Antianginal Drugs - Ch 54

Question 1

What is Angina?

Answer 1

-Chest pain
Supply of oxygen and nutrients in the blood is insufficient to meet demands of heart causing pain

Question 2

What are the types of angina?

Answer 2

Stable (angina pectoris)
Unstable
Variant/Prinzmetal’s
Microvascular

Question 3

What is stable angina?

Answer 3

Predictable
e.g, excercise, excitement

Question 4

What is unstable angina?

Answer 4

Occurs without activity

Question 5

What is Variant/Prinzmetal’s angina?

Answer 5

Coronary artery vasospasm

Question 6

What is microvascular angina?

Answer 6

Spasms in smallest coronary arteries
Longer lasting pain (>10min to 30 min)
More common in women

Question 7

What are the therapeutic goals of antianginal drugs?

Answer 7

Relieve pain of attack
Prevent angina (limit number of attacks)

Question 8

What are the broad treatment goals of antianginal drugs?

Answer 8

1. Improve blood flow in coronary circulation
2. Reduce heart muscle metabolic demands
3. or both

Question 9

What are the kinds of antianginal drugs?

Answer 9

Organic Nitrates
Beta-blockers
Calcium channel blockers
Ranolazine

Question 10

Examples of antianginal drug combinations?

Answer 10

Nitrates + CCBs
Nitrates + beta-blockers
CCBs + Beta-blockers
Nitrates + CCBs + Beta-Blockers

Question 11

What are the avaialble forms of organic nitrates?

Answer 11

Sublingual
Oral capsules/tablets
IV solutions
Ointments
Transdermal patches
Translingual sprays

Question 12

What do organic nitrates cause?

Answer 12

Vasodilation
-Relaxes vascular smooth muscle

Question 13

When coronary arteries dilate due to organic nitrates what happens?

Answer 13

Increased coronary blood flow which is useful in variant angina

Question 14

What happens when veins and systemic arteries relax due to organic nitrates?

Answer 14

Relaxed veins = Reduced cardiac preload
Relaxed systemic arteries = reduced cardiac afterload

Question 15

What is preload?

Answer 15

Stress on ventricular wall before systole
Volume of blood in ventricles at the end of diastole/before systole (Frank-starling law)

Question 16

What is afterload?

Answer 16

Resistance the heart has to pump against tat is determined by arteriolar pressure

Question 17

Decreased preload caused by organic nitrates does what?

Answer 17

Dilate veins which decreases stroke volume, cardiac output and BP
= decreased cardiac work

Question 18

Decreased afterload caused by organic nitrates does what?

Answer 18

Dilate arterties, decreases total peripheral resistance which decreases BP
= decreased cardiac work

Question 19

Examples of organic nitrate?

Answer 19

Nitroglycerin
Isosorbide mononitrate
Isosorbide dinitrate

Question 20

Nitroglycerin has a large what?

Answer 20

Large first-pass effect

Question 21

How is nitroglycerin administered for symptomatic treatment?

Answer 21

Sublingual, not PO

Question 22

How is nitroglycerin administered for angina prevention?

Answer 22

Patch or PO

Question 23

When is IV nitroglycerin used?

Answer 23

BP control in perioperative hypertension, heart failure, ischemic pain, pulmonary edema due to acute MI and hypertensive emergencies

Question 24

Prolonged action of isosorbide mononitrate is used for?

Answer 24

Prophylaxis

Question 25

How is isosorbide mononitrate administered?

Answer 25

PO -Has high bioavailability

Question 26

Organic nitrate SL tablet or spray is used for?

Answer 26

Acute relief of angina (few min, lasts ~ 1 hour)

Question 27

Organic nitrate Sl or oral is used for?

Answer 27

Prophylaxis in situations that may provoke angina like excercise

Question 28

Transdermal patches (nitroglycerin) or oral (nitroglycerin, isosorbide mononitrate) is used for?

Answer 28

Long-term prophylaxis of angina

Question 29

What adverse effects are associated with organic nitrates?

Answer 29

Headaches Postural hypotension Peripheral edema Reflex tachycardia

Question 30

headaches in patients taking nitrates are what?

Answer 30

Classic and predictable Usually diminish in intensity/frequency with continued use

Question 31

What does reflex tachycardia do?

Answer 31

Partially offsets beneficial effects May combine with beta-blocker

Question 32

What can develop quickly (over a single day) in patients taking oragnic nitrates?

Answer 32

Tolerance to the drug

Question 33

What should the nurse teach the client is they are taking SL nitroglycerin?

Answer 33

Never to chew or swallow sublingual form

Question 34

What should the nurse do when providing nitrate topical ointments or transdermal forms?

Answer 34

Rotate sites Remove old mediaction -remove topical forms at bedtime, apply new dose in the morning = reduce tolerance -allow for a nitrate-free period

Question 35

Examples of beta-blockers?

Answer 35

Atenolol Metoprolol (Lopressor) Propanolol (Inderal)

Question 36

What is the mechanism of action of beta-blockers?

Answer 36

Decrease heart rate = decrease cardiac work Decrease myocardiac contractility = decreased cardiac work =Decreases myocardiac oxygen demand

Question 37

What are beta-blockers used for?

Answer 37

Long-term prevention of angina -Not for acute exacerbations of angina Antihypertensive Cardioprottective effects after MI Migraines (propanolol)

Question 38

Adverse effects of beta-blockers?

Answer 38

Bradycardia, hypotension, HF Altered glucose and lipid metabolism Dizzininess, fatigue, letahrgy, weird dreams Impotence, wheezing, dyspnea

Question 39

What should clients taking beta-blockers monitor daily?

Answer 39

Pulse rate Report any pulse lower than 60 bpm

Question 40

Why should beta-blocker use never be abruptly discontinued?

Answer 40

Rebound hypertensive crisis

Question 41

Examples of CCBs?

Answer 41

Diltiazem (cardizem) Verapamil Nifedipine (other DHPs)

Question 42

What is the mechanism of action of CCBs?

Answer 42

Reduce myocardial contractility (negative inotropic action) cause peripheral arterial vasodilation Decreased myocardial oxygen demand

Question 43

What CCBs reduce myocardial contractility (negative inotropic action)?

Answer 43

Verapamil and diltiazem

Question 44

What CCBs cause peripheral arterial vasodilation?

Answer 44

All CCBs

Question 45

What drugs are first-line agents for treatment of angina, hypertension and supraventricular tachycardia?

Answer 45

Calcium channel blockers

Question 46

What should clients taking antianginal drugs avoid?

Answer 46

Consuming alcohol Going in hot baths, showers, hot tubs and saunas (they cause vasodilation and hypotension)

Question 47

Nurses should encourage clients to keep a record of what?

Answer 47

Their anginal attacks -precipitating factors -Numbers of pills taken -Therapeutic effects

Question 48

What should clients taking CCBs do to avoid constipation?

Answer 48

Adequate fluids and eat high-fibre foods