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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Antianginal Drugs - Ch 54 > Flashcards

Antianginal Drugs - Ch 54 Flashcards

1
Q

What is Angina?

A

-Chest pain
Supply of oxygen and nutrients in the blood is insufficient to meet demands of heart causing pain

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2
Q

What are the types of angina?

A

Stable (angina pectoris)
Unstable
Variant/Prinzmetal’s
Microvascular

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3
Q

What is stable angina?

A

Predictable
e.g, excercise, excitement

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4
Q

What is unstable angina?

A

Occurs without activity

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5
Q

What is Variant/Prinzmetal’s angina?

A

Coronary artery vasospasm

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6
Q

What is microvascular angina?

A

Spasms in smallest coronary arteries
Longer lasting pain (>10min to 30 min)
More common in women

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7
Q

What are the therapeutic goals of antianginal drugs?

A

Relieve pain of attack
Prevent angina (limit number of attacks)

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8
Q

What are the 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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9
Q

What are the kinds of antianginal drugs?

A

Organic Nitrates
Beta-blockers
Calcium channel blockers
Ranolazine

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10
Q

Examples of antianginal drug combinations?

A

Nitrates + CCBs
Nitrates + beta-blockers
CCBs + Beta-blockers
Nitrates + CCBs + Beta-Blockers

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11
Q

What are the avaialble forms of organic nitrates?

A

Sublingual
Oral capsules/tablets
IV solutions
Ointments
Transdermal patches
Translingual sprays

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12
Q

What do organic nitrates cause?

A

Vasodilation
-Relaxes vascular smooth muscle

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13
Q

When coronary arteries dilate due to organic nitrates what happens?

A

Increased coronary blood flow which is useful in variant angina

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14
Q

What happens when veins and systemic arteries relax due to organic nitrates?

A

Relaxed veins = Reduced cardiac preload
Relaxed systemic arteries = reduced cardiac afterload

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15
Q

What is preload?

A

Stress on ventricular wall before systole
Volume of blood in ventricles at the end of diastole/before systole (Frank-starling law)

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16
Q

What is afterload?

A

Resistance the heart has to pump against tat is determined by arteriolar pressure

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17
Q

Decreased preload caused by organic nitrates does what?

A

Dilate veins which decreases stroke volume, cardiac output and BP
= decreased cardiac work

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18
Q

Decreased afterload caused by organic nitrates does what?

A

Dilate arterties, decreases total peripheral resistance which decreases BP
= decreased cardiac work

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19
Q

Examples of organic nitrate?

A

Nitroglycerin
Isosorbide mononitrate
Isosorbide dinitrate

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20
Q

Nitroglycerin has a large what?

A

Large first-pass effect

21
Q

How is nitroglycerin administered for symptomatic treatment?

A

Sublingual, not PO

22
Q

How is nitroglycerin administered for angina prevention?

A

Patch or PO

23
Q

When is IV nitroglycerin used?

A

BP control in perioperative hypertension, heart failure, ischemic pain, pulmonary edema due to acute MI and hypertensive emergencies

24
Q

Prolonged action of isosorbide mononitrate is used for?

A

Prophylaxis

25
Q

How is isosorbide mononitrate administered?

A

PO
-Has high bioavailability

26
Q

Organic nitrate SL tablet or spray is used for?

A

Acute relief of angina (few min, lasts ~ 1 hour)

27
Q

Organic nitrate Sl or oral is used for?

A

Prophylaxis in situations that may provoke angina like excercise

28
Q

Transdermal patches (nitroglycerin) or oral (nitroglycerin, isosorbide mononitrate) is used for?

A

Long-term prophylaxis of angina

29
Q

What adverse effects are associated with organic nitrates?

A

Headaches
Postural hypotension
Peripheral edema
Reflex tachycardia

30
Q

headaches in patients taking nitrates are what?

A

Classic and predictable
Usually diminish in intensity/frequency with continued use

31
Q

What does reflex tachycardia do?

A

Partially offsets beneficial effects
May combine with beta-blocker

32
Q

What can develop quickly (over a single day) in patients taking oragnic nitrates?

A

Tolerance to the drug

33
Q

What should the nurse teach the client is they are taking SL nitroglycerin?

A

Never to chew or swallow sublingual form

34
Q

What should the nurse do when providing nitrate topical ointments or transdermal forms?

A

Rotate sites
Remove old mediaction
-remove topical forms at bedtime, apply new dose in the morning = reduce tolerance
-allow for a nitrate-free period

35
Q

Examples of beta-blockers?

A

Atenolol
Metoprolol (Lopressor)
Propanolol (Inderal)

36
Q

What is the mechanism of action of beta-blockers?

A

Decrease heart rate = decrease cardiac work
Decrease myocardiac contractility = decreased cardiac work

=Decreases myocardiac oxygen demand

37
Q

What are beta-blockers used for?

A

Long-term prevention of angina
-Not for acute exacerbations of angina

Antihypertensive
Cardioprottective effects after MI
Migraines (propanolol)

38
Q

Adverse effects of beta-blockers?

A

Bradycardia, hypotension, HF
Altered glucose and lipid metabolism
Dizzininess, fatigue, letahrgy, weird dreams
Impotence, wheezing, dyspnea

39
Q

What should clients taking beta-blockers monitor daily?

A

Pulse rate
Report any pulse lower than 60 bpm

40
Q

Why should beta-blocker use never be abruptly discontinued?

A

Rebound hypertensive crisis

41
Q

Examples of CCBs?

A

Diltiazem (cardizem)
Verapamil
Nifedipine (other DHPs)

42
Q

What is the mechanism of action of CCBs?

A

Reduce myocardial contractility (negative inotropic action)
cause peripheral arterial vasodilation
Decreased myocardial oxygen demand

43
Q

What CCBs reduce myocardial contractility (negative inotropic action)?

A

Verapamil and diltiazem

44
Q

What CCBs cause peripheral arterial vasodilation?

A

All CCBs

45
Q

What drugs are first-line agents for treatment of angina, hypertension and supraventricular tachycardia?

A

Calcium channel blockers

46
Q

What should clients taking antianginal drugs avoid?

A

Consuming alcohol
Going in hot baths, showers, hot tubs and saunas
(they cause vasodilation and hypotension)

47
Q

Nurses should encourage clients to keep a record of what?

A

Their anginal attacks
-precipitating factors
-Numbers of pills taken
-Therapeutic effects

48
Q

What should clients taking CCBs do to avoid constipation?

A

Adequate fluids and eat high-fibre foods

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (20 decks)

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