Chapter 23

Question 1

What are antianginal drugs used for?

Answer 1

chest pain/heart aches

Question 2

What is the definition of angina?

Answer 2

insufficient blood flow to the heart muscles from narrowing of coronary artery

Question 3

What is ischemia?

Answer 3

poor blood supply to an organ

Question 4

What is ischemic heart disesase?

Answer 4

poor blood supply to the hear muscle, atherosclerosis, coronary artery disease

Question 5

What is a MI?

Answer 5

-necrosis or death of cardiac tissue

Question 6

Types of angina

Answer 6

1. chronic stable angina (also called classic or effort angina) happens with strenuos activity
2. unstable angina (also called preinfarction or crescendo angina) patient can be doing nothing and it can start
3. vasospastic angina (also called prinzmetal or variant angina) no plaque build up, just vasoconstriction

Question 7

Drugs for angina

Answer 7

1. nitrates or nitrites
2. beta blockers
3. calcium channel blockers

Question 8

Available forms for nitrates or nitrites

Answer 8

1. sublingual
2. chewable tablets
3. oral capsules/tablets (long term therapy)
4. intravenous solutions
5. transdermal patches (in ER or ambulence)
6. ointments

Question 9

mechanism of drugs for angina

Answer 9

1. causes vasodilation
2. potent dilating effect on coronary arteries
3. used for treatment and prevention of MI

Question 10

Nitrostat is ___________

Answer 10

light sensitive, so it needs to stay in a brown container, don’t keep cotton in container because it’s not necessary

Question 11

nitro patch/ointment what do you need to do?

Answer 11

wear gloves when administering

Question 12

What are the rapid acting forms of nitrate and nitrite?

Answer 12

1. sublingual tablets

2. IV infusion

Question 13

Nitroglycerin

Answer 13

• prototypical nitrate
• large first-pass effect with oral forms
• used for symptomatic treatment of ischemic heart conditions
• IV form used for BP control in perioperative hypertension, hf, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies

Question 14

isosorbide

Answer 14

actions identical to nitroglycerin; used for angina, taken orally; produce headache, hypotension, and reflex tachycardia

Question 15

adverse effects

Answer 15

1. headaches
2. reflex tachycardia
3. orthostatic hypotension

Question 16

does tolerance occur with the use of nitrates and nitrites?

Answer 16

yes; can be prevented by giving them some “time off” (spreading out doses, take off dose and ointment at night)
-take the old patch off before putting the new one are

Question 17

contraindications for nitrate/nitrite

Answer 17

-known drug allergies, severe anemia, closed-angle glaucoma, hypotension, severe head injury, use of erectile dysfunction drugs

Question 18

how do beta blockers work

Answer 18

decrease in HR rate and contractility to conserve energy

Question 19

metoprolol is a

Answer 19

beta blocker used for high BP and angina

-beta blockers block the harmful effects of catecholamines, thus improving survival after an MI

Question 20

adverse effects of BB

Answer 20

bradycardia, decreased AV conduction, reduction of contractility, asthmatic effects, use with caution in patients with diabetes (can mask effects of hypoglycemia), insomnia, depression, bizarre dreams, sexual dysfunction-impotence

Question 21

Examples of calcium channel blockers

Answer 21

-verapamil, diltiazem

Question 22

indications for calcium channel blockers

Answer 22

• coronary artery spasms

- supraventricular tachycardia, hypertension, angina, migraine headaches, raynaud’s disease

Question 23

adverse effects of calcium channel blockers

Answer 23

-hypotension, palpitations, tachycardia, bradycardia, constipation, nausea, dyspnea, other adverse effects

Question 24

patients should report this while on angina drugs

Answer 24

blurred vision, persistent headache, dry mouth, edema, fainting episodes, weight gain of 2 lb in 1 day or 5 lb in 1 week, pulse rate less than 60 bpm, dyspnea

Question 25

Why do you take the cotton out of the container after opening it?

Answer 25

cotton inside the container draws moisture into the container and deactivates the drugs

Question 26

if anginal pain occurs

Answer 26

stop activity an sit or lie down, take a sublingual tablet, if you don't have relief in 5 minutes, call 911, take 2nd, if no relief in 5 minutes after that, take a 3rd one -DO not try to take self to the hospital

Question 27

How are IV forms of nitrate given?

Answer 27

must be given with special non-PVC tubing and bags - follow manfacterer's instructions for IV administration - use infusion pump - NEVER give IV push

Question 28

What should patients taking calcium channel blockers not take?

Answer 28

grapefruit juice