E1: Anti-ANGINALs Flashcards Preview

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Flashcards in E1: Anti-ANGINALs Deck (49):
1

Angina = pain when the heart becomes ______

anoxic

2

Pain occurs more often at _______

NIGHTTIME (Parasym actvivity and not enough O2 to the heart)

3

What type of angina is this? Coronary arteries not able to transport enough oxygen to meet myocardium demand....Oxygen imbalance causes ISCHEMIA..Stress, exertion, eating, anxiety, cold, local anesthesia, pain, atherosclerotic lesions (block flow of blood). If demand exceeds available oxygen, then NECROSIS occurs = MI

Typical (exertional) angina

4

Variant Angin: _____: 4 /100,000...More common in _____ (m/f?); Which RACE is more prone?

Rare...Japanese

5

What type of angina is more common? Which is more rare?

Typical (exertional) is more common....Variant Angina is more rare

6

When coronary arteries are normal: Mainly _____ receptors in coronary arteries = ________ causes vasodilation (improves bloodflow to the heart)

beta 2... epinephrine

7

Epinephrine also acts on _____ receptors (WHAAa??), increasing oxygen demand of the heart

beta 1

8

INTERESTANTE!!!! Individuals with variant angina have more ______ receptors than ______ receptors in their coronary arteries (vasoconstriction)

alpha 1....beta 2

9

Variant Angina: Epinephrine increases heart rate and cardiac output (____) but now vasoconstricts coronary arteries (_____)..Double Whammy

beta 1... alpha 1

10

IN variant angina: EKG diagnosis consists of an elevated _______ segment which is not present in normal angina

S-T segment

11

What are the 5 typical treatments of angina?

1.Nitrates 2.beta blockers 3.Ca2+ channel blockers 4.Antiplatelet drugs 5.Antithrombin therapy

12

Nitrites and Nitrates Cause relaxation of all ________

smooth muscle

13

Nitrates: Drugs work on endothelial cells that produce nitric
oxide...activates ________ which converts GTP to cGMP, which then causes dephosphorylation of light chain _____

guanylyl cyclase...myosin

14

Nitrates-Nitrites = Results in arterial and venous vaso______* WHICH decreases preload, which is ______ to the heart

dilation dawg.....venous return!

15

Nitrates: side effects- the rapid vasodilation causes _____... What are two other side effects?

headaches! (pressure in the skull dawg)...Flush/Postural Hypotension!!! & increased sympathetic activity

16

Nitrates oxidize hemoglobin to ________

methemoglobin

17

Large doses of nitrites/nitrates for LONG TERM
use decreases _________ capabilities

oxygen-carrying...YIKES

18

Nitrates: rapid _______ will develop: transdermal patches allow for a daily nitrate free interval....12 hours on, 12 hours off

tolerance

19

What are the 5 preparations of Nitrates?

1. Amyl Nitrate 2.Vaprole 3.Nitroglycerin 4.iso-sorbinde DInitrate (long acting) 5.iso-sorbide MONOnitrate (even longer acting)

20

How long do you wait after giving nitroglycerin before giving another dose? How many doses before calling 911?

5 minutes in between dose. after 3 does = 911

21

Nitroglycerin: Very caustic to _______ mucosa = looks like a burn

sublingual...DO NOT Tx if there is UNCONTROLLED ANGINA

22

Summary of Effects of Beta Blockers: _______ chronotropic

Negative

23

Summary of Effects of Beta Blockers: _______ inotropic

Negative

24

Summary of Effects of Beta Blockers: _______ arterial pressure

reduced

25

Summary of Effects of Beta Blockers: _______ afterload

reduced

26

NOTE: Beta blockers DO NOT cause ________

vasodilation

27

Patients with a history of MI will ALWAYS be taking ________

beta blockers!

28

Side effects of Beta Blockers: ______cardia... ________ in some forms of congestive
heart failure

Tom Bradycardia... Contraindicated!!!

29

Side effects of Beta Blockers: Contraindicated for ______ angina & OK for _______ angina

VARIANT Patient does not have enough beta receptors in coronary arteries, then if block, vasospasm = more angina due to greater oxygen deficit = potentially fatal!......OK for typical (exertional) angina

30

Side effects of Beta Blockers: Bronchial constriction/______ attacks

I'll give you asthma!

31

________ beta blockers are contraindicated in asthmatics

Nonselective

32

Nonselective beta blockers decrease glycogenolysis and glucagon secretion = ________ after insulin injection

hypotension

33

cardioselective agents are preferred for WHICH TWO CONDITIONS????

insulin- dependent DIABETIC and ASTHMATICS

34

Beta blockers often combined with _______ to prevent sodium retention

Diuretic

35

WHEELHOUSE! Oral Care Considerations with Beta Blockers--Non-selective beta blockers ENHANCE the pressor response to epinephrine: causing _______ & ________

hypertension and reflex bradycardia

36

WHEELHOUSE! Oral Care Considerations with Beta Blockers--OK to use epinephrine with __________ agents!!!!!
– Limit dose to _____ mg = ____ cartridges of 1:100,000

cardioselective....0.04mg = 2 cartridges

37

WHEELHOUSE! Oral Care Considerations with Beta Blockers--Renember? ________ may reduce effects of beta blockers when used for >3 weeks

NSAIDS

38

WHEELHOUSE! Oral Care Considerations with Beta Blockers--No precautions needed with ______ NSAID use

short term

39

Ca2+ Channel Blockers otra vez: ________ inotropic effect

Negative

40

Ca2+ Channel Blockers otra vez: Block Ca+ entry into the myocardial cell = less Ca+ inside of the cell maintains ________’s inhibitory effects by decreasing contraction of the heart

troponin’

41

Ca2+ Channel Blockers otra vez: Because the heart does not speed up, no pain from _______

angina

42

Ca2+ Channel Blockers otra vez: Some of these drugs cause smooth muscle relaxation of the coronary arteries = ________

vasodilation

43

Ca2+ Channel Blockers otra vez: What 2 drugs Decrease force of contraction of myocardium?

VERA-PA-mil AND DIL-TIA-zem

44

Ca2+ Channel Blockers otra vez: What drug Vasodilates coronary arteries to improve myocardial oxygenation?

AM-LOD-ipine

45

Ca2+ Channel Blockers otra vez: What 2 drugs Vasodilate peripheral arteries and veins, decreasing afterload and preload, which reduces the work of the heart?

NI-FED-ipine and NI-CARD-ipine

46

FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals---Limit ______ of procedures per visit

EXTENT

47

FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals---limit epinephrine (1:100,000) in local anesthesia to ___ cartridges...Cardiac dose = _____ mg epinephrine

2 cartidges...0.04mg

48

FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals---consider local anesthetics without _________

vasoconstrictor

49

FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals---Remember gingival hyperplasia with some __________

calcium channel blockers