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Pharmacology > Drugs for Angina Pectoris > Flashcards

Drugs for Angina Pectoris Flashcards

1
Q

Sudden pain beneath the sternum, often it radiates to the left shoulder, left arm and jaw

A

Angina pectoris

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2
Q

Anginal pain is often precipitated when the oxygen supply to the heart is insufficient to meet oxygen demand.

A

True

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3
Q

Angina often occurs secondary to atherosclerosis of the coronary arteries, so angina needs to be seen as a symptom of a disease and not a disease in its own right.

A

True

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4
Q

Chronic Stable Angina

A

Exertional angina

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5
Q

Variant Angina

A

Prinzmetal’s or vasospasm angina

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6
Q

_____ angina can be triggered by:

  • an increase in physical activity
  • emotional excitement
  • large meals
  • cold exposure
A

Stable

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7
Q

Underlying cause of exertional angina is _________ which is a condition characterized by deposition of fatty plaque in the arterial wall

A

Coronary Artery Disease

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8
Q

Treatment

A
  1. Increase cardiac oxygen supply

2. Decrease oxygen demand

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9
Q 
Heart Rate
Myocardial Contractility
Intramyocardial Wall Tension
---Cardiac Preload
----Cardiac Afterload
A

Oxygen Demand

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10
Q

Oxygen supply

A

Myocardial blood flow

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11
Q

Since the underlying cause of stable angina is the occlusion of coronary arteries, there is little we can do to increase cardiac oxygen supply

A

True

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12
Q

Chronic Stable Angina Treatment

A
  • Reduce intensity and frequency of attacks

- Imbalance of oxygen supply and oxygen demand

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13
Q

Therapeutic Agents for Chronic Stable Angina

A
  • Organic Nitrates
  • Beta-Blockers
  • Calcium Channel Blockers
  • Ranolazine (used in combination to increase benefit)
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14
Q

Must use anti platelet drug in combination drug with patients who have chronic stable angina

A

True

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15
Q

Not necessarily from CAD - Coronary artery SPASM, constricting blood flow to the myocardium
Can happen at any time, even during rest and sleep
Sometimes can occur in conjunction with stable angina
Chest discomfort, pain is secondary to insufficient oxygenation to the heart

A

Variant Angina

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16
Q

The goal is to reduce the incidence and severity of the attacks. INCREASING THE CARDIAC OXYGEN SUPPLY. Oxygen supply is increased with vasodilators, which prevent or relieve coronary artery spasm

A

Treatment for Variant Angina

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17
Q

Therapeutic effects for variant angina

A

Calcium channel blockers and organic nitrates (These relax the spasm)

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18
Q

_____ angina is considered a medical emergency

A

Unstable

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19
Q

Symptoms are from severe CAD, complicated by vasospasm, platelet aggregation, and transient coronary thrombi or emboli

A

Unstable angina

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20
Q

Chest pain at rest, new onset exertional or intensification of existing angina

A

Unstable

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21
Q

Reduce pain and prevent progression of the MI or death. HOSPITALIZATION. Anti-ischemic therapy combined with antiplatelet and anticoagulation therapy

A

Treatment for unstable angina

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22
Q

Two main goals for drug therapy for angina pectoris

A
  1. Prevention of myocardial infarction and death

2. Prevention of myocardial ischemia (reduced blood) and anginal pain

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23
Q

Anginal pain is from an imbalance between oxygen supply and oxygen demand.

A

True

24
Q

Oldest and most frequently used

A

Nitroglycerin

25
Q

In chronic angina and unstable angina:

dilates veins and decreases venous return (preload), which DECREASES cardiac oxygen demand

A

Nitroglycerin

26
Q

Nitroglycerin In variant angina:

Prevents or reduces coronary artery spasm, _______ oxygen supply

A

increases

27
Q

STABLE ANGINA:

(Nitroglycerin) Nitrates decrease oxygen demand by _____ veins, and decrease the cardiac preload

A

Dilating

28
Q

VARIANT ANGINA:

(Nitroglycerin) Increase oxygen supply by _____ the coronary artery spasm

A

relaxing

29
Q

______ acts directly on vascular smooth muscle for vasodilation, at usual dose, acts primarily on the veins.

A

Nitroglycerin

30
Q

Pharmacokinetics: Highly lipid soluble

Rapid inactivation by hepatic enzymes, most is destroyed by first pass effect

A

Nitroglycerin

31
Q

Headache
Orthostatic Hypotension
Reflex Tachycardia

A

Adverse effects of Nitroglycerin

32
Q

Hypotensive -Drugs/Antihypertensive –
–Intensify the effects of hypotensive drugs
–Use caution when using together with beta blockers, calcium channel blockers, diuretics and all drugs used for lowering blood pressure
-Alcohol Use – hypotension
Not used on Right Ventricular -Infarction – Preload sensitive

A

Nitroglycerin drug interactions

33
Q

_____ Inhibitors (sildenafil/Viagra) can lead to life-threatening hypotension – make sure you ask your patients about use of Viagra! (Nitroglycerin)

A

PDE5

34
Q

Pre administration assessment for Nitroglycerin

A

Screen medications CAREFULY
Caution with antihypertensives
CONTRAINDICATED with PDE5 inhibitors

35
Q

Sublingual Tablets (Rapid onset, Short duration) - Nitroglycerin

A

Use
–Treat acute attack
–Prophylaxis of acute attack
Nursing Considerations
–Use at first indication, do not wait till severe
–Use prior to activity that is known to cause chest pain, such as climbing a flight of stairs
–Store in a cool, dark place

36
Q

Treatment with SL tabs or translingual spray: (Nitroglycerin)

A

Stop activity. Sit or lie down.
Immediately put one SL tab or spray under tongue and let dissolve. Rest for 5 minutes.
If pain NOT relieved by first tablet, call 911, take a second tablet.
After another 5 min, if still no relief, administer a 3rd tablet or spray.
DO NOT use more than 3 doses
Record frequency, intensity, duration, location

37
Q

Nitroglycerin Patch (Slow onset, Long duration)

A

Use
–Long term prophylaxis against anginal attacks
Nursing Consideration
–Patches should not be cut
–Hairless area, rotate sites to prevent irritation
–Remove patch at night to prevent tolerance, be med free 10-12 hrs/day

38
Q

Nitroglycerin IV

A

Use
–Control angina not responding to other meds
–Control of b/p or induced hypotension during surgery
Heart failure resulting from acute MI
Nursing Considerations
–Start at slow rate, usually 5 mcg/min, and titrate gradually until response achieved
–Continuous cardiac and B/P monitoring

39
Q

Pharmacologic actions similar to NTG (Nitroglycerin)
Taken orally
Both can cause headache, hypotension, and reflex tachycardia
Different route of administration and time course of action.
USED AS A PREVENTATIVE NOT AN ABORTIVE MEDICATION FOR ANGINA

A

Isosorbide mononitrate and isosorbide dinitrate (Organic nitrates)

40
Q

1st line for angina of EFFORT, but are not effective against vasospastic angina (not good for the smooth muscles)

A

Beta Blockers

41
Q

The ending ends in –lol

Prototype: Propranolol, Metoprolol

A

Beta Blockers

42
Q

Beta Blocker: STABLE ANGINA:

Decrease oxygen demand by decreasing heart rate and contractility

A

True

43
Q

Beta Blocker: STABLE ANGINA: Lowering HR increases time in diastole, increasing blood flow through coronary vessels

A

True

44
Q

Bradycardia
Decreased atrioventricular conduction
Reduced contractility
Bronchoconstriction

A

Adverse effects of Beta Blocker

45
Q
  • -Avoid BB in pts with sick sinus syndrome, 2nd or 3rd degree AV blocks, and asthma.
  • –If an asthmatic must have a Beta Blocker (constrictor) , use metoprolol a beta1-selective (bc more towards the heart)
  • —Can mask signs of hypoglycemia Ikeep in mind with diabetics)
  • –BB must never be withdrawn abruptly, can increase the incidence and intensity of anginal attacks, can even cause MI – Taper this down
A

Nursing implications for Beta Blocker

46
Q
  • -Block calcium channels in the vascular smooth muscle, primarily the arterioles
  • -Arterioles dilate and reduce peripheral resistance (afterload)
  • -Relax coronary vasospasm
A

MOA of Calcium Channel Blocker

47
Q

Most commonly used: diltiazem, verapamil, nifedipine

A

Calcium Channel Blocker

48
Q

(Calcium channel blocker) STABLE ANGINA:

Promote relaxation of peripheral arterioles, leading to decrease in afterload

A

True

49
Q

(Calcium channel blocker) VARIANT ANGINA:

Promote relaxation of the coronary artery spasm

A

True

50
Q

Cardiovascular – dilation of the peripheral arterioles LOWERS blood pressure, and induce reflex tachycardia
Must be used cautiously with beta blockers and in patients with bradycardia, heart failure

A

Adverse effect of Calcium channel blocker

51
Q

New class of antianginal agents
Reduces anginal episodes and increased exercise tolerance
DOES NOT reduces heart rate, blood pressure or vascular resistance
Reduces accumulation of sodium and calcium in myocardial cells, which may help the myocardium use energy more efficiently

A

Ranolazine

52
Q

Caution: CAN prolong the QT interval = Torsade points = ventricular dysrhythmia

A

Ranolazine

53
Q

Pharmacokinetics
Absorption from the GI tract is variable, but NOT affected by food
Metabolized in liver, by CYP3A4

A

Ranolazine

54
Q

QT prolongation – can lead to torsades de pointes
Elevate Blood pressure (especially with renal impairment)
Constipation
Dizziness
Nausea
Headache

A

Adverse effects of Ranolazine

55
Q

CYP3A4 Inhibitors – grapefruit juice, HIV protease inhibitors, macrolide antibiotics, azole antifungal drugs and some calcium channel blockers

Dangerous accumulation of the drug can happen to the body so don’t give with CYP3A4 INHIBITOR
QT drugs – drugs that prolong the QT interval (sotalol, dofetilide)

A

Ranolazine drug interactions

56
Q

QT drugs – drugs that prolong the QT interval (sotalol, dofetilide)

Calcium Channel Blockers – most CCB, but not amlodipine – can inhibit the CYP3A4 and increase levels of ranolazine
AMLODIPINE IS THE ONLY ONE THAT SHOULD BE USED WITH RANOLAZINE

A

Ranolazine drug interactions

Pharmacology (2 decks)

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