Cardio 10 Deck 4 Flashcards
Angina
Clinical syndrome characterized by chest and/or arm discomfort
Caused by an imbalance between myocardial oxygen supply and demand (ischemia)
Associated with coronary artery disease
Pain is reproducible with physical exertion or emotional stress
Relieved by nitroglycerine
Goals of Drug Therapy for Angina
Elimination of anginal pain
Blood pressure (BP) less than 130/85 mm Hg and pulse less than 70 beats per minute
Reduce the risks of myocardial infarction (MI) and death
Treatment is aimed at (angina)
Increasing myocardial oxygen supply
Reducing myocardial oxygen demand
Minimizing or removing the occlusion
Treatment of Angina
Lifestyle changes
Surgical intervention
Pharmacological management
Drug classes for Angina
Aspirin Nitrates Beta blockers (BBs) Calcium channel blockers Angiotensin-converting enzyme inhibitors (ACEs) Statins
Coronary Vasodilators
Agents that serve to increase myocardial oxygen supply
Nitrates (nitroglycerin, isosorbide)
Prototype: nitroglycerine (NTG)
Calcium channel blockers (CCBs)
Nitro dose
one every 5 min up to three times. Usually told to ED
CCB use
will be on daily to prevent angina. Serve to increase myocardial oxygen supply
Nitrates Action low dose
Low doses of NTG dilate the veins, decreasing venous return to the heart.
Decreases preload
Nitrates Action high dose
Higher doses dilate arterial vessels.
Decreased vascular resistance (afterload)
Nitrates some dilation of
coronary arteries occur.
Atherosclerotic vessels do not dilate.
NTG Precautions and Contraindications
Contraindicated in hypersensitivity or idiosyncratic responses
Nitrate transdermal patch
Transdermal patches: allergy to adhesive may limit their use
NTG pregnancy category
C
BBs decrease the
force of myocardial contractility and decrease heart rate and conduction velocity.
BBs decrease systemic
vascular resistance and BP (afterload).
Decreased myocardial oxygen demand =
decreased anginal pain.
CCBs cause
arterial smooth muscle relaxation, which leads to peripheral vasodilation and decreased afterload.
CCBs may cause
coronary vasodilation.
Atherosclerotic vessels do not dilate.
CCB caution
may have swelling in lower extremities. Simply because of the action of the drug
ACEs act on
the renin-angiotensin-aldosterone (RAS) system
ACE cause
Decreased peripheral vascular resistance
Decreased afterload
ACE indirectly
reduce the secretion of aldosterone
Decreased sodium and water retention
Reducing extracellular fluid volume and preload
Aspirin
decreases platelet aggregation to prevent cycle of vasoconstriction and platelet buildup
Statins are preventive. They reduce
in low-density lipoprotein cholesterol levels, which plays a significant role in decreasing the formation of atherosclerotic plaque
Rational Drug Selection for angina
Grading of Angina by the New York Heart Association and the Canadian Cardiovascular Society
All patients with angina should be on
aspirin 81 to 325 mg/day
If patient cannot tolerate aspirin,
then clopidogrel (Plavix) 75 mg daily may be substituted.
NTG for exertional angina
Sublingual tablet (0.3 to 0.4 mg) or translingual spray is used for immediate symptom relief.
Class 1 grading of Angina NY
Proven coronary artery disease without symptoms
Class 2 grading Angina NY
Mild symptoms: angina and slight limitation during ordinary activity
Class 3 grading Angina NY
Marked limitations: angina during less-than-routine physical activity (walking short distances)
Class IV grading Angina NY
Severe limitations: angina during minimal activity or rest
Class 1 Grading Canadian
Ordinary physical activity, such as walking or climbing stairs, does not cause angina.
Class 2 Grading Canadian
Slight limitation of ordinary activity. Angina occurs on walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold wind, under emotional stress, or only during the few hours after awakening.
Class 3 Grading Canadian
Marked limitations of ordinary activity.
Class 4 Grading Canadian
inability to carry on any physical activity without discomfort. Angina may occur at rest.
Drugs for Stable Angina
ACE
Angiotensin II
BB
CCB
ACE are recommended for
for all symptomatic patients with chronic stable angina to prevent MI or death and to reduce symptoms
Angiotension II are recomended for
who are intolerant to ACEIs
BB are recommended as
initial therapy by all the guidelines for all patients
CCB are initial drug choice for
Initial drugs of choice for coronary artery vasospasm–associated angina
