WEEK 6-Anti-Anginal Agents:

Question 1

Angina Pectoris (Chest Pain)

Answer 1

When the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle “aches” (chest pain)

The heart requires a large supply of oxygen to meet the demands placed on it

Question 2

Chronic stable angina

Answer 2

(also called classic or effort angina) this is temp

Question 3

Unstable angina

Answer 3

(also called preinfarction or crescendo angina) most concerned about,
if untreated can lead to an MI

this is temp

Question 4

Vasospastic angina

Answer 4

(also called Prinzmetal’s or variant angina)
more severe chest pain

this is temp

Question 5

Agents

Answer 5

Nitrates/nitrites

Beta-blockers

Calcium channel blockers

Question 6

Overall Goal

Answer 6

Increase blood flow to ischemic heart muscle

Decrease myocardial oxygen demand

Decrease frequency, duration and intensity of anginal attacks

Improve the patient’s functional capacity with as few side effects as possible

Prevent or delay the worst possible outcome, MI

Question 7

Nitrates/Nitrites Nitroglycerin

Answer 7

Causes extreme vasodilatation due to relaxation of smooth muscles

Potent dilating effect on coronary arteries (small and large vessels)

Used for prevention and treatment of angina

**Main drug of choice for the management of angina due to rapid dilatation

Large first-pass effect with oral forms

Used for symptomatic treatment of ischemic heart conditions (angina)

IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies

Question 8

Nitrates - Isosorbide dinitrate

Answer 8

Used for:
ORAL FORM OF NITROGLY
Acute relief of angina (SL form) 			
Prophylaxis in situations that may provoke angina (exercise, stress)
Long-term prophylaxis of angina

SIDE EFFECTS:
Headache
Usually diminish in intensity and frequency with continued use
Flushing due to vasodilatation

Question 9

Beta-Blockers

Answer 9

atenolol (Tenormin)
metoprolol (Lopressor)
propranolol (Inderal)
nadolol (Corgard)
sotolol
bisprolol

Question 10

BETA BLOCKERS: Mechanism of action

Answer 10

Decrease HR, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart

Decrease myocardial contractility, helping to conserve energy or decrease demand

Question 11

BETA BLOCKERS:Indications

Answer 11

Angina
Hypertension
Cardioprotective effects, especially after MI (Metoprolol best tolerated)
Some used for migraine headaches

Question 12

Calcium Channel Blockers

Answer 12

Blocks or prevents calcium from entering into the cardiac cells thereby resulting in relaxation of the heart muscles which will decrease blood pressure and heart rate

Slows the AV node conduction and prolongs the refractory period

Question 13

Calcium Channel Blockers MECHANISM OF ACTION

Answer 13

Cause peripheral arterial vasodilation

Reduce myocardial contractility (negative inotropic action)

Result: decreased myocardial oxygen demand

Question 14

CCB Indications

Answer 14

Treatment of angina, hypertension, and supraventricular tachycardia (SVT)

Short-term management of atrial fibrillation and flutter (v lil output)

Several other uses

Question 15

CCB SIDE EFFECTS

Answer 15

Hypotension
Palpitations
Tachycardia  
Bradycardia
Nausea
Dyspnea
Constipation

Question 16

Alcohol consumption, whirlpools, hot tubs, or saunas will result in

Answer 16

vasodilatation, hypotension, and the possibility of fainting

Question 17

Nitroglycerin instructions on doses

Answer 17

.Pt can take up to 3 doses 5 minutes apart, if no improvement call 911

Question 18

Nitroglycerin : Instruct patients:

Answer 18

Never chew or swallow the SL form
Burning sensation with SL forms indicates that the drug is still potent
They can get a headache with NTG
Their blood pressure will drop so need to lie down when taking NTG
Proper storage- no plastic, dark containers, airtight

DO NOT TAKE DURING THE NIGHT

Question 19

Instruct patients to take prn nitrates at the first hint of anginal pain

Answer 19

.

Question 20

adenesine

Answer 20

creates a flat line on the cardiac monitor for a couple fo seconds.
by bolus because the half life is two to three seconds.

Question 21

side effects of nitrates

Answer 21

Patients should report blurred vision, persistent headache, dry mouth, dizziness, edema, fainting episodes, weight gain of 2 pounds in 1 day or 5 or more pounds in 1 week

Pulse rates less than 60, and any dyspnea

Question 22

why do ppl on cardiac drugs takers need to constipation pills

Answer 22

vagal stimuli from barring downwhich effects the BP to go down.