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Pharmacology Exam 2 > Antianginal Agents > Flashcards

Antianginal Agents Flashcards

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1
Q

What is Angina pectoris?

A

Pain because the oxygen demand of the heart is not met.

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2
Q

What is Atherosclerosis?

A

When blood vessels have accumulated several atheroma’s, this leads to swelling, decreased elasticity and an inability to respond to body signals such as vasodilation and constriction.

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2
Q

What is Atheroma?

A

Fatty tumors that narrow the pathway in arteries. They reduce the adaptability of the vessels and causes them to stiffen

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3
Q

What is Coronary artery Disease (CAD)?

A

When the arteries that supply blood to the heart become narrowed and oxygen supply to the heart is decreased.

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4
Q

What is Myocardinal infarction?

A

When a coronary artery is completely occluded and ischemia occurs. This caused cardiac muscles to die and the muscle tissue is replaced with scar tissue.

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5
Q

What is Prinzmetal’s angina?

A

When a vessel spasm in a coronary artery causes decreased blood flow, leading to chest pain.

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6
Q

What is Pulse Pressure?

A

When you subtract the diastolic pressure from systolic pressure, this represent the pressure it takes to fill the coronary arteries.

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7
Q

What is stable angina?

A

When there is chest pain due to an imbalance in cardiac oxygen demand vs supply. This pain is relieved by decreased physical activity.

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8
Q

Unstable angina?

A

When there is chest pain due to unmet oxygen demands, however pain wont stop even if the person stops their physical activity and rests.

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9
Q

What are the 3 types of angina?

A

Stable angina - no damage to heart muscles, basic reflexes surrounding the pain restore blood flow - pain decreases when activity decreases.

Unstable angina - episodes of pain occur even at rest. Cell death is not necessary happening but the patient is at an increased risk of complete occlusion. Patient should seek medical attention if pain doesn’t stop after a prolonged time.

Prinzmetal’s Angina - Caused by spasm of the blood vessels and not just by vessel narrowing/ atherosclerosis. Patients will usually experience the same pain at the same time every day, even at rest. May also be having ECG changes.

In all 3 the hearts oxygen demands are not being met.

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10
Q

Explain a myocardial infarction

A

When a coronary vessels becomes completely occluded it is unable to deliver blood to the cardiac muscle. The area of the muscle that is oxygen deprived becomes ischemic (not getting enough oxygen) and consequently becomes necrotic.
This results in excruciating pain, nausea and severe sympathetic stress reaction.
Arrythmias may develop from ischemia which results in irritable tissue. Most deaths from MI are due to lethal arrythmias.

Women and men experience different symptoms of heart attacks. Men are more likely to experience chest pain, left arm pain and shortness of breath. Women may experience GI upset or jaw pain.

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11
Q

What are the actions of antianginal drugs?

A

They improve blood delivery to the heart muscle by vasodilation - increased supply of oxygen
Improve blood delivery to the heart by decreasing workload of the heart - decreasing demand for oxygen.

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12
Q

What are some lifespan considerations that we should take into account when it come to antianginal agents and children?

A

We usually only give these medications for hypertension or arrythmias and these drugs are not commonly used in children.
If used, dose is determined by age and weight.
Patient should be monitored closely

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13
Q

What are some lifespan considerations that we should take into account when it come to antianginal agents and adults?

A

Activities that may cause angina should be determined and moderated.
Patients should be educated as to when to seek emergency treatment (when medication is not longer working)
Non-pharmacological measures should be educated (weight loss, diet, exercised)
Drugs are known to cross placenta and enter breastmilk.

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14
Q

What are some lifespan considerations that we should take into account when it come to antianginal agents and older adults?

A

More likely to experience adverse reactions (if taking more than one drug)
Safety measures should be put in place for balance and mobility issues related to the drug effect.
Dose should be started lower.

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15
Q

Name the 3 drug classes of Antianginal drugs.

A

Nitrates
Beta-Blockers
Calcium Channel Blockers

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16
Q

What are the suffix(es), drug classes and outliers for Nitrates?

A

Isosorbide dinitrate (prevention)
Isosorbide mononitrate (prevention)
Nitroglycerin (acute)

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17
Q

How does Nitrates work?

A

They work by dilating the blood vessels and decreasing BP.

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18
Q

What is the action of Nitrates?

A

They act directly on the smooth muscle to cause relaxation and depress muscle tone of blood vessels. Relax and dilates veins, arteries and capillaries. May also decrease muscle spasms.

Nitrates will NOT have an effect on vessels affected by coronary artery disease, or dead tissue.

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19
Q

Why would we give someone Nitroglycerin?

A

For prevention and treatment of attacks of angina pectoris.

Nitroglycerin is a nitrate.

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20
Q

What are the suffix(es), drug classes and outliers for Nitrates?

A

(Nitro/Nitrate)

Isosorbide dinitrate (preventative)
Isosorbide mononitrate (preventative)
Nitroglycerin (preventative & treatment of acute attack)

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21
Q

When should we NOT give Isosorbide mononitrate to a patient?

A

If the patient have an allergy, severe anemia (due to blood oxygen being low), head trauma or cerebral hemorrhage (vasodilation could cause further bleeding).

Isosorbide mononitrate is a nitrate.

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22
Q

What are some adverse reactions that are seen when we are giving patients Nitroglycerin?

A

All adverse effects are related to vasodilation and decrease in blood flow.

CNS: Headache, dizziness, and weakness
GI: nausea, vomiting due to decreased blood flow to GI tract.
CV: Hypotension
Misc. : Flushing & sweating (pooling in capillaries), Pallor, increased perspiration
There is also a risk of developing tolerance in long term use which makes the nitrates less effective.

Nitroglycerin is a nitrate

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23
Q

When should we be extra cautious when giving Isosorbide dinitrate to a patient?

A

In patient who are pregnant or lactating
Patients with hepatic or renal diseases - due to problems with excreting nitrates.
Hypotension, hypovolemia and conditions that limit cardiac output (may be exacerbated by nitrates)

Isosorbide dinitrate is a nitrate.

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24
What are some drug-drug interactions that may be seen with Nitrates?
Ergot derivatives -Hypertension can occur and antianginal effect will be decreased. Heparin - heparin will become less effective. Erectile dysfunction drugs : Sildenafil, tadalafil and vardenafil - may cause SEVERE hypotension.
25
What nursing assessments should be done prior to prescribing a patient Nitrates?
contraindications or cautions physical assessment: skin for color, intactness, and any signs of redness, irritation, or breakdown CNS : level of alertness, affect, and reflexes Respiratory: Monitor respirations and auscultate lungs; CV: assess pulse rate, blood pressure, heart rate, and rhythm, ECG. Assess pain (baseline to make sure meds. are helping), including onset, duration, intensity, location, and measures used to relieve it. Investigate activity level prior to and after the onset of pain. Monitor liver and renal function tests, complete blood count.
26
What nursing diagnoses should be made prior to administering Nitroglycerine to a patient?
There may be altered cardiac output related to vasodilation and hypotensive effects. Injury risk related to CNS or CV effects. Altered tissue perfusion (total body) related to hypotension or change in cardiac output. Knowledge deficit regarding drug therapy. Nitroglycerine is a Nitrate.
27
What nursing implementations should we be prepared for when we administer Isosorbide mononitrate to patients?
Have the patient lay or sit down prior to administration (BP changes) Sublingual preparations under the tongue or in the buccal pouch, may be repeated in 5 minutes if relief is not felt for a total of 3 doses. If pain persists, the patient should go to the emergency room. Give sustained release forms with water, and caution the patient not to chew or crush them. Long-acting preparations should be administered with plans for nitrate-free intervals. Rotate the sites of topical forms. Translingual spray is used under the tongue and not inhaled an keep a record of the number of sprays used if a translingual spray form is used. Emergency life-support equipment readily available in case of hypotension. Taper the dose gradually after long-term therapy. Provide comfort measures. Provide thorough patient teaching. Isosorbide mononitrate is a nitrate.
28
What are the suffix(es), drug names and potential outliers for Antianginal Beta blockers?
"-olol" Atenolol Metoprolol Propranolol Nadolol
29
How does beta blockers work?
By blocking the stimulatory effects of the sympathetic nervous system
30
What is the action of antianginal beta blockers?
By blocking the beta-adrenergic receptors in the heart we are preventing it from increasing heart rate and contractility. This decreases excitability of the hear, decreases oxygen demand and decreases cardiac output as well as lowering BP. It also acts on beta blockers on the kidneys to decrease the release of renin.
31
Why would you give Nadolol to a patient?
Beta blockers are given for long-term management of angina caused by atherosclerosis. Used in combination with nitrates to increase exercise tolerance. Also given to patient who has had an MI to prevent re-infarction in stable patients 1-4 weeks after an MI. It does this by reducing oxygen demands for a prolonged period of time.
32
When would we NOT give Atenolol to patients?
We would not give beta blockers to patients who suffer from bradycardia, heart block, shock because beta blockers slow down the heart rate. We should also not give beta blockers to patients with prinzmetal angina because they may cause vasospasms and peripheral ischemia.
33
When would we be cautious of giving a patient Metoprolol?
Patients who are suffering from diabetes mellitus, peripheral vascular disease, asthma/COPD, Thyrotoxicosis (a form of hyperthyroidism) should avoid beta blockers because patients with these conditions may become destabilized by blocking the SNS (sympathetic nervous system). Patients taking beta blockers with these conditions needs to be monitored frequently.
34
What are some adverse reactions of beta-blockers?
Adverse effects are related to the blockage of the sympathetic nervous system. CNS : Dizziness, fatigue, emotional depression r/t to effect on neurotransmitter levels in the brain.. GI : Nausea, vomiting, diarrhea. CV : CHF, decreased cardiac output and arrythmias. Respiratory: Bronchospasms, dyspnea and cough (due to blocking adrenergic receptors in the lungs - non selective beta blockers) Decreased exercise tolerance and malaise.
35
What are some drug-drug interactions that may be experienced with Propranolol?
Beta blockers may interact with diabetic agents (may mask hypoglycemia symptoms, so patients on both these medications needs to check glucose levels often) and NSAIDs (may reduce the beta blockers ability to lower BP)
36
Before prescribing Nadolol to a patient, what nursing assessments should we do first?
Before prescribing beta blockers we should assess for contraindications or cautions Perform a physical assessment : Assess level of orientation and sensation. Monitor pulse, blood pressure, and heart rate, and obtain an ECG. Assess respirations and auscultate lungs for adventitious sounds. Examine the abdomen and auscultate bowel sounds; monitor urine output (to monitor that no obstruction is forming) Monitor electrolyte levels, renal and hepatic function studies (electrolyte imbalances may impact drug efficacy)
37
What are some nursing diagnoses that should be made prior to giving patients Atenolol?
Beta blockers may cause impared comfort related to CNS, GI, and systemic effects. Altered cardiac output related to CV effects. Altered tissue perfusion related to CV effects. Injury risk related to CNS effects. Activity intolerance related to sympathetic blocking. Knowledge deficit regarding drug therapy.
38
What implementations should we be prepared to make when we are giving a patient Metoprolol?
Beta blockers should not be stopped abruptly after chronic therapy, taper gradually over two weeks (sudden stop may cause rebound hypertension or arrythmias). Continuously monitoring a patient receiving an intravenous form of these drugs. Give oral forms of metoprolol with food. Monitor blood pressure, pulse, rhythm, and cardiac output regularly. Arrange for supportive care and comfort measures. Provide thorough patient teaching - decrease in libido and impotence could be due to decrease of the effect of the SNS.
39
How does Calcium channel blockers work?
They prevent the flow of calcium through cells.
40
What are the suffix(es), drug names and potential outlier for antianginal calcium channel blockers?
Dihydropyridine "- dipine" Amlodipdine Nicardipine Nifedipine Nondihydropyridine Diltiazem Verapamil
41
What are the two main types of antianginal calcium channel blockers?
Dihydropyridine (more vascular selective and used in hypertension and angina) & Nondihydropyridine (more myocardinal selective and used in arrythmias and angina)
42
What is the action of antianginal calcium channel blockers?
Preventing flow of calcium through the cells, the medications slow the action potential and prevent /decrease the ability of the muscle to contract. This causes a loss of smooth muscle tone, vasodilation and decreased peripheral resistance.
43
Which patients/patient conditions would be administer Nicardipine?
We would administer calcium channel blockers to treat Prinzmetal's angina, chronic angina (stable angina), effort associated angina (a type of stable angina) and for hypertension due to the vasodilation effect.
44
When would we NOT administer Nifedipine?
We would not administer calcium channels blockers to patients who are allergic, pregnant or lactating due to unknown effects.
45
When would we be extra cautious of prescribing Verapamil to a patient?
We would be careful with giving calcium channel blockers to patients who suffer from heart block or sick sinus syndrome, renal or hepatic dysfunction or heart failure (due to decreased cardiac output).
46
What are some known adverse effects of antianginal calcium blockers?
Adverse effects are related to cardiac output and the effect on cardiac output and smooth muscle. CV: hypotension (vasodilation) , cardiac arrythmias (electrolyte imbalance) GI : stomach upset (blood shifting to other organs) Skin flushing and rash (change in blood flow) CNS: Headache, dizziness and fatigue
47
Are there any drug-drug interactions when it comes to antianginal calcium blockers?
Yes, however they vary with each individual drug. Diltiazem should not be taken with cyclosporine. Verapamil should not be taken with Digoxin or with general anesthetics.
48
Before prescribing Diltiazem to a patient, what should we assess for?
Before administering antianginal calcium blockers we should assess for contraindications or cautions. Perform a physical assessment: Inspect skin for color and integrity. Assess pulse rate, blood pressure, heart rate, and rhythm; obtain an ECG. Monitor respirations and auscultate lungs. Monitor liver and renal function tests.
49
What nursing diagnoses should be made prior to administering Nifedipine?
When we administer antianginal calcium blockers we should be prepared for altered cardiac output risk related to hypotension and vasodilation. Injury risk related to CNS or CV effects. Altered tissue perfusion (total body) related to hypotension. or change in cardiac output. Knowledge deficit regarding drug therapy.
50
What implementations would we be prepared to make after administering Amlodipine to a patient?
When a patient is taking calcium channel blockers it is important to monitor the patient's blood pressure, cardiac rhythm, and cardiac output closely. Monitor blood pressure carefully if the patient is also taking nitrates. If a patient is on long-term therapy, regularly monitor blood pressure and cardiac rhythm. Provide comfort measures. Provide thorough patient teaching.
51
Why does patients who take antidiabetic medications and antianginal beta blockers monitor their blood sugar levels often?
Because beta blockers may mask the symptoms of hypoglycemia
52
In children what two conditions would we give antianginal medications for?
Hypertension or Arrythmias
53
What drug may be used in children?
Nitroglycerin
54
What type of tissue will nitrates not have an effect on?
Dead tissue or tissue affected by coronary artery disease.
55
Which drug can decrease muscle spasms?
Nitrates
56
what decreases preload and afterload?
Decrease in blood pressure
57
Nitroglycerin will make heparin _________ __________
Less effective.
58
Sildenafil, tadalafil and vardenafil are what type of drugs, and may lead to severe hypotension if mixed with nitrates?
Erectile dysfunction medications
59
Why should we assess the skin as part of our nursing assessment for nitrates?
Nitrates may be given as an ointment which may thin the skin. Its important that topical sites are rotated to avoid skin breakdown. Before applying the ointment its important to make sure the skin is intact.
60
How many doses of nitroglycerin may be repeated in a row and how long do you need to wait between each dose?
3 times with 5 minutes in between each dose.
61
Is there a risk of tolerance build up with nitrates?
Yes. It is therefore important that the patient takes breaks from the dugs in between,
62
What is important to instruct a patient of when it comes to the use of a nitrate spray?
That it is not an inhaler and that the spray should be aimed under the tongue. They should also record how many sprays they use so that they do not run out of their medication before it is time to have it refilled.
63
What can happen if you do not taper out nitrate medication?
Stopping the medication immediately may lead to a myocardial infarction. Medication should be tapered off over 2 weeks.
64
Which medication decreases cardiac output and renin?
Beta blockers
65
Which medication blocks the sympathetic nervous system?
Beta Blockers.
66
Would we ever combine beta blockers with nitrates?
Yes, this combination helps to increase the patients to perform ADLs and exercise without experiencing angina.
67
Which drug would we administer after an MI to increase oxygen tot he heart and prevent re-infarction?
Beta Blockers.
68
Why would we not give beta blockers to treat Prinzmetal angina?
They may cause vasospasms and cause peripheral ischemia.
69
What conditions does the SNS normally manage the homeostasis for?
Diabetes Mellitus, Peripheral vascular disease, Asthma/COPD and Thyrotoxicosis. Blocking these with beta blockers may worsen these conditions.
70
When treating someone with angina, are the beta blocker doses higher or lower than when treating a patient for HTN?
Lower.
71
Beta Blockers affect the CNS and may lead to depression or mood changes. TRUE/FALSE
True
72
Which drug category may reduce the beta blockers ability to lower blood pressure?
NSAIDs
73
Which medication may mask the symptoms of hyperglycemia?
Beta Blockers, Patients with diabetes need to monitor glucose levels often.
74
Why should we assess the abdomen for blockage when taking beta blockers?
Due to the effect on the sympathetic nervous system which decreases GI motility.
75
Dihydropyridine work to treat ____________ & _____________
hypertension and angina
76
Nonihydropyridine work to treat ____________ & _____________
Arrythmias and angina

Pharmacology Exam 2 (20 decks)

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