Drugs for Angina, MI & CVA Flashcards
what is atherosclerosis?
-presence of plaque within arterial walls
what is plaque and its effects on the vascular system?
- accumulation of fatty, fibrous material that narrows arteries, increases TPR, and reduces vascular elasticity
angina pectoris
- acute chest pain arising from inadequate oxygen supply to the myocardium; steady intense pain that is accompanied with a crushing/constricting sensation
where does angina pectoris pain radiate?
- across the left shoulder, down the left arm, but can move up to the jaw, or across the thoracic region of the back
what are sone signs and symptoms of angina pectoris?
- panic
- pallor
- dyspnea
- diaphoresis
- tachycardia
what are sone signs and symptoms of angina pectoris?
- panic
- pallor
- dyspnea
- diaphoresis
- tachycardia
- elevated BP
what triggers angina pectoris and how long does it last?
- physical exertion or emotional excitement
- symptoms improve with rest, stress reduction and nitroglycerin
- 10 to 15 minutes
what are the two types of angina pectoris?
stable and unstable
stable angina
- predictable frequency, duration and intensity
- no associated myocardial damage; relief with rest
- pain comes from lactic acid build up
unstable angina
- variable intensity, occurs during periods of rest, increased frequency, no associated myocardial damage
- risk of MI
- medical emergency
what are non-pharmacological treatments of stable angina pectoris?
- limit alcohol consumption
- eliminate foods high in cholesterol, saturated fats and sodium
- control hyperlipidemia
- control hypertension
- regular exercise
pharmacological management of stable angina pectoris
- drug therapies reduce myocardial oxygen demand or improve oxygen supply to the myocardium
- slow heart rate
- reduce force of cardiac contraction
- dilate veins
- dilate arterioles
nitrates mechanism of action
- first line therapy of terminating an angina attack
- facilitate the formation of nitric acid
- relax coronary arteries and venous smooth muscle
how do nitrates dilate venous smooth muscle?
- decrease amount of blood returning to the heart
- decrease cardiac output, workload and oxygen demand
- risk of hypotension
how do nitrates dilate arterial smooth muscle?
- increases blood flow to myocardium
- improves oxygen supply to myocardium
short acting nitroglycerin and how is it administered?
- used to terminate an angina attack
- tablet and spray; IV, topical and PO
what is the protocol with short acting nitroglycerin?
- rest, take drug and wait 5 minutes
- if no improvement take another dose, wait 5 minutes to a max of 3 doses in 15 minutes
long acting isosorbide dinitrate
-decreases intensity and frequency of angina attacks
what is the protocol with isosorbide dinitrate?
- remove patch for 12-16 hours or withhold at night
- slow withdrawal from medications to prevent risk of MI
what are some adverse effects for nitrates ?
- throbbing headache, dizziness, weakness, hypotension, reflex tachycardia
what are some drug interactions for nitrates?
- drugs for the treatment of erectile dysfunction may cause life threatening hypotension, alcohol
beta adrenergic antagonists mechanism of action
- first line therapy for prevention of chronic stable angina attacks
- reduces cardiac workload, slows heart rate and reduces contractility decreasing oxygen demand
caution with beta adrenergic antagonists
- those with asthma, COPD, depression and diabetes
what are some adverse effects with beta adrenergic antagonists?
- related to SANS blockade
- fatigue, weakness, bradycardia, sleep disturbances, hypotension
- rapid withdrawal worsens angina; reduce over 1-2 weeks
