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Pharm > anti-anginal > Flashcards

anti-anginal Flashcards

1
Q

what is ischemia?

A

poor blood supply to an organ

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2
Q

what is ischemic heart disease?

A

poor blood supply to the heart muscle **(means in red)

atherosclerosis
CAD

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3
Q

what is myocardial infarction?

A

necrosis, or death of cardiac tissue ***

disabling or fatal

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4
Q

clinical syndrome char b y episodes of chest pain occur with ____ produce ___ most often caused by ____ MAY be caused by

A

occurs with mocardiac o2 deficit
produces myocardial ischemia
most often caused by atherosclerotic plaque in coronary arteries
may be caused by coronary vasospasm

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5
Q

what is CAD?

A

development, progression of atherosclerotic plaque

continuum progresses from angina to MI

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6
Q

what are the 3 types of angina?

A

classic, variant, and unstable

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7
Q

what is stable angina?

A

results from coronary artery obstr by atheromatous plaque
triggered by 4 Es: exercise, emotion, cold and eating
pain lasts for 1-15 min builds gradually to max. intensity: relieved by rest/ administration of nitro

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8
Q

what is variant angina? (prinzmetal angina)

A

occurs at rest. nitro relieves pain

ca channel blockers- main form of treatment to reduce the incidence of acute events

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9
Q

what is unstable angina?

A

result of atherosclerotic progression. high chance of getting MI. precipitated by the factors for angina. it occurs at rest (or with minimal exertion) lasting for more than 20 minutes

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10
Q

substernal chest pain symp? might be mistaken for? (I think relating to just angina)

A

constriction, squeezing, suffocating
may radiate to the jaw, neck, shoulder, both arms, back

may be mistaken for arthritis, ingestion
N/V, dizziness, diaphoresis, SOB, or fear or impeding doom may be associated

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11
Q

do males and females experience same type of pain?

A

no quality changes and women dent always experience classic arm pain but feel unusual fatigue, sweating and SOB, beck/jaw/back pain “i thought i had the flu”

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12
Q

how does acute coronary syndrome occur?

A

Acute coronary syndrome (any condition brought on by sudden, reduced blood flow to the heart) may be seen when the fibrous cap raptures, exposing thrombogenic material, producing a thrombus within the lumen. At this point, the intraluminal thrombi can occlude arteries outright or will detach, move into the circulation, and eventually occlude smaller, distal branches of the coronary artery causing thromboembolism and likely an acute MI or ST-segment elevation MI.

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13
Q

what are some lifestyle changes, for CAD?

A

-obesity, stop smoking
-elevated triglycerides, cholesterold
elevated BP, fasting glucose
-dietary changes” dec in salt, sugar, trans fat

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14
Q

other non-pharmacological management of CAD?

A

Patient education

Revascularization, interventional procedures

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15
Q

what are some pharmacological management of CAD?

A 
nitrates and nitrites
beta-adnergic blocking agents
calcium channel blocking agents
-reduce myocardial oxygen deman
-inc myocardial blood supply
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16
Q

what are some available forms of nitrates and nitrites?

does it bypass the liver?

A 
sublingual (bypass)
chewable tablets
oral capsules/tablets
IV (bypass)
transdermal patches (bypass)
translingual (bypass)
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17
Q

are nitrates long term or short term?

A

long term- used for prevention

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18
Q

MOA of nitrates or nitrites?

A
  • causes vasodilation bc of relaxation of smooth muscles
  • potent dilating effect on coronary arteries
  • result: oxygen to ischemic myocardial tissue
  • used for prevention and treatments of angina ***
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19
Q

what are rapid acting forms of nitrates and nitrites?

A

used to treat acute anginal attacks

sublingual tablets or spray; IV infusion

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20
Q

what are some long acting forms of nitrates and nitrites used for?

what are short acting forms of nitrates and nitrites used for?

A

used to prevent anginal episodes (long acting) **

used to treat anginal attacks Sublingual tablets or spray; IV infusion
short term

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21
Q

rapid or long acting? isosorbide dinitrate

A

both

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22
Q

rapid or long acting? isosorbide mononitrate

A

primarily long acting

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23
Q

nitroglycerin -what kind of nitrate? used for? what form?

A

Prototypical nitrate
Large first-pass effect with oral forms
Used for symptomatic treatment of ischemic heart conditions (angina)
Intravenous form used for control of blood pressure in perioperative hypertension, treatment of heart failure, ischemic pain, pulmonary edema associated with acute myocardial infarction, and hypertensive emergencies (malignant hypertension = >180/120)*****

24
Q

what are some adverse effects of nitrates?

A

**headaches (usually diminish in intensity and freq with cont use)
reflex tach
postural hypotension
tolerance may develop

25
Q

when does tolerance occur in nitrates and how can it be prevented?

A

occurs in patients taking nitrates around the lock or with long-acting forms
prevented by allowing a regular nitrate free period to allow enzyme pathways to replenish

26
Q

what might you instruct your patient with a transdermal form of nitrate to do? in reg: tolerance

A

may be instructed to remove patch at bedtime for 8 hours, then apply a new patch in the morning

27
Q

what are some contraindications of nitrates?

A 
known drug alergy
severe anemia
closed-angle glaucoma
hypotension
severe head injury
*use of erectile dysfunction drugs
28
Q

when are beta blocker s used?

A

mainstay in the treatment of cardiovascular diseases

  • angina
  • MI
  • hypertension
  • dysrhythmias
29
Q

what are some abtianginal beta blockers?

A

atenolol
metoprolol
propranolol hydrcoholride
nadolol (napm)

30
Q

MOA of beta blockers?

A

block beta 1 receptors on the heart
**dec HR, resulting in dec myocardial oxygen demand and inc oxygen delivery to the heart
dec myocardial contractility, helping to conserve energy or dec deman

31
Q

what is the result of catecholamines on the heart after an MI

A

there is an increase of catecholamines in the heart following an MI which irritate the heart causing an imbalance in supply and demand ratio and even lead to life threatening dysrhythmias

32
Q

what is the effect of beta blockers on catecholamines?

A

block the harmful effects of catecholamines and improve survival after an MI

33
Q

indications for beta blockers?

A

angina, HTN, cardiac dysrhythmias, MI, some used for migraine headaches, essential tremors and stage fright

34
Q

contraindications for beta blockers?

A

systolic heart failure, serious conduction disturbances

caution: bronchial asthma because any level of blockage of beta 2 receptors can promote bronchoconstriction

diabetes mellitus: can mask hypoglycaemia-induced tachy

peripheral vascular disease: may further compromise cerebral or peripheral blood flow

35
Q

adverse effects for beta blockers on cardiovascular?

A

bradycardia, hypotension, AV block

36
Q

adverse effects for beta blockers on metabolic system?

A

hyperglycaemia, hypoglycaemia, hyperlipiedmia

37
Q

adverse effects on CNS for beta blockers?

A

dizziness, fatigue, depression, lethargy

38
Q

other AE for beta blockers?

A

erectile dysfunction, wheezing, dyspnea

39
Q

what are some adjunctive antianginal drugs?

A

aspirin (antithrombotic effects)
antiipidemics (reduce serum cholesterol)
antihypertensives

40
Q

what are the goals of therapy for abtianginal drugs?

A

Relieve acute anginal pain
Reduce number and severity of acute anginal attacks
Improve exercise tolerance and life quality
Delay progression of CAD
Prevent MI and sudden cardiac death

41
Q

preventing tolerance strategies with atianginal drugs?

A

administer lowest effective dose and avoid long acting forms of nitrates
only use long acting forms during waking hours

42
Q

what are some ca channel blockers for chronic stable angina?

A

amlodipine
diltiazem
nifedipine
verapamil hydrochloride

(andV)

43
Q

MOA of ca channel blockers?

A

causes coronary artery vasodilation
cause peripheral arterial vasodilation, this dec systemic vascular resistance
reduce the workload of the heart
result: dec myocardial oxygen demand

44
Q

are ca channel blockers first line treatments?

A

yes with beta blockers

45
Q

indications for ca channel blockers?

A
  • Angina
  • Hypertension
  • Supraventricular tachycardia
  • **Coronary artery spasms (Prinzmetal angina)
  • Short-term management of atrial fibrillation and flutter
  • Migraine headaches
  • Raynaud’s disease
  • dihydropyridine nimodipine: cerebral artery spasms associated with aneurysm rupture
46
Q

contraindications for calcium channel blockers?

A

-known drug allergy
-acute myocardial infaraction
-second or third degree AV block (unless the patient has a pacemaker)
hypotension

47
Q

adverse effects for calcium channel blockers?

A

limited
primarily relate to overexpression of they therapeutic effects
-May cause hypotension, palpitations, tachy, or brady, constipation, nausea, dyspnea, other adverse effects

48
Q

what is the proper way to take nitro? or the improper way? ***

A

** instruct pt to never chew or swallow the sublingual form and if there is a burning sensation felt with sublingual forms indicates that the drug is still potent

49
Q

how long is potency good for for nitro?

A

3-6 months. instruct pt to keep a fresh supply of sublingual med on hand

50
Q

how can you preserve potency for nitro ?

A

**meds should be stored in an airtight, dark glass bottle with a metal cap and no cotton filler

51
Q

at what point of anginal pain should you take nitro?

A

**take as needed nitrates at the first hint of anginal pain

52
Q

if the patient is experiencing chest pain the patient taking sublingual nitro should do what?

A

*should lie down o prevent or decrease sissiness and fainéant that may occur because of hypotension

53
Q

patients taking beta blockers should monitor ____

A

***their pulse rates daily and report rates lower than 60 beats/min or symp relative bradycardia

isntruct pt to report dizziness or fainting

54
Q

can patients stop beta blockers if they feel they need to?

A

**no tell them they cannot abruptly discontinue b-blockers

55
Q

are beta blockers used for immediate relief?

A

no just long-term prevention angina

56
Q

what is a serious problem with ca channel blockers (side effect i guess?)

A

*** constipation so instruct pt fluids, fibre

57
Q

general adverse effects for antianaginal drugs?

A

allergic reactions, headaches, lightheadedness, hypotension, dizziness

Pharm (20 decks)

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