina
-hypertension
-super ventricular tachycardia

68
Q

Encourage clients to keep a record of

A

Anginal attacks
-pills taken, therapeutic effects, precipitating factors

69
Q

Alcohol consumption, hot baths, hot tubs or saunas cause…

A

Vasodilation and hypotension

70
Q

Client implications of CCBs

A

Constipation is a common problem
-adequate fluids and eat high fibre foods

Pharmacology (23 decks)

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