Chapter 24 Flashcards
angina pectoris
chest pain due to decreased blood flow (ischemia) to the heart
atherosclerosis
fatty degeneration of arteries due to the accumulation of cholesterol plaques
coronary artery
artery that supplies blood flow to the heart
coronary artery disease (CAD)
condition due to atherosclerosis and insufficient blood flow to the heart
exertional angina
angina pectoris caused by increased physical exertion
ischemia
insufficient blood flow to a tissue
variant or prinzmetal angina
angina pectoris caused by vasospasm of the coronary arteries
Exertional
Classification of Angina Pectoris
caused by exercise, overexertion, stress
Variant or Prinzmetal
Classification of Angina Pectoris
caused by vasospasm of coronary arteries
Unstable
Classification of Angina Pectoris
occurs when coronary arteries are almost completely blocked
Treatment of CAD
Aimed at:
- Reducing the number and severity of anginal attacks
- Limiting progression of atherosclerosis
- Preventing occurrence of myocardial infarction (MI) and possible death
Non-drug components
- Diets low in fat and cholesterol
- Exercise
- Smoking cessation
- Weight control
Drug components
- Nitrates
- Beta-blockers
- Calcium channel blockers
Nitrates
Produce a general vasodilation of systemic veins and arteries
How are Nitrates administered
During angina attacks to relieve pain
On a daily basis to prevent angina attacks
Mechanism of action for Nitrates
Nitrate oxide relaxes vascular smooth muscle.
Vasodilation decreases preload and afterload.
Clinical Use of Nitrates
Sublingual nitroglycerin
-Relieves acute angina attacks
Nitroglycerin ointment 2%
-Helps prevent the occurrence of angina
Nitroglycerin extended-release capsules
-Used daily as a form of prophylaxis
Transdermal nitroglycerin (Transderm-nitro) -Used in the prevention of angina
Nitroglycerin for intravenous infusion
-Used during emergency and surgical situations
Adverse effects of Nitrates
Cutaneous flushing, dizziness, headache, weakness, and fainting
Sudden drops in blood pressure can cause reflex tachycardia
Patient education of Nitrates
Patients must carry the prescribed medication at all times.
-Tablets must be stored in light-resistant, airtight containers.
Individuals experiencing angina must sit down and place a nitroglycerin tablet under the tongue.
Awareness of side effects is important.
Drug Integrations with Nitrates
Nitrate drugs should not be taken in combination with drugs that treat erectile dysfunction.
Causes excessive vasodilation, hypotension, reflex tachycardia, and potentially myocardial infarction
Beta Adrenergic Blocking Drugs
Reverse the effects of sympathetic activation
Decrease cardiac work and oxygen consumption
Indication of Beta Adrenergic Blocking Drugs
Long-term (chronic) management of angina pectoris
Adverse effects of Beta Adrenergic Blocking Drugs
Drowsiness, tiredness, and GI disturbances
Effects of excessive dosage
-Bradycardia, hypotension, and possible development of heart failure
Nonselective beta-blockers should not be given to asthma or COPD patients.
-Can cause bronchoconstriction
Calcium Channel Blockers Mechanism of action
Inhibit the influx of calcium ions into vascular smooth muscle
-Enable arteriolar vasodilation and reduce blood pressure
Administered on a daily basis to prevent angina
-Preferred drugs for treatment of variant or Prinzmetal angina and to relieve vasospasm
Calcium Channel Blockers
Drugs with direct cardiac effects
Verapamil
-Used to treat supraventricular arrhythmias and angina
Diltiazem
-Possesses greater vasodilating effects in comparison to verapamil
Calcium Channel Blockers
Drugs without direct cardiac effects
Nifedipine
-Potent arterial vasodilator
Nicardipine
-Causes vasodilation and relaxation of coronary artery spasm
Other calcium antagonists
-Amlodipine, felodipine, and isradipine
Adverse effects of Calcium Channel Blockers
Headache, facial flushing, dizziness, hypotension, and minor GI disturbances
Verapamil and diltiazem
- Overdosage can cause bradycardia, AV block, decreased myocardial contraction, and possible heart failure.
- Contraindicated with beta-blockers
- Causes excessive cardiac depression and heart failure
External, fixed, or stable
Preferred Therapy for Angina Pectoris
- nitrates
- beta-blockers
- calcium channel blockers
Variant or Prinzmetal
Preferred Therapy for Angina Pectoris
- calcium channel blockers
- nitrates
Unstable
Preferred Therapy for Angina Pectoris
- anitplatelet
- anticoagulant therapy
- life style changes
