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Pharmacology > Drugs for Angina Pectoris > Flashcards

Drugs for Angina Pectoris Flashcards

(56 cards)

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1
Q

Sudden pain beneath the sternum, often it radiates to the left shoulder, left arm and jaw

A

Angina pectoris

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2
Q

Anginal pain is often precipitated when the oxygen supply to the heart is insufficient to meet oxygen demand.

A

True

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3
Q

Angina often occurs secondary to atherosclerosis of the coronary arteries, so angina needs to be seen as a symptom of a disease and not a disease in its own right.

A

True

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4
Q

Chronic Stable Angina

A

Exertional angina

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5
Q

Variant Angina

A

Prinzmetal’s or vasospasm angina

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6
Q

_____ angina can be triggered by:

  • an increase in physical activity
  • emotional excitement
  • large meals
  • cold exposure
A

Stable

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7
Q

Underlying cause of exertional angina is _________ which is a condition characterized by deposition of fatty plaque in the arterial wall

A

Coronary Artery Disease

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8
Q

Treatment

A
  1. Increase cardiac oxygen supply

2. Decrease oxygen demand

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9
Q 
Heart Rate
Myocardial Contractility
Intramyocardial Wall Tension
---Cardiac Preload
----Cardiac Afterload
A

Oxygen Demand

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10
Q

Oxygen supply

A

Myocardial blood flow

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11
Q

Since the underlying cause of stable angina is the occlusion of coronary arteries, there is little we can do to increase cardiac oxygen supply

A

True

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12
Q

Chronic Stable Angina Treatment

A
  • Reduce intensity and frequency of attacks

- Imbalance of oxygen supply and oxygen demand

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13
Q

Therapeutic Agents for Chronic Stable Angina

A
  • Organic Nitrates
  • Beta-Blockers
  • Calcium Channel Blockers
  • Ranolazine (used in combination to increase benefit)
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14
Q

Must use anti platelet drug in combination drug with patients who have chronic stable angina

A

True

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15
Q

Not necessarily from CAD - Coronary artery SPASM, constricting blood flow to the myocardium
Can happen at any time, even during rest and sleep
Sometimes can occur in conjunction with stable angina
Chest discomfort, pain is secondary to insufficient oxygenation to the heart

A

Variant Angina

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16
Q

The goal is to reduce the incidence and severity of the attacks. INCREASING THE CARDIAC OXYGEN SUPPLY. Oxygen supply is increased with vasodilators, which prevent or relieve coronary artery spasm

A

Treatment for Variant Angina

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17
Q

Therapeutic effects for variant angina

A

Calcium channel blockers and organic nitrates (These relax the spasm)

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18
Q

_____ angina is considered a medical emergency

A

Unstable

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19
Q

Symptoms are from severe CAD, complicated by vasospasm, platelet aggregation, and transient coronary thrombi or emboli

A

Unstable angina

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20
Q

Chest pain at rest, new onset exertional or intensification of existing angina

A

Unstable

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21
Q

Reduce pain and prevent progression of the MI or death. HOSPITALIZATION. Anti-ischemic therapy combined with antiplatelet and anticoagulation therapy

A

Treatment for unstable angina

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22
Q

Two main goals for drug therapy for angina pectoris

A
  1. Prevention of myocardial infarction and death

2. Prevention of myocardial ischemia (reduced blood) and anginal pain

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23
Q

Anginal pain is from an imbalance between oxygen supply and oxygen demand.

24
Q

Oldest and most frequently used

Study These Flashcards
A

Nitroglycerin

25
In chronic angina and unstable angina: | dilates veins and decreases venous return (preload), which DECREASES cardiac oxygen demand
Nitroglycerin
26
Nitroglycerin In variant angina: | Prevents or reduces coronary artery spasm, _______ oxygen supply
increases
27
STABLE ANGINA: | (Nitroglycerin) Nitrates decrease oxygen demand by _____ veins, and decrease the cardiac preload
Dilating
28
VARIANT ANGINA: | (Nitroglycerin) Increase oxygen supply by _____ the coronary artery spasm
relaxing
29
______ acts directly on vascular smooth muscle for vasodilation, at usual dose, acts primarily on the veins.
Nitroglycerin
30
Pharmacokinetics: Highly lipid soluble | Rapid inactivation by hepatic enzymes, most is destroyed by first pass effect
Nitroglycerin
31
Headache Orthostatic Hypotension Reflex Tachycardia
Adverse effects of Nitroglycerin
32
Hypotensive -Drugs/Antihypertensive – --Intensify the effects of hypotensive drugs --Use caution when using together with beta blockers, calcium channel blockers, diuretics and all drugs used for lowering blood pressure -Alcohol Use – hypotension Not used on Right Ventricular -Infarction – Preload sensitive
Nitroglycerin drug interactions
33
_____ Inhibitors (sildenafil/Viagra) can lead to life-threatening hypotension – make sure you ask your patients about use of Viagra! (Nitroglycerin)
PDE5
34
Pre administration assessment for Nitroglycerin
Screen medications CAREFULY Caution with antihypertensives CONTRAINDICATED with PDE5 inhibitors
35
Sublingual Tablets (Rapid onset, Short duration) - Nitroglycerin
Use --Treat acute attack --Prophylaxis of acute attack Nursing Considerations --Use at first indication, do not wait till severe --Use prior to activity that is known to cause chest pain, such as climbing a flight of stairs --Store in a cool, dark place
36
Treatment with SL tabs or translingual spray: (Nitroglycerin)
Stop activity. Sit or lie down. Immediately put one SL tab or spray under tongue and let dissolve. Rest for 5 minutes. If pain NOT relieved by first tablet, call 911, take a second tablet. After another 5 min, if still no relief, administer a 3rd tablet or spray. DO NOT use more than 3 doses Record frequency, intensity, duration, location
37
Nitroglycerin Patch (Slow onset, Long duration)
Use --Long term prophylaxis against anginal attacks Nursing Consideration --Patches should not be cut --Hairless area, rotate sites to prevent irritation --Remove patch at night to prevent tolerance, be med free 10-12 hrs/day
38
Nitroglycerin IV
Use --Control angina not responding to other meds --Control of b/p or induced hypotension during surgery Heart failure resulting from acute MI Nursing Considerations --Start at slow rate, usually 5 mcg/min, and titrate gradually until response achieved --Continuous cardiac and B/P monitoring
39
Pharmacologic actions similar to NTG (Nitroglycerin) Taken orally Both can cause headache, hypotension, and reflex tachycardia Different route of administration and time course of action. USED AS A PREVENTATIVE NOT AN ABORTIVE MEDICATION FOR ANGINA
Isosorbide mononitrate and isosorbide dinitrate (Organic nitrates)
40
1st line for angina of EFFORT, but are not effective against vasospastic angina (not good for the smooth muscles)
Beta Blockers
41
The ending ends in –lol Prototype: Propranolol, Metoprolol
Beta Blockers
42
Beta Blocker: STABLE ANGINA: | Decrease oxygen demand by decreasing heart rate and contractility
True
43
Beta Blocker: STABLE ANGINA: Lowering HR increases time in diastole, increasing blood flow through coronary vessels
True
44
Bradycardia Decreased atrioventricular conduction Reduced contractility Bronchoconstriction
Adverse effects of Beta Blocker
45
- -Avoid BB in pts with sick sinus syndrome, 2nd or 3rd degree AV blocks, and asthma. - --If an asthmatic must have a Beta Blocker (constrictor) , use metoprolol a beta1-selective (bc more towards the heart) - ---Can mask signs of hypoglycemia Ikeep in mind with diabetics) - --BB must never be withdrawn abruptly, can increase the incidence and intensity of anginal attacks, can even cause MI – Taper this down
Nursing implications for Beta Blocker
46
- -Block calcium channels in the vascular smooth muscle, primarily the arterioles - -Arterioles dilate and reduce peripheral resistance (afterload) - -Relax coronary vasospasm
MOA of Calcium Channel Blocker
47
Most commonly used: diltiazem, verapamil, nifedipine
Calcium Channel Blocker
48
(Calcium channel blocker) STABLE ANGINA: | Promote relaxation of peripheral arterioles, leading to decrease in afterload
True
49
(Calcium channel blocker) VARIANT ANGINA: | Promote relaxation of the coronary artery spasm
True
50
Cardiovascular – dilation of the peripheral arterioles LOWERS blood pressure, and induce reflex tachycardia Must be used cautiously with beta blockers and in patients with bradycardia, heart failure
Adverse effect of Calcium channel blocker
51
New class of antianginal agents Reduces anginal episodes and increased exercise tolerance DOES NOT reduces heart rate, blood pressure or vascular resistance Reduces accumulation of sodium and calcium in myocardial cells, which may help the myocardium use energy more efficiently
Ranolazine
52
Caution: CAN prolong the QT interval = Torsade points = ventricular dysrhythmia
Ranolazine
53
Pharmacokinetics Absorption from the GI tract is variable, but NOT affected by food Metabolized in liver, by CYP3A4
Ranolazine
54
QT prolongation – can lead to torsades de pointes Elevate Blood pressure (especially with renal impairment) Constipation Dizziness Nausea Headache
Adverse effects of Ranolazine
55
CYP3A4 Inhibitors – grapefruit juice, HIV protease inhibitors, macrolide antibiotics, azole antifungal drugs and some calcium channel blockers Dangerous accumulation of the drug can happen to the body so don’t give with CYP3A4 INHIBITOR QT drugs – drugs that prolong the QT interval (sotalol, dofetilide)
Ranolazine drug interactions
56
QT drugs – drugs that prolong the QT interval (sotalol, dofetilide) Calcium Channel Blockers – most CCB, but not amlodipine – can inhibit the CYP3A4 and increase levels of ranolazine AMLODIPINE IS THE ONLY ONE THAT SHOULD BE USED WITH RANOLAZINE
Ranolazine drug interactions

Pharmacology (2 decks)

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