Chapter 23 Flashcards
What are antianginal drugs used for?
chest pain/heart aches
What is the definition of angina?
insufficient blood flow to the heart muscles from narrowing of coronary artery
What is ischemia?
poor blood supply to an organ
What is ischemic heart disesase?
poor blood supply to the hear muscle, atherosclerosis, coronary artery disease
What is a MI?
-necrosis or death of cardiac tissue
Types of angina
- chronic stable angina (also called classic or effort angina) happens with strenuos activity
- unstable angina (also called preinfarction or crescendo angina) patient can be doing nothing and it can start
- vasospastic angina (also called prinzmetal or variant angina) no plaque build up, just vasoconstriction
Drugs for angina
- nitrates or nitrites
- beta blockers
- calcium channel blockers
Available forms for nitrates or nitrites
- sublingual
- chewable tablets
- oral capsules/tablets (long term therapy)
- intravenous solutions
- transdermal patches (in ER or ambulence)
- ointments
mechanism of drugs for angina
- causes vasodilation
- potent dilating effect on coronary arteries
- used for treatment and prevention of MI
Nitrostat is ___________
light sensitive, so it needs to stay in a brown container, don’t keep cotton in container because it’s not necessary
nitro patch/ointment what do you need to do?
wear gloves when administering
What are the rapid acting forms of nitrate and nitrite?
- sublingual tablets
2. IV infusion
Nitroglycerin
- prototypical nitrate
- large first-pass effect with oral forms
- used for symptomatic treatment of ischemic heart conditions
- IV form used for BP control in perioperative hypertension, hf, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies
isosorbide
actions identical to nitroglycerin; used for angina, taken orally; produce headache, hypotension, and reflex tachycardia
adverse effects
- headaches
- reflex tachycardia
- orthostatic hypotension
does tolerance occur with the use of nitrates and nitrites?
yes; can be prevented by giving them some “time off” (spreading out doses, take off dose and ointment at night)
-take the old patch off before putting the new one are
contraindications for nitrate/nitrite
-known drug allergies, severe anemia, closed-angle glaucoma, hypotension, severe head injury, use of erectile dysfunction drugs
how do beta blockers work
decrease in HR rate and contractility to conserve energy
metoprolol is a
beta blocker used for high BP and angina
-beta blockers block the harmful effects of catecholamines, thus improving survival after an MI
adverse effects of BB
bradycardia, decreased AV conduction, reduction of contractility, asthmatic effects, use with caution in patients with diabetes (can mask effects of hypoglycemia), insomnia, depression, bizarre dreams, sexual dysfunction-impotence
Examples of calcium channel blockers
-verapamil, diltiazem
indications for calcium channel blockers
- coronary artery spasms
- supraventricular tachycardia, hypertension, angina, migraine headaches, raynaud’s disease
adverse effects of calcium channel blockers
-hypotension, palpitations, tachycardia, bradycardia, constipation, nausea, dyspnea, other adverse effects
patients should report this while on angina drugs
blurred vision, persistent headache, dry mouth, edema, fainting episodes, weight gain of 2 lb in 1 day or 5 lb in 1 week, pulse rate less than 60 bpm, dyspnea
Why do you take the cotton out of the container after opening it?
cotton inside the container draws moisture into the container and deactivates the drugs
if anginal pain occurs
stop activity an sit or lie down, take a sublingual tablet, if you don’t have relief in 5 minutes, call 911, take 2nd, if no relief in 5 minutes after that, take a 3rd one
-DO not try to take self to the hospital
How are IV forms of nitrate given?
must be given with special non-PVC tubing and bags
- follow manfacterer’s instructions for IV administration - use infusion pump
- NEVER give IV push
What should patients taking calcium channel blockers not take?
grapefruit juice
