objective 2.2 (pt.2) (2)

Question 1

occurs when the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle cramps and “aches”
The heart requires a large supply of oxygen to meet the demands placed on it

Answer 1

angina pectoris (chest pain)

Question 2

what are the types of angina?

Answer 2

Chronic stable angina (also called classic or effort angina)
Unstable angina (also called preinfarction angina)
Vasopastic angina (spasm of cardiac arteries)

Question 3

simply means poor blood supply to an organ

Answer 3

ischemia

Question 4

Poor blood supply to the heart muscle
Atherosclerosis blocks and hardens arteries, causing coronary artery disease

Answer 4

ischemic heart disease

Question 5

full blockage of cardiac artery which then causes
Necrosis, or death of cardiac tissue and it can be disabling or fatal

Answer 5

myocardial infarction

Question 6

what are the drugs used for angina?

Answer 6

Nitrates and nitrites
ß blockers
Calcium channel blocker

Question 7

cause vasodilation through the relaxation of smooth muscles. They have a potent dilating effect on coronary arteries.
Result: oxygen to ischemic myocardial tissue
Used for prevention and treatment of angina

Answer 7

nitrates and nitrites

Question 8

what are the available forms of nitrates and nitrites?

Answer 8

sublingual*, chewable tablets, oral caps/tabs, intravenous solutions, transdermal patches, ointments, translingual sprays

Question 9

Used to prevent anginal episodes

Answer 9

long-acting forms

Question 10

Prototypical nitrate
Large first-pass effect with oral forms
Used for symptomatic treatment of ischemic heart conditions
IV form used for control of BP in perioperatice hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute myocardial infarction, and hypertensive emergencies

Answer 10

nitroglycerin

Question 11

both rapid and long actin

Answer 11

isosorbide

Question 12

primarily long acting

Answer 12

isosorbide mononirate

Question 13

*large first-pass effect with oral forms: liver breaks down much of the drug, requires higher doses
Normally given sublingual for acute angina attacks
Used for symptomatic treatment of ischemic heart conditions
IV form used for treatment of HF, ischemic pain, and pulmonary edema associated with acute MI, and hypertensive emergencies

Answer 13

nitrates

Question 14

what are the AE of nitrates?

Answer 14

The main AE is headaches
Usually diminish in intensity and frequency with continued use
Postural hypotension- will drop BP, reflex tachycardia
Tolerance may develop: occurs in pts taking nitrates around the clock or with long-acting forms
This is prevented by allowing a regular nitrate-free period

Question 15

what is the contraindications of nitrates?

Answer 15

known drug allergy, severe anemia, closed-angle glaucoma, hypotension, severe head injury
Use of the erectile dysfunction durgs sildenafil citrate, tadalafil, and vardenaful hydrochloride
May lead to severe and life threatening hypotension

Question 16

re the mainstay in the treatment of several cardiovascular diseases:
Angina, MI, HTN, dysrhythmias
Block ß1 receptors on the heart which:
Decreases HR, resulting in decreased myocardial O2 demand and increases oxygen delivery to the heart
Decrease myocardial contractility which helps to conserve energy and decrease demand
After MI, a high level of circulating catecholamines irritates the heart, causing an imbalance in supply and demand ratio, and can even be life-threatening
ß blockers block the harmful effects of catecholamines, thus improving survival after an MI

Answer 16

beta blockers

Question 17

what are the contraindications of beta blockers?

Answer 17

Systolic heart failure: failure of enough pressure during a heartbeat to supply the body
Serious conduction disturbances as they slow the HR
Caution: bronchial asthma, bcuz any level of blockade of ß2 receptors can promote bronchoconstriction
Diabetes mellitus: can mask hypoglycemia-induced tachycardia
Peripheral vascular disease: may further compromise cerebral or peripheral blood flow

Question 18

what are the AE of beta blockers?

Answer 18

Cardiovascular: bradycardia, hypotension, atrioventricular block
Metabolic: hyperglycemia, hypoglycemia, hyperlipidemia
CNS: dizziness, fatigue, depression, hyperlipidemia
Other: erectile dysfunction,wheezing, dyspnea

Question 19

what are examples of beta blockers?

Answer 19

Metoprolol: commonly used
Atenolol
Propranolol
Nadolol

Question 20

Indication: prophylactic treatment of angina pectoris
Use of this after MI has been shown to decrease mortality

Answer 20

atenolol

Question 21

Indication: prophylactic treatment of angina
Reduced mortality rate in pts after MI and treating angina

Answer 21

metoprolol

Question 22

cause coronary artery vasodilation and peripheral arterial vasodialtion.
Decreases systemic vascular resistance
Reduce the workload of the heart
Result: decreased myocardial oxygen demand therefore decreasing the risk of angina

Answer 22

calcium channel blockers

Question 23

what are the indications of calcium channel blockers?

Answer 23

ANGINA
Coronary artery spasms
Supraventricular tachycardia
Short-term management of atrial fibrillation and flutter
Migraine headaches
Raynauds disease

Question 24

what are the contraindications of calcium channel blockers?

Answer 24

Known drug allergy
Acute MI
Hypotension
Second-or third-degree atrioventricular block

Question 25

what are the AE of calcium channel blockers?

Answer 25

*hypotension
Tachycardia or bradycardia
constipation , nausea, dyspnea

Question 26

Indicated for both angina and HTN
Most popular calcium channel blocker of the dihydropyridine subclass

Answer 26

amlodipine

Question 27

Very effective for the treatment of angina resulting from HTN and coronary insufficiency
Sed in the treatment of atrial fibrillation and flutter, svt

Answer 27

diltiazem

Question 28

what are examples of calcium channel blockers?

Answer 28

Amlodipine
Diltiazem
Nifedipine
Verapamil