Chapter 23 Antianginal Drugs

Question 1

Angina pectorals

Answer 1

Chest pain
When the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle “aches”.

Question 2

Types of angina

Answer 2

Chronic stable angina
Unstable angina
Vasospastic angina

Question 3

Chronic stable angina

Answer 3

Aka classic or effort angina
Chest pain that is primarily caused by atherosclerosis, which results in long-term but relatively stable level of obstruction in one or more coronary arteries.

If too much effort is put out, they get chest pain.
Can turn in to MI if nothing is done to control chest pain.

Question 4

Unstable angina

Answer 4

Aka preinfarction or crescendo angina

Early stage of progressive coronary artery disease.

Question 5

Vasospastic angina

Answer 5

Aka prinzmetal or variant angina
Prinzmetal - smooth muscle spasm chest pain that occurs at rest is indicative of prinzmetal angina.
Variant - stress related ischemic induced myocardial chest pain caused by spasms of the coronary arteries.

Question 6

Nitrates & Nitrites

Answer 6

Used to treat angina. Also used to treat acute angina attacks. Given to pt’s with hx of HF.
Available forms to bypass the liver:
Sublingual, transdermal patches, translingual sprays, IV solutions.
Used transdermal patches must be disposed by placing the patch in a secure disposable container, or flush down the toilet.

Question 7

Long acting forms of nitrates and nitrites

Answer 7

Used to PREVENT angina episodes

Transdermal dosage formulations of nitro are used for the long term prophylactic management of angina pectoris.

Question 8

Adverse effects of nitrates

Answer 8

Headaches: usually diminish in intensity and frequency with continued use.

Tolerance
Occurs in pt’s taking nitrates around the clock or with long acting forms
Prevented by allowing a regular nitrate free period to allow enzyme pathways to replenish.
Transdermal forms: remove patch at bedtime for 8 hours, then apply a new patch in the morning.
It is safe to take it off at bedtime because BP isn’t high at night when we are resting.
Interactions: alcohol, beta blockers, ccb’s, ED mess, phenothiazines.

Question 9

Beta blockers

Answer 9

Most effective in the Tx of exertional angina.

Approved for Tx of MI, hypertension, cardiac dysrythmias, and essential tremor.

Question 10

Metroprolol

Lopressor

Answer 10

Cardio protector: protects heart from catecholamines after MI.
After an MI, a high level of circulating catecholamines irritate the heart and cause an imbalance of supply and demand ratio. Can lead to life threatening dysrhythmias.

Question 11

Beta Blocker Adverse Effects

Answer 11

Bradycardia, hyperglycemia and or hypoglycemia.
Contraindicated in pt’s with diabetes mellitus due to masking hypoglycemia induced tachycardia.
pt’s with a HR of 60 bpm, do not give!