Antianginals Flashcards
Which type of angina is caused by stresses?
Typical or exertional
What causes typical angina?
coronary arteries not able to transport enough oxygen to meet myocardium demand
If demand for oxygen is greater than available,
Then what?
necrosis = MI
2 other names for variant angina
atypical
Prinzmetals
Whats the difference on an EKG between typical and variant angina
with variant, elevated ST segment
Normal coronary arteries have mainly ___ receptors which with epi cause ____ which improves blood flow. Epi on ____ receptors cause increasing ____ demand on the heart. Individuals with variant angina have more ____ receptors than Beta 2 receptors which leads to _____ which results in lack of oxygenation due to _____.
B2 vasodilation B1 oxygen A1 vasoconstriction vasospasm
List 6 factors that may trigger an angina attack
- physical exertion
- mechanical stress
- increased contractillity
- Increased HR/BP
- Cold temps
- hyperventilation
What is the MOA of nitrites/nitrates, beta blockers and Ca channel blockers as it relates to management of angina?
Relaxation of all SM = no contraction = arterial and venous vasodilation
Nitroglycerin works on endothelial cells that produce?
Nitric oxide
What are the 4 effects of nitrites/nitrates as it relates to angina?
- vasodilation
- decrease preload and venous return
- decrease work
- decrease oxygen demand
9 side effects of nitrites/nitrates as it relates to angina?
- headache! due to rapid vasodilation
- weakness/dizziness
- flush
- postural hypotension and syncope (increases with alcohol
- tachycardia and increased peripheral resistance
- rash
- oxidation of hemoglobin to methemoglobin
- decrease oxygen carrying capabilities (with large dose)
Which drug that treats angina is known to give a flushing side effect?
amyl nitrate
Name the 3 rapid onset angina drugs
- amyl nitrate
- nitroglycerin
- transdermal patch
Name the 2 long acting angina drugs
- Isordil
2. Imdur
Whats the epi limit for a angina patient?
1:100,000 epi - 2 cartridges = 0.04mg epi
5 groups of drugs used to treat unstable angina
- nitrates
- beta blockers
- ca channel blockers
- antiplatelet drugs
- antithrombin therapy
Nitrates cause relaxation of all ____ ___. Uses a ___ messenger system. Results in ___ and ___ vasodilation.
Smooth muscle
second
arterial and venous
what are 4 routes of administration of nitrates?
- sublingual
- topical
- oral
- transdermal (12 hours on 12 hours off)
Which antiangina drug has the fastest onset?
amyl nitrate - Vaporole, white pack you mash and snort, onset is less than a minute, lasts 3-15 minutes
What the onset time for nitroglycerin placed sublingually?
1-3 minutes
Whats the max does of nitro in spray form?
3 times, 5 min apart
How long do the long acting nitrates last?
- Isordil - onset 2-10 minutes, sublingual lasts 1-2 hours while oral pill lasts 4-6 hours
- Imdur - onset 30-60 minutes and pill has half life of 4 hours
beta blockers are indicated for all acute coronary syndromes, whats their MOA?
Decrease workload of the heart by decreasing CO and arterial pressure, which decreases venous return, decreases preload and decreases oxygen demand
Beta blockers do NOT cause vasodilation and pts that have had an MI should always be taking them, decreases mortality. What is a side effect and who is it contraindicated for?
Bradycardia
Contraindicated in CHF, asthma, and variant angina
