objective 2.2 (pt.2) (2) Flashcards
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
angina pectoris (chest pain)
what are the types of angina?
Chronic stable angina (also called classic or effort angina)
Unstable angina (also called preinfarction angina)
Vasopastic angina (spasm of cardiac arteries)
simply means poor blood supply to an organ
ischemia
Poor blood supply to the heart muscle
Atherosclerosis blocks and hardens arteries, causing coronary artery disease
ischemic heart disease
full blockage of cardiac artery which then causes
Necrosis, or death of cardiac tissue and it can be disabling or fatal
myocardial infarction
what are the drugs used for angina?
Nitrates and nitrites
ß blockers
Calcium channel blocker
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
nitrates and nitrites
what are the available forms of nitrates and nitrites?
sublingual*, chewable tablets, oral caps/tabs, intravenous solutions, transdermal patches, ointments, translingual sprays
Used to prevent anginal episodes
long-acting forms
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
nitroglycerin
both rapid and long actin
isosorbide
primarily long acting
isosorbide mononirate
*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
nitrates
what are the AE of nitrates?
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
what is the contraindications of nitrates?
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
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
beta blockers
what are the contraindications of beta blockers?
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
what are the AE of beta blockers?
Cardiovascular: bradycardia, hypotension, atrioventricular block
Metabolic: hyperglycemia, hypoglycemia, hyperlipidemia
CNS: dizziness, fatigue, depression, hyperlipidemia
Other: erectile dysfunction,wheezing, dyspnea
what are examples of beta blockers?
Metoprolol: commonly used
Atenolol
Propranolol
Nadolol
Indication: prophylactic treatment of angina pectoris
Use of this after MI has been shown to decrease mortality
atenolol
Indication: prophylactic treatment of angina
Reduced mortality rate in pts after MI and treating angina
metoprolol
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
calcium channel blockers
what are the indications of calcium channel blockers?
ANGINA
Coronary artery spasms
Supraventricular tachycardia
Short-term management of atrial fibrillation and flutter
Migraine headaches
Raynauds disease
what are the contraindications of calcium channel blockers?
Known drug allergy
Acute MI
Hypotension
Second-or third-degree atrioventricular block
what are the AE of calcium channel blockers?
*hypotension
Tachycardia or bradycardia
constipation , nausea, dyspnea
Indicated for both angina and HTN
Most popular calcium channel blocker of the dihydropyridine subclass
amlodipine
Very effective for the treatment of angina resulting from HTN and coronary insufficiency
Sed in the treatment of atrial fibrillation and flutter, svt
diltiazem
what are examples of calcium channel blockers?
Amlodipine
Diltiazem
Nifedipine
Verapamil
