Flashcards in E1: Anti-ANGINALs Deck (49):
Angina = pain when the heart becomes ______
Pain occurs more often at _______
NIGHTTIME (Parasym actvivity and not enough O2 to the heart)
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
Variant Angin: _____: 4 /100,000...More common in _____ (m/f?); Which RACE is more prone?
What type of angina is more common? Which is more rare?
Typical (exertional) is more common....Variant Angina is more rare
When coronary arteries are normal: Mainly _____ receptors in coronary arteries = ________ causes vasodilation (improves bloodflow to the heart)
beta 2... epinephrine
Epinephrine also acts on _____ receptors (WHAAa??), increasing oxygen demand of the heart
INTERESTANTE!!!! Individuals with variant angina have more ______ receptors than ______ receptors in their coronary arteries (vasoconstriction)
alpha 1....beta 2
Variant Angina: Epinephrine increases heart rate and cardiac output (____) but now vasoconstricts coronary arteries (_____)..Double Whammy
beta 1... alpha 1
IN variant angina: EKG diagnosis consists of an elevated _______ segment which is not present in normal angina
What are the 5 typical treatments of angina?
1.Nitrates 2.beta blockers 3.Ca2+ channel blockers 4.Antiplatelet drugs 5.Antithrombin therapy
Nitrites and Nitrates Cause relaxation of all ________
Nitrates: Drugs work on endothelial cells that produce nitric
oxide...activates ________ which converts GTP to cGMP, which then causes dephosphorylation of light chain _____
Nitrates-Nitrites = Results in arterial and venous vaso______* WHICH decreases preload, which is ______ to the heart
dilation dawg.....venous return!
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
Nitrates oxidize hemoglobin to ________
Large doses of nitrites/nitrates for LONG TERM
use decreases _________ capabilities
Nitrates: rapid _______ will develop: transdermal patches allow for a daily nitrate free interval....12 hours on, 12 hours off
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)
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
Nitroglycerin: Very caustic to _______ mucosa = looks like a burn
sublingual...DO NOT Tx if there is UNCONTROLLED ANGINA
￼Summary of Effects of Beta Blockers: _______ chronotropic
￼Summary of Effects of Beta Blockers: _______ inotropic
￼Summary of Effects of Beta Blockers: _______ arterial pressure
￼Summary of Effects of Beta Blockers: _______ afterload
NOTE: Beta blockers DO NOT cause ________
Patients with a history of MI will ALWAYS be taking ________
Side effects of Beta Blockers: ______cardia... ________ in some forms of congestive
Tom Bradycardia... Contraindicated!!!
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
Side effects of Beta Blockers: Bronchial constriction/______ attacks
I'll give you asthma!
________ beta blockers are contraindicated in asthmatics
Nonselective beta blockers decrease glycogenolysis and glucagon secretion = ________ after insulin injection
cardioselective agents are preferred for WHICH TWO CONDITIONS????
insulin- dependent DIABETIC and ASTHMATICS
Beta blockers often combined with _______ to prevent sodium retention
WHEELHOUSE! ￼Oral Care Considerations with Beta Blockers--Non-selective beta blockers ENHANCE the pressor response to epinephrine: causing _______ & ________
hypertension and reflex bradycardia
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
WHEELHOUSE! ￼Oral Care Considerations with Beta Blockers--Renember? ________ may reduce effects of beta blockers when used for >3 weeks
WHEELHOUSE! ￼Oral Care Considerations with Beta Blockers--No precautions needed with ______ NSAID use
Ca2+ Channel Blockers otra vez: ________ inotropic effect
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
Ca2+ Channel Blockers otra vez: Because the heart does not speed up, no pain from _______
Ca2+ Channel Blockers otra vez: Some of these drugs cause smooth muscle relaxation of the coronary arteries = ________
Ca2+ Channel Blockers otra vez: What 2 drugs Decrease force of contraction of myocardium?
VERA-PA-mil AND DIL-TIA-zem
Ca2+ Channel Blockers otra vez: What drug Vasodilates coronary arteries to improve myocardial oxygenation?
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
FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals---Limit ______ of procedures per visit
FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals---limit epinephrine (1:100,000) in local anesthesia to ___ cartridges...Cardiac dose = _____ mg epinephrine
FAAAREEEAAAKIN WHEELHOUSE: Oral Care Considerations with Antianginals---consider local anesthetics without _________