Cardio Drugs pt.2 Flashcards
Coronary Artery Disease is also known as atherosclerosis. What are some risk factors?
Hyperlipidemia HTN DM Genetics Lifestyle - sedentary, stress, obesity
____ deposits build up in blood vessel walls and narrow the passageway for movement of blood. This will eventually lead to blockage of the coronary arteries and a “heart attack.”
fatty
What are the clinical manifestations of CAD (Coronary Artery Disease)?
Early stages are asymptomatic
eventually: Excessively fatigue dyspnea chest pain palpitations (a noticeably rapid, strong, or irregular heartbeat due to agitation, exertion, or illness.) ECG change
How do we treat CAD?
Statins (Lipitor/Zocor) ACE inhibitors Antiplatelet agents (aspirin) Calcium channel blocker Surgical - angioplasty
Which cholesterol is the “good” one? HDL or LDL?
HDL
H for helper
What do we want to see in cholesterol?
Reduction in LDL and triglycerides
Improved HDL
Improved HDL to LDL ratio
What types of medication can we use to lower lipids
Bile Acid Sequestrants such as Cholestyramine (QUestran)
*This medication is like metamucil. You stir it into water and it becomes thick and sludgy. When you drink it, it binds to bile acids (which contain cholesterol) and carries them out in feces, thereby reducing cholesterol. Reduces plasma cholesterol levels. The liver then uses the remaining serum cholesterol in the body to produce bile.
HMG - CoA reductase inhibitors (Statins) such as atorvastatin (Lipitor/Crestor).
*HMG-CoA reductase is used in synthesis of cholesterol. If we inhibit this enzyme, less cholesterol is synthesized. Serum levels will decrease because existing LDLs will be absorbed for processing into cholesterol (HDL levels will increase slightly).
Cholesterol Absorption Inhbitor such as ezetimibe (Zetia).
*This medication prevents absorption of cholesterol in the small intestine. This means less cholesterol makes it to the liver, therefore, the liver will use serum cholesterol and the overall cholesterol level will drop.
Other antihyperlipidemic Agents
- Niacin (Vitamin B3) - inhibits the release of free fatty acids from adipose tissue, increases the rate o triglyceride removal from plasma and reduces LDL, Trigylcerides while increasing HDL levels.
- Fenofibrates - includes fenofibrate/TriCor and gemfibrozil (Lopid). Stimulate breakdown of lipoprotein from the tissues and their removal from the plasma. Leads to decrease i lipoprotein and triglyceride synthesis and secretion
Why would a patient be given crestor over lipitor?
Lipitor can cause pain in muscles due to breakdown of muscle. Can lead to kidney damage when putting out so much creatinine. Crestor does not.
QUestran is not seen often. Why?
GI issues.
Causes loss of fat soluble vitamins (A & E especially)
Increases bleeding time
Taken with medications prevents absorption of medications MUST TAKE SEPARATELY
What is rhabdomyolysis?
the destruction of striated muscle cells
When taking atorvastatin (Lipitor ), a lipid lowering agent (HMG-CoA Inhibitor), what must the patient be taught to report? To avoid?
Teach:
Report muscle pain (causes rhabdomyolysis)
Take the medication in the evening (lipids are produced at night)
Avoid grapefruit juice and alcohol
ezetimibe (Zetia prevents absorption of cholesterol in the small intestine. Just like other lipid lowering agents it can cause what adverse effects?
abdominal pain, headache, dizziness.
Niacin (Niaspan) is also known as Vitamin B3 and inhibits the release of free fatty acids from adipose tissue. What is the biggest issue with this drug?
How you take it because it causes severe flushing (skin feels like it is falling off/burning). You must increase it slowly!
Steps to take it:
- You take an aspirin or an advil and wait twenty minutes
- eat low fat snack and wait
- take niacin then go to bed
- skin feels like its falling off or burning
- Patient either calls Dr or goes to ER because they think something is wrong.
Over time it becomes more tolerable.
DO NOT TAKE WITH Niacin (Vitamin B3) because it is essentially the same thing.
What is angina?
angina
a condition marked by severe pain in the chest, often also spreading to the shoulders, arms, and neck, caused by an inadequate blood supply to the heart.
Caused by insufficient blood flow to the heart. Results from temporary myocardial ischemia
Angina Pectoris is translated as suffocation of the chest
If the heart does not have pain fibers, how does it feel pain? Why is this important?
The body’s response to lack of oxygen in heart muscles is to release substance P which reacts with pain receptors elsewhere. This is why patients with angina pectoris complain of chest or left arm pain, while other have pain in the jaw or teeth. Most people react to this pain by stopping whatever one is doing. Once they rest long enough, oxygen is able to catch up to meet demands and the pain is gone.
THis is called STABLE ANGINA because no damage to muscles takes place and blood is restored. It can be a chronic problem.
What is unstable angina?
After administering med and resting no relief? Unstable Angina.
Narrowing of arteries becomes more pronounced and patient experiences ischemia** even at rest. THis is called unstable angina. Although heart muscle may not be damaged, the patient is at increased risk of complete blockage of blood supply to the heart muscles IF the heart needs to work harder or he oxygen demand increases.
**is·che·mi·a
an inadequate blood supply to an organ or part of the body, especially the heart muscles.
What is an uncommon form of angina? What causes it?
prinzmetal angina, caused by spasm of the blood vessels. Even at rest this person may feel the pain. We would see an ECG change.
What group of meds relieve angina pectoris?
Nitrates (nitroglycerin - Nitrostat) Beta Blockers (metoprolol - Toprol) Calcium Channel Blockers (do;toaze, (Cardizem) Antiplatelet agents (aspirin)
Remember that slowing the heart down can also decrease angina. That is why Beta Blockers, Calcium Channel Blockers, Antiplatelet agents work.
How do we diagnose?
EKG during an attack
Coronary angiograph/angiogram
________ relieve angina by dilating veins and coronary arteries. It acts on smooth muscle to promote relaxation. Give them three time with a five minute delay between each dose.
nitrates
nitroglycerin (Nitrostat)
- Make sure you rinse the mouth before administering
- Keep in dark container
Why do we give nitrates sublingually?
Faster absorption
Can also be given:
IV Translingual spray Transmucosal tablet Oral, SR tablet Topical Transdermal (patch) - remove old, change location, sign&date
What is the main contraindication for Nitrate? Cautions? Adverse Effects?
severe anemia.
do not take with conditions that limit cardiac output (remember we are going to slow the HR down and reduce cardiac output. Therefore, slowing further could be devastating).
Causes an instant headache. It causes vasodilation which leads to a headache.
What is the best antianginal agent to use for long term management of angina? How do they work?
beta-adrenergic blockers (metoprolol Toprol or propranolol Inderal) relieve angina by decreasing the oxygen demands on the heart. SLOWS THE HR!
ALWAYS REMEMBER: caution in diabetes - may lead to hyperglycemia; hides hypoglycemic symptoms
What is the best antianginal agent to use for Prinzmetal’s angina (remember it is caused by spasm)?
Calcium Channel Blocker (diltiazem - ardizem) because it blocks contraction.
What are non drug treatments for angina?
Angioplasty - surgical repair or unblocking of a blood vessel, especially a coronary artery
Stents - a tubular support placed inside a blood vessel, canal, or duct to aid healing or relieve an obstruction.
Intraaortic balloon pump - The Intra-aortic balloon pump (IABP) is a mechanical device that increases myocardial oxygen perfusion while at the same time increasing cardiac output. Increasing cardiac output increases coronary blood flow and therefore myocardial oxygen delivery.
T or F: MI is major cause of death caused by CAD.
True
Men and women have varying symptoms.
- Symptoms include acute, crushing/squeezing chest pain that is unrelieved by rest or nitroglycerin (>15 min).
- Pain radiates to left arm or up to jaw.
- Cool/clammy and/or pallor skin
- Confusion, dizziness, fainting
- anxiety
- Dyspnea
