Angina

Question 1

With Stable angina you want to

Answer 1

decrease oxygen demand

Question 2

Variant angina you want to

Answer 2

increase o2 supply with vasodilation of coronary arteries

Question 3

unstable angina you want to

Answer 3

• med emergency

- treat as MI until proven

Question 4

Organic nitrates prototype

Answer 4

Nitroglycerin

Question 5

Action of nitro

Answer 5

Causes vasodilation of vessels in stable angina decreasing oxygen demand
- increase oxygen supply in variant angina by relaxing coronary artery vasospasm

Question 6

Forms of Nitro

Answer 6

• oral, sublingual, IV, buccal, patch

- short and long acting: isorbade dintrite and isosrobide mononitrite

Question 7

Most common form of Nitro

Answer 7

• sublingual
• store in dark package
• dont pour in hand
• dont storei n bathroom
• peak plasma within 4 mins

Question 8

Admin directions of nitro

Answer 8

sublinguual -> do not chew or swallow

• admin 1 SL tablet every 5 mins x3
• IF no relief after 1st dose, then call EMS

Question 9

Education for organic nitrates

Answer 9

• Refrain from alcohol -> severe hypotension
• Transdermal patches-> rotate sites
  Tolerance develops
• drug-free periods at night
  Common SE:
  -Headache
• Hypotension, orthostatic hypotension
• tachycardia

WEAR gloves for paste and transdermal administration
- wipe off skin before applying defib pads to skin

Question 10

Nitro drug interaction

Answer 10

• life threatening hypotension and cardiovascular collapse interaction with viagra or other ED drugs

Question 11

Beta Blockers for angina Action

Answer 11

• Reduces cardiac oxygen demand of heart by slowing HR and reducing contractility
• 1st line of tx for chronic stable angina

Question 12

NSG consideration

Answer 12

• Check the pulse ( hold if <60 or if they have HF or angina then 50bpm)
• Check BP
• Diabetes: mask s/s of hypoglycemia
• Teach not to stop abruptly
• Avoid in asthma/ COPD (cardiac nonselective)
• Monitor for brady and AV block

Question 13

Beta Blocker prototype is

Answer 13

metoprolol

Question 14

Calcium channel Blockers Action

Answer 14

Cause arteriolar smooth muscle relaxation-> dec BP ( afterload) -> dec myocardial oxygen demand
- can cause vasospasm to increase oxygen delivery

Question 15

CCB SE

Answer 15

hypotension and reflex Tachy

Question 16

Monitoring for CCB

Answer 16

S/S of HF with diltiazem and verapamil 
-DAily weights ( fluid rentention) 
DO not crush exteended release 
No grapefruit juice 
-Watch for bradycardai and AV Block with diltiazem and verapamil 
Protoype: diltiazem

Question 17

Ranolazine (Ranexa)

Answer 17

• newest anti-angianl drug
• decreases incidence of angina and increase exercise tolerance
  -Don’t really know how it works
  CYP450 metabolism pathway-drug interactions (no grapefuit juice)

Question 18

AE of Ranolazine

Answer 18

increase QT interval

- constipation, dizziness, nausea, and HA