Therapeutic Care of Angina Pectoris, Myocardial Infarction, and Cerebrovascular Accident

Question 1

Myocardial Ischemia

Question 2

Angina Pectoris

Answer 2

Defined as acute chest pain caused by myocardial ischemia
Symptoms include crushing, painful feeling in chest (in males, pain may be referred to left arm

Question 3

Silent – myocardial ischemia

Answer 3

occurs but no pain, asymptomatic; high risk for acute MI

Question 4

Unstable

Answer 4

unpredictable, occurs at rest

Question 5

Angina of effort

Answer 5

occurs when patient over-exerts during an activity, increasing oxygen demand

Question 6

Nutritional Therapy of Angina

Answer 6

Large meals should be avoided because they __Increase___ the work-load of the heart. Plus, blood is diverted to the digestive system and reduced to the coronary arteries.

If a large meal is eaten, should lie down and rest for 1 to 2 hours

Quit smoking as it causes vasoconstriction__ and an increase in HR

Question 7

Limit salt and saturated fats. Maintain ideal body weight. Why is weight important?

Question 8

Physiotherapy

Answer 8

A regular exercise program that conditions but does not overstress the heart.
Walking on a flat surface 30 minutes a day 5 days a week is recommended.
Nitro tablets may be used prophylactically before physical exertion or sexual intercourse.

Question 9

prophylactically

Answer 9

prevention of

Question 10

Mental Health

Answer 10

Counseling should be provided. Why?
to help you be calmer

Question 11

Oxygen Therapy

Answer 11

During an acute attack supplemental oxygen may be necessary.

Question 12

Pharmacological Management of Angina Pectoris

Answer 12

Number on goal: reduce the frequency and the intensity of the attacks

Answer 13

Terminate anginal episodes by _______dialate____coronary arteries to ___decrease_ O2 needs

Answer 14

Prevent anginal episodes by reducing ____cardiac ____ _____workload____ and O2 demand

Question 15

Drug Classes for Angina Pectoris – Organic Nitrates

Answer 15

• Can cause flusing and headache

Answer 16

Obtain complete health history including allergies and drug history, characteristics of angina, history of cardiac disorders
Assess vital signs and 12 lead ECG
Obtain lab tests including cardiac enzymes, complete blood count (CBC), kidney and liver function tests

Assess if client has taken phosphodiesterase -5 inhibitors (such as sildenafil) within last 24 hours why?

Question 17

Nitro glycerin patches are used for the _______ of angina.
How are they administered?

Answer 17

Prevention if Angina

• Switch sites
• ## Needs to be on clean dry skin

Question 18

Other Drugs in the treatment of Angina

Answer 18

Beta Blockers – relieve angina by decreasing the oxygen demands of the heart. Often considered first line drugs for chronic angina

Calcium Channel Blockers- relieve angina by dilating coronary vessels and reducing workload of the heart.

These meds will be discussed in more detail in hypertension.

Question 18

Prototype Drug Atenolol (Tenormin)

Answer 18

Therapeutic effects and uses
Stable angina, MI
Hypertension
Mechanism of action
Blocks beta1 receptors in heart causing a reduction in HR, and contractility which decreases CO and blood pressure
O2 demand is decreased, relieving angi

Question 18

At high doses, can block beta2 receptors and exacerbate asthma by promoting____________

Answer 18

by promoting bronchoconstriction

Question 19

Prototype Drug Atenolol (Tenormin) (2 of 2)

Answer 19

Adverse effects
Bradycardia, hypotension
Fatigue, weakness
Nausea, vomiting
At high doses, can block beta2 receptors and exacerbate asthma by promoting__________________

Question 20

Prototype Drug Metoprolol (Lopressor Adverse effects

Answer 20

Masks hypoglycemia
HTN
GI effects

Question 22

Drug Classes for Angina Pectoris – Calcium Channel Blockers (1 of 2)

Question 23

Drug Classes for Angina Pectoris – Calcium Channel Blockers (2 of 2)

Answer 23

- Don't give to pt with HF - It can cause fluid overload - Heart Block: causes heart to skip a beat

Question 24

Prototype Drug Diltiazem (Cardizem, Tiazac) (1 of 2)

Answer 24

Blocks cardiac calcium channels Decreases HR and force of contraction, decreasing O2 demand of myocardium Blocks vascular smooth muscle channels Increases O2 supply in coronary arteries (vasodilation) Decreases O2 demand by decreasing afterload (decreased HR anf contraction)

Question 25

Prototype Drug Diltiazem (Cardizem, Tiazac) (2 of 2)

Answer 25

- Slow heart down - bradycardia - Hypotension - Vasodilate: Flushing, dizziness, headac - is a calcium channel block and are r

Question 26

Pharmacotherapy of Myocardial Infarction

Answer 26

Treatment goals Restore blood supply to myocardium Thrombolytics, organic nitrates Reduce myocardial oxygen demand Beta blockers Control MI‒associated dysrhythmias Beta blockers, calcium channel blockers Reduce post-MI mortality ASA, ACE inhibitors Manage severe MI pain and anxiety Analgesics

Question 27

important medications

Answer 27

Anti platelets -ASA chewable, then either ticagrelor or clopidogrel. Dramatically reduces mortality in the coming weeks. Clopidogrel and ticlopidine (ticid) antiplatelet drugs usen in the prevention of MI Anticoagulants- Heparin IV Other medications; Atropine- for symptomatic bradyarrhythmia's Dimenhydrinate ? Fentanyl? Lorazepam? Metoclopramide? Morphine? Nitro spray?

Question 28

If the GI tract remains functional then it is preferred to use the Enteral Feeding route vs TPN Why?

Question 29

Labetalol IV or Captopril IV or Hydralazine IV What would you be monitoring after each dose? - Blood pressure Treatment of Ischemic CVA Thrombolytics- tPA (alteplase) Clot buster Must be given within ____ hours of onset of symptoms Risk?

Answer 29

Must be given within