Angina

Question 1

Stable vs stable angina

Answer 1

Stable = predictable. worse with exercise

Unstable = occurs without activity

Question 2

Variant angina

Answer 2

Coronary artery vasospasm

Question 3

Microvascular angina

Answer 3

Spasms in smallest coronary arteries
Pain is longer lasting
More common in women

Question 4

Antianginal drug goals

Answer 4

Improve blood flow in coronary circulation

reduce heart muscle metabolic demands

Question 5

Organic Nitrates

Answer 5

cause relaxation of smooth muscle

dilate coronary arteries

reduce preload and afterload

Question 6

Organic Nitrates available forms

Answer 6

Sublingual
Oral capsules/tablets
IV
Ointments
Patches
Sprays

Question 7

Organic Nitrates mechanism

Answer 7

Vasodilation
Dilates coronary arteries which causes increased coronary blood flow

Useful in variant angina

Reduces cardiac preload (relaxes veins)
Reduces cardiac afterload *relaxes systemic arteries)

Question 8

Decreased preload vs decreased afterload

Answer 8

Preload is stress on the ventricular wall before systole. Volume of blood in ventricles end of diastole/before systole.
Decreased preload = dilate veins. Decreases stroke volume and cardiac output and BP = decreased cardiac work

Afterload is resistance the heart has to pump against.
Decreased afterload = arteriolar vasodilator and so decreased BP = decreased cardiac work

Question 9

Nitroglycerin

Answer 9

Organic nitrate
Large first-pass effect
Sublingual

IV form for BP control in perioperative hypertension, HF tx, ischemic pain, pulm edema

Question 10

Isosorbide Mononitrate

Answer 10

Organic nitrite
oral (high bioavailability)
Prolonged action for prophylaxis

Question 11

Nitrate form for acute, prophylaxis in provoking situations, and long-term prophylaxis

Answer 11

Acute: SL tablet or spray

Prophylaxis in situations that may provoke: SL, oral

Long-term prophylaxis: patch, oral

Question 12

Organic Nitrate ADVERSE EFFECTS

Answer 12

Headache
-Classic and predictable in almost all patients

Postural hypotension

Reflex tachycardia
Partially offsets beneficial effects. can combine w beta blocker

can build tolerance

Question 13

How to reduce nitrate tolerance

Answer 13

Removal of old medication

remove topical forms at bedtime

Question 14

Beta blockers

Answer 14

-B-adrenoreceptor antagonists
-Decrease HR
-Decrease contractility
-long-term prevention of angina. NOT for acute exacerbations

Atenolol
Metoprolol
propranolol

Question 15

Calcium Channel Blockers

Answer 15

First-line tx of angina

Reduce contractility (negative inotropic) - verapamil and diltiazem

Peripheral arterial vasodilation - all calcium channel blockers
Decreased myocardial oxygen demand

•Diltiazem
•Varapamil
•Nifedipine (DHPs. end in “pine”)

Question 16

Client implications

Answer 16

Alcohol consumption, hot baths, and saunas cause vasodilation and hypotension

•Encourage client to keep record of angina attacks

•Constipation common problem with calcium channel blockers