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Flashcards in 1 - Antianginals Deck (16):
1

What happens when the oxygen demand of the myocardium exceeds the amount of available oxygen?

Necrosis occurs = myocardial infarction

ANGINA first 

2

Describe Variant (Atypical, Prinzmetal's) Angina?

  • Rare - 4/100,000 people
  • Have more alpha 1 receptors than beta 2 receptors in their coronary arteries (vasoconstriction)
    • Epinephrine - usually increases rate and output, but now vasoconstricts coronary arteries (alpha 1)

3

What is the EKG diagnosis of Variant angina?

Elevated S-T segment which is not present in normal angina

4

What are the treatments of unstable angina?

  • Nitrates
  • Beta blockers
  • Calcium channel blockers
  • Antiplatelet drugs
  • Antithrombin therapy

5

How do nitrites/nitrates work?

  • Cause relaxation of all smooth muscle
  • Results in arterial and venous vasodilation
  • Decreases venous return to heart (decrease preload)
  • Decrease work, O2 demand

6

What are the common side effects of nitrites and nitrates?

  • Vasodilation = intense/fast = headaches
  • Flush
  • Postural hypotension and syncope
  • Tachycardia and increased peripheral resistance
  • Methemoglobin
    • Decreases ovygen carrying capabilities

7

What do nitrates oxidize hemoglobin into?

Methemoglobin

8

What are the common preparations of nitrates?

  • Amyl nitrate - source of nitric oxide (vasodilator) - fastest onset
  • Nitroglycerin - rescue drug, photosensitive, patch - up to 12 hrs
  • Isosorbide dinitrate (Isordil) - long acting, 2-10 min onset
  • Isosorbide mononitrate (Imdur) - 30-60 min onset

9

How do beta blockers work?

  • Decrease workload of the heart
  • Decreasing cardiac output (afterload) and arterial pressure
  • Decreases venous return
  • Decreases preload
  • Decreases oxygen demand
  • Decreased myocardial oxygen demand

10

Beta blockers do not cause ________?

Vasodilation

11

Patients with a history of MI will always be taking what?

Beta Blockers

12

What is contraindicated for taking beta blockers?

  • Variant Angina

13

What are some characteristics of cardioselective vs nonselective beta blockers?

  • Non-Selective Beta blockers
    • Contraindicated in asthmatics
  • Cardioselective Beta blockers
    • Preferred for insulin-dependent diabetics and asthmatics

14

What drug has a negative inotropic effect?

Calcium channel blockers

15

What do calcium channel blockers cause?

  • Vasodilation of coronary arteries (amlodipine)
  • Decrease force of contraction of myocardium (verapamil, diltiazem)
  • Vasodilate peripheral arteries and veins, leads to reduced work load on heart (nifedipine, nicardipine)

16

In a patient taking antianginals, can you use epinephrine?

Yes, but limit (1:100,00) in local anesthesia to 2 cartridges