Chapter 51- Drugs for Angina Pectoris Flashcards
When does anginal pain occur?
When the oxygen DEMAND does not meet the heart’s oxygen SUPPLY
Name 3 main families of antianginal agents
-nitrates
-beta-blockers
-Calcium Channel Blockers
The goal of antianginal therapy is to reduce _________ & _________ of angina attacks.
-intensity
-frequency
Drug therapy for stable angina focuses on reducing oxygen __________ on the heart.
Demand
Drugs for stable angina reduce the : _______ ______, __________, _________,_______
heart rate, contractility, preload, and afterload
What additional drug is now considered a first-line agent but can cause a dose-dependent prolongation of the QT interval?
Ranolazine
What is another ADR can ranolazin cause in someone with severe renal disease?
Elevation in BP
Antianginal agents are used to provide symptom relief and do not affect the underlying pathology.
True or false?
True
Most commonly, stable angina is predicatble and triggered by what 3 things?
- physical activity
-emotional stress
-large meals
In the unhealthy heart, the coronary arterioles are unable to compensate and increase blood flow during exertion.
True or false?
True
Drug therapy for variant angina focuses on increasing cardiac ______ supply. Variant angina is cause by a _____ in the coronary artery.
Oxygen, Spasm
What 2 groups of drugs are used to treat variant angina?
-organic nitrates
-CCB
Besides the antianginal agents, What are the 3 main classifications that can be used for long-term prevention or management of recurrent angina?
Antiplatelets
Antilipidemics
ACE-inhibitors
Antiplatelet decrease_______
Platelet aggregation
Antilipidemics reduce _____________.
major risk factor for coronary atherosclerosis.
What is the initial treatment of Angina pectoris consists of _______________ plus a ____________ antianginal agent.
SL nitroglycerin
long-acting
Can beta-blockers be used in the treatment of VARIANT angina?
NO
Which class of drug is preferred for baseline therapy because they can decrease mortality and suppress nitrate-induced reflex tachycardia?
Beta-blockers
Organic nitrates relieve angina by causing _________?
Vasodilation.
What is the drug of choice for relieving acute angina attacks?
Nitroglycerin
What is the active form of nitrates?
Nitric oxide
NTG does not increase blood flow directly to the ischemic areas of the heart. WHY?
It cannot dilate atherosclerotic coronary arteries.
NTG provides pain relief from the effects of NTG on ______________
Peripheral blood vessels
NTG has high _____-______, so it can be administrred various routes since it can cross membranes easily
Lipid-solubility
NTG duration is very ______ due to what?
short; due to its rapid inactivation by hepatic enzymes
Initial therapy with NTG can produce severe ________ due to vasodilation, but this diminishes over the first few weeks.
headaches
NTG mainly reduces _________
preload (dilation in veins is more significant than in the arterioles)
What drug is absolutely contraindicated with NTG?
PDE5 inhibitors (sildenafil)
( due to the potential life-threatening hypotension)
What are 2 ways that tolerance to nitrates can be prevented or minimized?
- use lowest effective dose
-ensure nitrate-free intervals (usually best at night)
Two main differences r/t NTG preparations are their ________ & ________ of action
Onset & duration
Preparations with a rapid onset are used to _______ an ongoing angina attack or used as a _________ and taken just prior to anticipated exertion.
terminate
prophylactic
Long-acting preparations are used to provide ________________ against attacks. These agents should permit at least ______ drug-free hours, but are given on a _________ schedule.
sustained protection
8-12
fixed
If anginal pain does not respond to NTG, it may indicate _______________.
MI
For a MI, a pt must take a total of ___ tablets every ___ min.
3
5
For a MI, the tablet must completely ________ and not be _________.
dissolve; swallowed
IV NTG must be stored in a ______ container (away from heat and moisture). IV NTG must be administered in a ______ bottle to prevent absorption.
Dark
glass (plastic will absorb the nitrate)
Pt should be told to discard open bottles after __ months. How would you know if potency still exists?
6
The person should feel a fizzling or burning sensation under their tongue.
