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Pharm Part II > E1: Anti-ANGINALs > Flashcards

E1: Anti-ANGINALs Flashcards

1
Q

Angina = pain when the heart becomes ______

A

anoxic

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2
Q

Pain occurs more often at _______

A

NIGHTTIME (Parasym actvivity and not enough O2 to the heart)

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3
Q

What type of angina is this? Coronary arteries not able to transport enough oxygen to meet myocardium demand….Oxygen imbalance causes ISCHEMIA..Stress, exertion, eating, anxiety, cold, local anesthesia, pain, atherosclerotic lesions (block flow of blood). If demand exceeds available oxygen, then NECROSIS occurs = MI

A

Typical (exertional) angina

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4
Q

Variant Angin: _____: 4 /100,000…More common in _____ (m/f?); Which RACE is more prone?

A

Rare…Japanese

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5
Q

What type of angina is more common? Which is more rare?

A

Typical (exertional) is more common….Variant Angina is more rare

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6
Q

When coronary arteries are normal: Mainly _____ receptors in coronary arteries = ________ causes vasodilation (improves bloodflow to the heart)

A

beta 2… epinephrine

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7
Q

Epinephrine also acts on _____ receptors (WHAAa??), increasing oxygen demand of the heart

A

beta 1

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8
Q

INTERESTANTE!!!! Individuals with variant angina have more ______ receptors than ______ receptors in their coronary arteries (vasoconstriction)

A

alpha 1….beta 2

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9
Q

Variant Angina: Epinephrine increases heart rate and cardiac output (____) but now vasoconstricts coronary arteries (_____)..Double Whammy

A

beta 1… alpha 1

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10
Q

IN variant angina: EKG diagnosis consists of an elevated _______ segment which is not present in normal angina

A

S-T segment

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11
Q

What are the 5 typical treatments of angina?

A

1.Nitrates 2.beta blockers 3.Ca2+ channel blockers 4.Antiplatelet drugs 5.Antithrombin therapy

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12
Q

Nitrites and Nitrates Cause relaxation of all ________

A

smooth muscle

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13
Q

Nitrates: Drugs work on endothelial cells that produce nitric
oxide…activates ________ which converts GTP to cGMP, which then causes dephosphorylation of light chain _____

A

guanylyl cyclase…myosin

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14
Q

Nitrates-Nitrites = Results in arterial and venous vaso______* WHICH decreases preload, which is ______ to the heart

A

dilation dawg…..venous return!

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15
Q

Nitrates: side effects- the rapid vasodilation causes _____… What are two other side effects?

A

headaches! (pressure in the skull dawg)…Flush/Postural Hypotension!!! & increased sympathetic activity

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16
Q

Nitrates oxidize hemoglobin to ________

A

methemoglobin

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17
Q

Large doses of nitrites/nitrates for LONG TERM

use decreases _________ capabilities

A

oxygen-carrying…YIKES

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18
Q

Nitrates: rapid _______ will develop: transdermal patches allow for a daily nitrate free interval….12 hours on, 12 hours off

A

tolerance

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19
Q

What are the 5 preparations of Nitrates?

A
  1. Amyl Nitrate 2.Vaprole 3.Nitroglycerin 4.iso-sorbinde DInitrate (long acting) 5.iso-sorbide MONOnitrate (even longer acting)
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20
Q

How long do you wait after giving nitroglycerin before giving another dose? How many doses before calling 911?

A

5 minutes in between dose. after 3 does = 911

21
Q

Nitroglycerin: Very caustic to _______ mucosa = looks like a burn

A

sublingual…DO NOT Tx if there is UNCONTROLLED ANGINA

22
Q

Summary of Effects of Beta Blockers: _______ chronotropic

23
Q

Summary of Effects of Beta Blockers: _______ inotropic

24
Q

Summary of Effects of Beta Blockers: _______ arterial pressure

25
Q

Summary of Effects of Beta Blockers: _______ afterload

26
Q

NOTE: Beta blockers DO NOT cause ________

A

vasodilation

27
Q

Patients with a history of MI will ALWAYS be taking ________

A

beta blockers!

28
Q

Side effects of Beta Blockers: ______cardia… ________ in some forms of congestive
heart failure

A

Tom Bradycardia… Contraindicated!!!

29
Q

Side effects of Beta Blockers: Contraindicated for ______ angina & OK for _______ angina

A

VARIANT Patient does not have enough beta receptors in coronary arteries, then if block, vasospasm = more angina due to greater oxygen deficit = potentially fatal!……OK for typical (exertional) angina

30
Q

Side effects of Beta Blockers: Bronchial constriction/______ attacks

A

I’ll give you asthma!

31
Q

________ beta blockers are contraindicated in asthmatics

A

Nonselective

32
Q

Nonselective beta blockers decrease glycogenolysis and glucagon secretion = ________ after insulin injection

A

hypotension

33
Q

cardioselective agents are preferred for WHICH TWO CONDITIONS????

A

insulin- dependent DIABETIC and ASTHMATICS

34
Q

Beta blockers often combined with _______ to prevent sodium retention

35
Q

WHEELHOUSE! Oral Care Considerations with Beta Blockers–Non-selective beta blockers ENHANCE the pressor response to epinephrine: causing _______ & ________

A

hypertension and reflex bradycardia

36
Q

WHEELHOUSE! Oral Care Considerations with Beta Blockers–OK to use epinephrine with __________ agents!!!!!
– Limit dose to _____ mg = ____ cartridges of 1:100,000

A

cardioselective….0.04mg = 2 cartridges

37
Q

WHEELHOUSE! Oral Care Considerations with Beta Blockers–Renember? ________ may reduce effects of beta blockers when used for >3 weeks

38
Q

WHEELHOUSE! Oral Care Considerations with Beta Blockers–No precautions needed with ______ NSAID use

A

short term

39
Q

Ca2+ Channel Blockers otra vez: ________ inotropic effect

40
Q

Ca2+ Channel Blockers otra vez: Block Ca+ entry into the myocardial cell = less Ca+ inside of the cell maintains ________’s inhibitory effects by decreasing contraction of the heart

A

troponin’

41
Q

Ca2+ Channel Blockers otra vez: Because the heart does not speed up, no pain from _______

42
Q

Ca2+ Channel Blockers otra vez: Some of these drugs cause smooth muscle relaxation of the coronary arteries = ________

A

vasodilation

43
Q

Ca2+ Channel Blockers otra vez: What 2 drugs Decrease force of contraction of myocardium?

A

VERA-PA-mil AND DIL-TIA-zem

44
Q

Ca2+ Channel Blockers otra vez: What drug Vasodilates coronary arteries to improve myocardial oxygenation?

A

AM-LOD-ipine

45
Q

Ca2+ Channel Blockers otra vez: What 2 drugs Vasodilate peripheral arteries and veins, decreasing afterload and preload, which reduces the work of the heart?

A

NI-FED-ipine and NI-CARD-ipine

46
Q

FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals—Limit ______ of procedures per visit

47
Q

FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals—limit epinephrine (1:100,000) in local anesthesia to ___ cartridges…Cardiac dose = _____ mg epinephrine

A

2 cartidges…0.04mg

48
Q

FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals—consider local anesthetics without _________

A

vasoconstrictor

49
Q

FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals—Remember gingival hyperplasia with some __________

A

calcium channel blockers

Pharm Part II (28 decks)

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