Drugs for Angina, MI & CVA

Question 1

what is atherosclerosis?

Answer 1

-presence of plaque within arterial walls

Question 2

what is plaque and its effects on the vascular system?

Answer 2

• accumulation of fatty, fibrous material that narrows arteries, increases TPR, and reduces vascular elasticity

Question 3

angina pectoris

Answer 3

• acute chest pain arising from inadequate oxygen supply to the myocardium; steady intense pain that is accompanied with a crushing/constricting sensation

Question 4

where does angina pectoris pain radiate?

Answer 4

• across the left shoulder, down the left arm, but can move up to the jaw, or across the thoracic region of the back

Question 5

what are sone signs and symptoms of angina pectoris?

Answer 5

• panic
• pallor
• dyspnea
• diaphoresis
• tachycardia

Question 6

what are sone signs and symptoms of angina pectoris?

Answer 6

• panic
• pallor
• dyspnea
• diaphoresis
• tachycardia
• elevated BP

Question 7

what triggers angina pectoris and how long does it last?

Answer 7

• physical exertion or emotional excitement
• symptoms improve with rest, stress reduction and nitroglycerin
• 10 to 15 minutes

Question 8

what are the two types of angina pectoris?

Answer 8

stable and unstable

Question 9

stable angina

Answer 9

• predictable frequency, duration and intensity
• no associated myocardial damage; relief with rest
• pain comes from lactic acid build up

Question 10

unstable angina

Answer 10

• variable intensity, occurs during periods of rest, increased frequency, no associated myocardial damage
• risk of MI
• medical emergency

Question 11

what are non-pharmacological treatments of stable angina pectoris?

Answer 11

• limit alcohol consumption
• eliminate foods high in cholesterol, saturated fats and sodium
• control hyperlipidemia
• control hypertension
• regular exercise

Question 12

pharmacological management of stable angina pectoris

Answer 12

• drug therapies reduce myocardial oxygen demand or improve oxygen supply to the myocardium
• slow heart rate
• reduce force of cardiac contraction
• dilate veins
• dilate arterioles

Question 13

nitrates mechanism of action

Answer 13

• first line therapy of terminating an angina attack
• facilitate the formation of nitric acid
• relax coronary arteries and venous smooth muscle

Question 14

how do nitrates dilate venous smooth muscle?

Answer 14

• decrease amount of blood returning to the heart
• decrease cardiac output, workload and oxygen demand
• risk of hypotension

Question 15

how do nitrates dilate arterial smooth muscle?

Answer 15

• increases blood flow to myocardium

- improves oxygen supply to myocardium

Question 16

short acting nitroglycerin and how is it administered?

Answer 16

• used to terminate an angina attack

- tablet and spray; IV, topical and PO

Question 17

what is the protocol with short acting nitroglycerin?

Answer 17

• rest, take drug and wait 5 minutes

- if no improvement take another dose, wait 5 minutes to a max of 3 doses in 15 minutes

Question 18

long acting isosorbide dinitrate

Answer 18

-decreases intensity and frequency of angina attacks

Question 19

what is the protocol with isosorbide dinitrate?

Answer 19

• remove patch for 12-16 hours or withhold at night

- slow withdrawal from medications to prevent risk of MI

Question 20

what are some adverse effects for nitrates ?

Answer 20

• throbbing headache, dizziness, weakness, hypotension, reflex tachycardia

Question 21

what are some drug interactions for nitrates?

Answer 21

• drugs for the treatment of erectile dysfunction may cause life threatening hypotension, alcohol

Question 22

beta adrenergic antagonists mechanism of action

Answer 22

• first line therapy for prevention of chronic stable angina attacks
• reduces cardiac workload, slows heart rate and reduces contractility decreasing oxygen demand

Question 23

caution with beta adrenergic antagonists

Answer 23

• those with asthma, COPD, depression and diabetes

Question 24

what are some adverse effects with beta adrenergic antagonists?

Answer 24

• related to SANS blockade
• fatigue, weakness, bradycardia, sleep disturbances, hypotension
• rapid withdrawal worsens angina; reduce over 1-2 weeks

Question 25

calcium channel blockers mechanism of action

Answer 25

• used for prevention of chronic stable angina in clients who cannot tolerate beta blockers
• decrease myocardial oxygen demand, relax arteriolar smooth muscle lowering blood pressure and decreasing after load, decrease heart rate

Question 26

what are some adverse effects with calcium channel blockers?

Answer 26

• related to effects on cardiac output and smooth muscle
• dizziness, light-headedness, fatigue, bradycardia, flushing, nausea
• monitor for hypotension and reflex tachycardia

Question 27

what is a MI and when does it occur?

Answer 27

• a result of advanced coronary artery disease
• an MI occurs when the coronary artery is completely ischemic
• myocytes begin to die unless blood supply is restored
• necrotized tissue release enzyme markers of tissue injury which can be used to confirm MI vs unstable angina

Question 28

what are the goals of therapy with an MI?

Answer 28

• reduce myocardial oxygen demand
• restore blood supply to the damaged myocardium
• control dysrhythmias
• reduce post- MI mortality with anti platelet drugs, and anticoagulant therapy

Question 29

what is a Cerebrovascular Accident (CVA)?

Answer 29

• a stroke

- 80% thrombotic strokes, 20% hemorrhagic strokes

Question 30

what are the warning signs for stroke?

Answer 30

• paralysis on one side
• vision problems
• dizziness
• speech problems
• headache

Question 31

what are pharmacological managements of thrombotic stroke?

Answer 31

• prevention; lifestyle management, antihypertensive drugs, anti platelet therapy, anticoagulant therapy
• treatment: thrombolytics; admninistration within 3 hours of brain attack can completely restore function in affected brain areas