Antianginals

Question 1

What do arteries do?

Answer 1

Deliver oxygen to the heart

Question 2

What is angina?

Answer 2

AKA angina pectoris

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

Question 3

What are the types of angina?

Answer 3

Chronic stable angina
Variant angina
Unstable angina

Question 4

What is atherosclerosis?

Answer 4

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

Question 5

What is vasospasm?

Answer 5

Sudden constriction of a blood vessel

Question 6

What is chronic stable angina?

Answer 6

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

Question 7

What is unstable angina?

Answer 7

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

Question 8

What is variant angina?

Answer 8

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

Question 9

What is myocardial ischemia?

Answer 9

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

Question 10

What is myocardial infarction?

Answer 10

AKA heart attack

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

Question 11

What is coronary artery disease?

Answer 11

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

Question 12

What are the main drug classes for angina?

Answer 12

Nitrates
Beta-blockers
Calcium channel blockers

Question 13

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

Answer 13

Relieve pain by decreasing oxygen demand

Does not stop the cause of angina

Question 14

What do beta-blockers do for angina?

Answer 14

Decrease heart rate and contractility

Question 15

What do calcium channel blockers do for angina?

Answer 15

Reduce afterload by dilating arterioles

Question 16

What is afterload?

Answer 16

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

Question 17

What is preload?

Answer 17

The left ventricular end-diastolc pressure

The amount of ventricular stretch at the end of diastole

Question 18

What do nitrates do for angina?

Answer 18

Reduce preload by dilating veins

Question 19

What is the difference between controller and rescue drugs?

Answer 19

Controller drugs are continually taken to prevent angina

Rescue drugs are taken when angina occurs

Question 20

Which drugs are controller drugs?

Answer 20

Beta-blockers
Calcium channel blockers
Long-acting nitrates

Question 21

Which drugs are rescue drugs?

Answer 21

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

Question 22

What is the treatment strategy for angina?

Answer 22

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

Question 23

How does nitroglycerin tolerance develop?

Answer 23

Occurs when patients take nitrate very often

Tolerance develops rapidly over the course of a single day

Question 24

How can nitroglycerin tolerance be prevented and treated?

Answer 24

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

Question 25

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

Answer 25

(Chronic stable angina) | Dilates veins which reduces venous return and preload, which decreases the workload of the heart

Question 26

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

Answer 26

Dilates coronary arteries which improves blood flow through coronary vasculature

Question 27

What are the drug effects of nitrates for atherosclerosis angina?

Answer 27

Decreased cardiac oxygen demand

Question 28

What are the drug effects of nitrates for variant angina?

Answer 28

Increased cardiac oxygen supply

Question 29

What are indications for nitrates?

Answer 29

Stable, unstable, and variant angina

Question 30

What are contraindications for nitrates?

Answer 30

Hypotension | Erectile dysfunction drugs (can cause severe hypotension)

Question 31

What are the adverse effects of nitrates?

Answer 31

Headache Orthostatic hypotension Reflex tachycardia Tolerance

Question 32

When is sublingual nitroglycerin administered?

Answer 32

During acute angina attack

Question 33

How is sublingual nitroglycerin administered?

Answer 33

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

Question 34

What is the onset and duration of nitroglycerin patches?

Answer 34

Effect begins in 30 - 60 minutes | Lasts up to 14 hours

Question 35

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

Answer 35

Remove patch for 10 - 12 hours each night

Question 36

How is nitroglycerin ointment administered?

Answer 36

Must wear gloves to avoid touching ointment with hands | Use paper to spread ointment in a thin layer

Question 37

What are the nursing implications for nitrates?

Answer 37

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

Question 38

What are some things to educate the patient about nitrates?

Answer 38

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

Question 39

What is the prefix for beta-blockers?

Answer 39

-olol

Question 40

What is the mechanism of action for beta-blockers?

Answer 40

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

Question 41

What are the drug effects of beta-blockers?

Answer 41

Decreased myocardial oxygen demand

Question 42

What are some beta-blockers?

Answer 42

Propranolol (Inderal) | Metoprolol (Lopressor)

Question 43

What are the indications for beta-blockers?

Answer 43

Prophylaxis of stable angina and long term management

Question 44

What is prophylaxis?

Answer 44

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

Question 45

What are the contraindications of beta-blockers?

Answer 45

Bradycardia AV block Asthma

Question 46

What are the adverse effects of beta-blockers?

Answer 46

``` Dizziness Bradycardia/heart block Masks s/s of hypoglycemia Bronchocontriction Constipation ```

Question 47

What are the nursing implications for beta-blockers?

Answer 47

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

Question 48

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

Answer 48

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

Question 49

What is the mechanism of action for calcium channel blockers?

Answer 49

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

Question 50

What are the drug effects of calcium channel blockers?

Answer 50

Decreased afterload | Decreases workload of heart, therefore decreases myocardial oxygen demand

Question 51

What are some calcium channel blockers?

Answer 51

Diltiazem (Cardizem) | Verapamil (Calan)

Question 52

What are indications for calcium channel blockers?

Answer 52

Prophylaxis of stable and variant angina

Question 53

What are the adverse effects of calcium channel blockers?

Answer 53

Dizziness Hypotension Constipation Peripheral edema

Question 54

What are the nursing implications for calcium channel blockers?

Answer 54

Monitor vital signs

Question 55

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

Answer 55

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