CH 28: Angina and MI

Question 1

leading cause of death in the US

Answer 1

coronary artery disease

Question 2

defining characteristics of CAD

Answer 2

the narrowing or occlusion of a coronary artery

Question 3

the depriving of oxygen and nutrients in cells from narrowing of a coronary artery

Answer 3

myocardial ischemia

Question 4

why might CAD have no symptoms

Answer 4

If the ischemia develops over a long period, the heart may compensate for its inadequate blood supply

Question 5

If CAD progresses what process and symptoms can occur

Answer 5

the myocardium does not receive enough oxygen to meet the metabolic demands of the heart,

symptoms of angina begin to appear.

Question 6

persistent myocardial ischemia can lead to:

Answer 6

MI (heart attack)

Question 7

most common cause of CAD

Answer 7

atherosclerosis that narrows the arteries

Question 8

acute chest pain caused by insufficient oxygen to a portion of the myocardium

Answer 8

angina pectoris

Question 9

goals for pharmacotherapy of angina

Answer 9

 reduce the intensity and frequency of angina episodes.
 improve exercise tolerance
 allow the patient to routinely participate in activities of daily living.
 Long-term goals include extending the patient’s lifespan by preventing serious consequences of ischemic heart disease such as dysrhythmias, heart failure, and MI.

Question 10

Anti-anginal drugs reduce the demand for oxygen by:

Answer 10

 Slowing the heart rate
 Dilating veins so the heart receives less blood (reduced preload)
 Causing the heart to contract with less force (reduced contractility)
 Lowering blood pressure, thus offering the heart less resistance when ejecting blood from its chambers (reduced afterload).

Question 11

MOA of beta blockers

Answer 11

reduce workload

Question 12

MOA of CCB

Answer 12

reduce blood pressure and workload
dilates coronary arteries

Question 13

therapeutic effects of the nitrates
Nitroglycerin (short acting)
Isosorbide (dinitrate and mononitrate)

Answer 13

Dilates veins
Dilates coronary arteries
More perfusion to the heart

Question 14

adverse effects of the nitrates
Nitroglycerin (short acting)
Isosorbide (dinitrate and mononitrate)

Answer 14

Headache,
postural hypotension,
flushing of face,
dizziness,
rash (transdermal patch), tolerance
Anaphylaxis,
circulatory collapse due to hypotension,
syncope due to orthostatic hypotension

Question 15

safety and monitoring for nitrates
Nitroglycerin (short acting)
Isosorbide (dinitrate and mononitrate)

Answer 15

Tolerance
Reflex tachycardia
Hypotension
Check bp
Remove patches at night only use 12 to 18 hours per day
Glass bottle for IV
Cover the bottle to avoid light exposure
DO NOT USE IT WITH ERECTILE DYSFUNCTION DRUGS

Question 16

therapeutic effects of ranolazine (antianginal -non nitrate)

Answer 16

Decreases oxygen demand of the myocardial cells
Does not change heart rate or bp

Question 17

MOA of statins

Answer 17

reduce LDL

Question 18

sudden reduced flow of blood to the heart

Answer 18

Acute coronary syndrome

Question 19

pharmacologic goals of MI

Answer 19

 Restore blood supply (reperfusion) to the damaged myocardium as quickly as possible (through the use of thrombolytics or PCI.)
 Reduce myocardial oxygen demand (with organic nitrates, beta-blockers, or angiotensin-converting enzyme (ACE) inhibitors to prevent additional infarctions.)
 Control or prevent MI-associated dysrhythmias (with beta-blockers or another antidysrhythmic.)
 Reduce post-MI mortality (with aspirin, beta-blockers, and ACE inhibitors.)
 Manage severe MI pain and associated anxiety (with narcotic analgesics.)
 Prevent enlargement of the thrombus (with anticoagulants and antiplatelet drugs.)

Question 20

MI treatment with Thrombolytics

Answer 20

 Provides quick restoration of cardiac circulation and reduces mortality
 Most effective within 20 min to 12 hours after onset of symptoms
 Hopefully given within 30 min of onset
 Narrow margin of safety between dissolving clot and causing a brain bleed