anti-anginal

Question 1

what is ischemia?

Answer 1

poor blood supply to an organ

Question 2

what is ischemic heart disease?

Answer 2

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

atherosclerosis
CAD

Question 3

what is myocardial infarction?

Answer 3

necrosis, or death of cardiac tissue ***

disabling or fatal

Question 4

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

Answer 4

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

Question 5

what is CAD?

Answer 5

development, progression of atherosclerotic plaque

continuum progresses from angina to MI

Question 6

what are the 3 types of angina?

Answer 6

classic, variant, and unstable

Question 7

what is stable angina?

Answer 7

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

Question 8

what is variant angina? (prinzmetal angina)

Answer 8

occurs at rest. nitro relieves pain

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

Question 9

what is unstable angina?

Answer 9

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

Question 10

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

Answer 10

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

Question 11

do males and females experience same type of pain?

Answer 11

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”

Question 12

how does acute coronary syndrome occur?

Answer 12

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.

Question 13

what are some lifestyle changes, for CAD?

Answer 13

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

Question 14

other non-pharmacological management of CAD?

Answer 14

Patient education

Revascularization, interventional procedures

Question 15

what are some pharmacological management of CAD?

Answer 15

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

Question 16

what are some available forms of nitrates and nitrites?

does it bypass the liver?

Answer 16

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

Question 17

are nitrates long term or short term?

Answer 17

long term- used for prevention

Question 18

MOA of nitrates or nitrites?

Answer 18

• 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 ***

Question 19

what are rapid acting forms of nitrates and nitrites?

Answer 19

used to treat acute anginal attacks

sublingual tablets or spray; IV infusion

Question 20

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

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

Answer 20

used to prevent anginal episodes (long acting) **

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

Question 21

rapid or long acting? isosorbide dinitrate

Answer 21

both

Question 22

rapid or long acting? isosorbide mononitrate

Answer 22

primarily long acting

Question 23

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

Answer 23

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)*****

Question 24

what are some adverse effects of nitrates?

Answer 24

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

what are some contraindications of nitrates?

Answer 27

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

Question 28

when are beta blocker s used?

Answer 28

mainstay in the treatment of cardiovascular diseases - angina - MI - hypertension - dysrhythmias

Question 29

what are some abtianginal beta blockers?

Answer 29

atenolol metoprolol propranolol hydrcoholride nadolol (napm)

Question 30

MOA of beta blockers?

Answer 30

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

Question 31

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

Answer 31

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

Question 32

what is the effect of beta blockers on catecholamines?

Answer 32

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

Question 33

indications for beta blockers?

Answer 33

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

Question 34

contraindications for beta blockers?

Answer 34

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

Question 35

adverse effects for beta blockers on cardiovascular?

Answer 35

bradycardia, hypotension, AV block

Question 36

adverse effects for beta blockers on metabolic system?

Answer 36

hyperglycaemia, hypoglycaemia, hyperlipiedmia

Question 37

adverse effects on CNS for beta blockers?

Answer 37

dizziness, fatigue, depression, lethargy

Question 38

other AE for beta blockers?

Answer 38

erectile dysfunction, wheezing, dyspnea

Question 39

what are some adjunctive antianginal drugs?

Answer 39

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

Question 40

what are the goals of therapy for abtianginal drugs?

Answer 40

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

Question 41

preventing tolerance strategies with atianginal drugs?

Answer 41

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

Question 42

what are some ca channel blockers for chronic stable angina?

Answer 42

amlodipine diltiazem nifedipine verapamil hydrochloride (andV)

Question 43

MOA of ca channel blockers?

Answer 43

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

Question 44

are ca channel blockers first line treatments?

Answer 44

yes with beta blockers

Question 45

indications for ca channel blockers?

Answer 45

- 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

Question 46

contraindications for calcium channel blockers?

Answer 46

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

Question 47

adverse effects for calcium channel blockers?

Answer 47

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

Question 48

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

Answer 48

** 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

Question 49

how long is potency good for for nitro?

Answer 49

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

Question 50

how can you preserve potency for nitro ?

Answer 50

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

Question 51

at what point of anginal pain should you take nitro?

Answer 51

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

Question 52

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

Answer 52

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

Question 53

patients taking beta blockers should monitor ____

Answer 53

***their pulse rates daily and report rates lower than 60 beats/min or symp relative bradycardia isntruct pt to report dizziness or fainting

Question 54

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

Answer 54

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

Question 55

are beta blockers used for immediate relief?

Answer 55

no just long-term prevention angina

Question 56

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

Answer 56

*** constipation so instruct pt fluids, fibre

Question 57

general adverse effects for antianaginal drugs?

Answer 57

allergic reactions, headaches, lightheadedness, hypotension, dizziness