Chapter 45: Angina Pectoris Flashcards

1
Q

Drugs to tx angina

A

Nitroglycerine
Beta Blocker
Calcium Channel Blockers
Isorbide Mononitrate (or dinitrate)
Ranolazine (Ranexa)

Used to treat angina pectoris
Used in CAD to prevent angina
Angina may lead to myocardial infarction (MI)

First on try lifestyle changes
Medications increase O2 supply by vasodilating coronary arteries

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2
Q

Types of angina

A

Stable-Occurs with predictable
stress or exertion
relieve by nitro or rest

Unstable- Unpredictable regarding stress/exertion and intensity
-Not relieved by rest or nitro

Variant (Prinzmetal’s)- Vasospasm
Causes: coke, inherited
Tx: CCB

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3
Q

Nitro

A

Drug of choice fr acute angina

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4
Q

Nitro MOA

A

Stimulates vascular smooth muscle relaxation resulting in vasodilation. Decreases the pain of angina by decreasing the cardiac O2 demand.

Pretty much works on VV no AA –vasodilation on smooth mm in VV indirectly affects smooth mm in arteries -> more O2 getting to myocardium

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5
Q

Nitro uses

A

Rapid onset: termination of an ongoing attack and short term prophylaxis before anticipated exertion.

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6
Q

Nitro SE

A

Headache, orthostatic hypotension, reflex tachycardia

Reflex tachycardia if someone takes to much nitro they can build up tolerance and have tachy
HA will diminish after they use to and their body wont respond as dramatically. Tx HA with NSAIDS or ASA

Can reverse tolerance by holding nitro for short time
Nitro patch: on for 12 hr, off for 12 hr

D/c slowly to prevent reflex tachy

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7
Q

Nitro forms

A

SL tablets, Translingual spray, transdermal patches, topical ointment
Watch interactions with antihypertensives.
Overuse can lead to tolerance.

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8
Q

Nitro stat SL tablets

A

Rapid Onset

Should not be chewed, crushed, or swallowed.
They work much faster when absorbed through the lining of the mouth.

Usually give relief in 1 to 5 minutes.
May take 0.3-0.6 mg as needed for a total of 3 doses in 15 min,
If CP persists after 3 doses, Call 911.***

Storage
Keep out of the reach of children.
Sublingual tablets should be kept in the original glass bottle with screw cap.
store the bottle at room temperature, away from heat, moisture, and direct light.

Expires every 6 month.

A tingling feeling under the tongue means it is working.

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9
Q

Nitro prescribing considerations: therapeutic goals

A

Reduction of the frequency and intensity of attacks

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10
Q

Prescribing considerations: baseline data

A

Note frequency and intensity of attacks. BP and HR should be noted

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11
Q

Prescribing consideration: monitoring

A

No routine blood monitoring necessary

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12
Q

Prescribing considerations: identifying high risk patients

A

Use with caution in hypotensive patients and in patients taking drugs that lower BP

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13
Q

Prescribing considerations: evaluating therapeutic effects

A

Instruct patients to keep a record of frequency and intensity of attacks and factors that precipitate these attacks

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14
Q

Nitro: min ADR

A

Use with phosphodiesterase type 5 inhibitors is contraindicated:
avanafil (Stendra®),
sildenafil (Viagra®),
tadalafil (Cialis®),
vardenafil (Levitra®)

Using these medicines together may cause hypotension (blurred vision, dizziness, lightheadedness, or fainting).

If patient is taking these medicines and have an angina attack, they must be instructed to go to the ER right away.

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15
Q

Isorbide Mononitrate and Isorbide Dinitrate trade names

A

Imdur, Isordil

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16
Q

Isorbide Mononitrate and Isorbide Dinitrate MOA

A

Same as nitro

17
Q

Isorbide Mononitrate and Isorbide Dinitrate uses

A

Angina

18
Q

Isorbide Mononitrate and Isorbide Dinitrate route

A

PO

19
Q

Isorbide Mononitrate and Isorbide Dinitrate SE

A

HA, hypotension, and reflux tachycardia

20
Q

Isorbide Mononitrate and Isorbide Dinitrate dosage

A

Taken regularly for sustained prophylaxis. Due to tolerance, the dosing preparations should allow at least 12 hour drug free hours a day.

21
Q

Ranolazine (Ranexa) MOA

A

Exact mechanism is unknown however, Reduces accumulation of sodium and calcium in myocardial cells

Newer class of anti anginals

22
Q

Ranolazine use

A

1st like for angina

23
Q

Ranolazine SE

A

QT Prolongation, elevation of BP

24
Q

Ranolazine safety/monitoring

A

Avoid grapefruit juice

25
Q

Other drugs Ranolazine is often given with

A

Drugs used to prevent MI and Death
Antiplatelet Drugs
Cholesterol lowering Drugs
ACE i