Chapter 51- Drugs for Angina Pectoris

Question 1

When does anginal pain occur?

Answer 1

When the oxygen DEMAND does not meet the heart’s oxygen SUPPLY

Question 2

Name 3 main families of antianginal agents

Answer 2

-nitrates
-beta-blockers
-Calcium Channel Blockers

Question 3

The goal of antianginal therapy is to reduce _________ & _________ of angina attacks.

Answer 3

-intensity
-frequency

Question 4

Drug therapy for stable angina focuses on reducing oxygen __________ on the heart.

Answer 4

Demand

Question 5

Drugs for stable angina reduce the : _______ ______, __________, _________,_______

Answer 5

heart rate, contractility, preload, and afterload

Question 6

What additional drug is now considered a first-line agent but can cause a dose-dependent prolongation of the QT interval?

Answer 6

Ranolazine

Question 7

What is another ADR can ranolazin cause in someone with severe renal disease?

Answer 7

Elevation in BP

Question 8

Antianginal agents are used to provide symptom relief and do not affect the underlying pathology.
True or false?

Answer 8

True

Question 9

Most commonly, stable angina is predicatble and triggered by what 3 things?

Answer 9

• physical activity
  -emotional stress
  -large meals

Question 10

In the unhealthy heart, the coronary arterioles are unable to compensate and increase blood flow during exertion.
True or false?

Answer 10

True

Question 11

Drug therapy for variant angina focuses on increasing cardiac ______ supply. Variant angina is cause by a _____ in the coronary artery.

Answer 11

Oxygen, Spasm

Question 12

What 2 groups of drugs are used to treat variant angina?

Answer 12

-organic nitrates
-CCB

Question 13

Besides the antianginal agents, What are the 3 main classifications that can be used for long-term prevention or management of recurrent angina?

Answer 13

Antiplatelets
Antilipidemics
ACE-inhibitors

Question 14

Antiplatelet decrease_______

Answer 14

Platelet aggregation

Question 15

Antilipidemics reduce _____________.

Answer 15

major risk factor for coronary atherosclerosis.

Question 16

What is the initial treatment of Angina pectoris consists of _______________ plus a ____________ antianginal agent.

Answer 16

SL nitroglycerin
long-acting

Question 17

Can beta-blockers be used in the treatment of VARIANT angina?

Answer 17

NO

Question 18

Which class of drug is preferred for baseline therapy because they can decrease mortality and suppress nitrate-induced reflex tachycardia?

Answer 18

Beta-blockers

Question 19

Organic nitrates relieve angina by causing _________?

Answer 19

Vasodilation.

Question 20

What is the drug of choice for relieving acute angina attacks?

Answer 20

Nitroglycerin

Question 21

What is the active form of nitrates?

Answer 21

Nitric oxide

Question 22

NTG does not increase blood flow directly to the ischemic areas of the heart. WHY?

Answer 22

It cannot dilate atherosclerotic coronary arteries.

Question 23

NTG provides pain relief from the effects of NTG on ______________

Answer 23

Peripheral blood vessels

Question 24

NTG has high _____-______, so it can be administrred various routes since it can cross membranes easily

Answer 24

Lipid-solubility

Question 25

NTG duration is very ______ due to what?

Answer 25

short; due to its rapid inactivation by hepatic enzymes

Question 26

Initial therapy with NTG can produce severe ________ due to vasodilation, but this diminishes over the first few weeks.

Answer 26

headaches

Question 27

NTG mainly reduces _________

Answer 27

preload (dilation in veins is more significant than in the arterioles)

Question 28

What drug is absolutely contraindicated with NTG?

Answer 28

PDE5 inhibitors (sildenafil)
( due to the potential life-threatening hypotension)

Question 29

What are 2 ways that tolerance to nitrates can be prevented or minimized?

Answer 29

• use lowest effective dose
  -ensure nitrate-free intervals (usually best at night)

Question 30

Two main differences r/t NTG preparations are their ________ & ________ of action

Answer 30

Onset & duration

Question 31

Preparations with a rapid onset are used to _______ an ongoing angina attack or used as a _________ and taken just prior to anticipated exertion.

Answer 31

terminate
prophylactic

Question 32

Long-acting preparations are used to provide ________________ against attacks. These agents should permit at least ______ drug-free hours, but are given on a _________ schedule.

Answer 32

sustained protection
8-12
fixed

Question 33

If anginal pain does not respond to NTG, it may indicate _______________.

Answer 33

MI

Question 34

For a MI, a pt must take a total of ___ tablets every ___ min.

Answer 34

3
5

Question 35

For a MI, the tablet must completely ________ and not be _________.

Answer 35

dissolve; swallowed

Question 36

IV NTG must be stored in a ______ container (away from heat and moisture). IV NTG must be administered in a ______ bottle to prevent absorption.

Answer 36

Dark
glass (plastic will absorb the nitrate)

Question 37

Pt should be told to discard open bottles after __ months. How would you know if potency still exists?

Answer 37

6
The person should feel a fizzling or burning sensation under their tongue.