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UNRS 113 > Antianginals > Flashcards

Antianginals Flashcards

1
Q

What do arteries do?

A

Deliver oxygen to the heart

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2
Q

What is angina?

A

AKA angina pectoris

Chest pain when the heart does not get enough oxygen-rich blood

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3
Q

What are the types of angina?

A

Chronic stable angina
Variant angina
Unstable angina

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4
Q

What is atherosclerosis?

A

Hardening and narrowing of the arteries due to fatty plaque deposits in the arterial walls

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5
Q

What is vasospasm?

A

Sudden constriction of a blood vessel

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6
Q

What is chronic stable angina?

A

Angina primarily caused by atherosclerosis or can be triggered by exertion or stress
Pain is intense but subsides within 15 minutes

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7
Q

What is unstable angina?

A

It is usually the early stage of coronary artery disease and often ends in myocardial infarction
Pain increases in severity and frequency also increases

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8
Q

What is variant angina?

A

AKA vasopastic angina
Caused by spasms in muscle surrounding coronary arteries
Pain often occurs at rest and without precipitating cause
Usually occurs at same time of day

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9
Q

What is myocardial ischemia?

A

Blockage of coronary arteries leading to decreased blood flow to heart, preventing the heart from receiving enough oxygen

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10
Q

What is myocardial infarction?

A

AKA heart attack

Necrosis of the myocardium caused by the interruption of blood flow to the heart

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11
Q

What is coronary artery disease?

A

Heart disease when the coronary arteries harden and narrow resulting in decreased oxygen-rich blood flow to the heart causing a heart attack (MI)

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12
Q

What are the main drug classes for angina?

A

Nitrates
Beta-blockers
Calcium channel blockers

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13
Q

What is the general idea of what the drugs for angina do?

A

Relieve pain by decreasing oxygen demand

Does not stop the cause of angina

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14
Q

What do beta-blockers do for angina?

A

Decrease heart rate and contractility

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15
Q

What do calcium channel blockers do for angina?

A

Reduce afterload by dilating arterioles

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16
Q

What is afterload?

A

The pressure against the wall of the left ventricle during ejection of blood

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17
Q

What is preload?

A

The left ventricular end-diastolc pressure

The amount of ventricular stretch at the end of diastole

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18
Q

What do nitrates do for angina?

A

Reduce preload by dilating veins

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19
Q

What is the difference between controller and rescue drugs?

A

Controller drugs are continually taken to prevent angina

Rescue drugs are taken when angina occurs

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20
Q

Which drugs are controller drugs?

A

Beta-blockers
Calcium channel blockers
Long-acting nitrates

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21
Q

Which drugs are rescue drugs?

A

Sublingual (SL), translingual spray, and intravenous (IV) nitroglycerin

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22
Q

What is the treatment strategy for angina?

A

Reduce intensity and frequency of attacks by:

-Increasing blood flow to ischemic heart muscle

  • Decreasing myocardial oxygen demand by:
  • Lowering heart rate
  • Lowering contractility
  • Lowering afterload
  • Lowering preload
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23
Q

How does nitroglycerin tolerance develop?

A

Occurs when patients take nitrate very often

Tolerance develops rapidly over the course of a single day

24
Q

How can nitroglycerin tolerance be prevented and treated?

A

Prevent by allowing 8 drug free hours a night and treat night angina with short-acting NGT
Tolerance can be reversed by withholding nitrates for a short time

25
Q

What is the mechanism of action of nitrates for atherosclerosis angina?

A

(Chronic stable angina)

Dilates veins which reduces venous return and preload, which decreases the workload of the heart

26
Q

What is the mechanism of action of nitrates for variant angina?

A

Dilates coronary arteries which improves blood flow through coronary vasculature

27
Q

What are the drug effects of nitrates for atherosclerosis angina?

A

Decreased cardiac oxygen demand

28
Q

What are the drug effects of nitrates for variant angina?

A

Increased cardiac oxygen supply

29
Q

What are indications for nitrates?

A

Stable, unstable, and variant angina

30
Q

What are contraindications for nitrates?

A

Hypotension

Erectile dysfunction drugs (can cause severe hypotension)

31
Q

What are the adverse effects of nitrates?

A

Headache
Orthostatic hypotension
Reflex tachycardia
Tolerance

32
Q

When is sublingual nitroglycerin administered?

A

During acute angina attack

33
Q

How is sublingual nitroglycerin administered?

A

Advise patient to sit down and take one tablet (should feel burning sensation under tongue)
Relief should occur within 5 minutes
If no relief after first tablet, call 911 then take another dose

May be repeated every 5 minutes for 3 doses

34
Q

What is the onset and duration of nitroglycerin patches?

A

Effect begins in 30 - 60 minutes

Lasts up to 14 hours

35
Q

How can tolerance to nitro be reduced when using nitroglycerin patches?

A

Remove patch for 10 - 12 hours each night

36
Q

How is nitroglycerin ointment administered?

A

Must wear gloves to avoid touching ointment with hands

Use paper to spread ointment in a thin layer

37
Q

What are the nursing implications for nitrates?

A

Identify risk factors for coronary artery disease
Obtain baseline data regarding frequency, intensity, duration, location, and precipitating factors of attacks
Assess vital signs and EKG

38
Q

What are some things to educate the patient about nitrates?

A

Proper technique for administering medication
Manage headache with acetaminophen
Do not take with erectile dysfunction drugs

39
Q

What is the prefix for beta-blockers?

A

-olol

40
Q

What is the mechanism of action for beta-blockers?

A

Prevent stimulation of beta receptors in the heart which decreases heart rate and contractility
Prevents release of renin

41
Q

What are the drug effects of beta-blockers?

A

Decreased myocardial oxygen demand

42
Q

What are some beta-blockers?

A

Propranolol (Inderal)

Metoprolol (Lopressor)

43
Q

What are the indications for beta-blockers?

A

Prophylaxis of stable angina and long term management

44
Q

What is prophylaxis?

A

The measure taken to maintain health and prevent the spread of disease

45
Q

What are the contraindications of beta-blockers?

A

Bradycardia
AV block
Asthma

46
Q

What are the adverse effects of beta-blockers?

A 
Dizziness
Bradycardia/heart block
Masks s/s of hypoglycemia
Bronchocontriction
Constipation
47
Q

What are the nursing implications for beta-blockers?

A

Assess for contraindications
Assess vital signs
-Hold and notify for heart rate less than 60

48
Q

What are some things to educate the patient about beta-blockers?

A

Used for long-term prevention and NOT immediate relief
Change positions slowly
Avoid time in hot tubs/saunas which result in vasodilation
Monitor glucose
Do not abruptly stop

49
Q

What is the mechanism of action for calcium channel blockers?

A

Prevents influx of calcium ion across cell membrane of vascular smooth muscle
Dilation of peripheral and coronary arteries

50
Q

What are the drug effects of calcium channel blockers?

A

Decreased afterload

Decreases workload of heart, therefore decreases myocardial oxygen demand

51
Q

What are some calcium channel blockers?

A

Diltiazem (Cardizem)

Verapamil (Calan)

52
Q

What are indications for calcium channel blockers?

A

Prophylaxis of stable and variant angina

53
Q

What are the adverse effects of calcium channel blockers?

A

Dizziness
Hypotension
Constipation
Peripheral edema

54
Q

What are the nursing implications for calcium channel blockers?

A

Monitor vital signs

55
Q

What are some things to educate the patient about calcium channel blockers?

A

Avoid hazardous activities while dizzy
Change positions slowly
Increase fluid and fiber intake to prevent constipation

UNRS 113 (4 decks)

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