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NP 614 Test 2 > PHARMACOLOGY FOR CAD > Flashcards

PHARMACOLOGY FOR CAD Flashcards

(64 cards)

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0
Q

Reaches plasma levels in 20 minutes….results in platelet inhibition in 60 min

A

Aspirin

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1
Q

An effective treatment of CAD BECAUSE OF ITS EFFECTS ON PLATELETS AND VASCULAR ENDOTHELIAL CELLS.

A

ASPIRIN

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2
Q

Benefits pt in early stages of MI……GIVE 325 mg loading dose

A

Aspirin

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3
Q

Cew or crush enteric coated for

A

Faster absorption

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4
Q

Greater reduction of mi in men in women better against

A

Stroke…….aspirin

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5
Q

Mainstay med for pt with cad

A

Beta blockers

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6
Q

Decrease myocardial o2 consumption by decreasing heart rate at rest and exercise.

A

Beta blockers

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7
Q

Reduce mortality from MI

Reduces sudden cardiac death

A

Beta blockers

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8
Q

Beta blockers can be classified according to the relative __________ and ______.

A

Cardio selectivity

Lipid solubility

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10
Q

For beta blocker to be nonselective it must have an affinity for both _____and _______.

A

Beta 1 and beta 2 receptors.

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11
Q

For a beta blocker to be selective, it must have an affinity for

A

Beta one receptors

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12
Q

The blockade of beta two receptors may lead to

A

Bronco spasm and bronco constriction

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13
Q

The blockade of beta two receptors in a patient with diabetes may lead to an inappropriate response to

A

Hypoglycemia

It may mask symptoms.

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14
Q

What type of patient may benefit from a lower dose of beta one selective agents?

A

Patients with CAD, asthma, COPD, diabetes, or intermittent claudication.

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15
Q

Side effects of beta blockers include

A

Fatigue, impotence, cold extremities, bronco spasm, worsening claudication, Brady cardia, and cardiac conduction disturbances

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16
Q

Name some NON-SELECTIVE beta 1 and beta 2 blockers

A 
Propranolol - Inderal
timolol - biocarden
nadolol - corgard
sotalol-betapace
penbutolol -levatol
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17
Q

Name some nonselective VASOdilatory beta blocker agents

A

labetalol

pindolol

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18
Q

Name some cardio selective beta receptors only.

A 
acebutolol
atenolol
metoprolol
esmolol 
bisoprolol
nebivolol
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19
Q

This drug process is both beta and Alpha blocking actions and can be used to treat patients with Angina as well as patients with significant hypertension

A

Labetalol

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20
Q

These drugs promote vascular smooth muscle relaxation resulting in arterial and venous dilatation. They are recommended for the treatment of stable and unstable and Gina and the management of an acute MI.

A

Nitrates

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21
Q

Three nitrate preparations are currently available for use in the United States

A

Nitroglycerin
Isosorbide Denitrates
Isosorbide mononitrate

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22
Q

This nitrate is given sublingual and most useful for acute angina events due to the rapid action. Give name and dosage.

A

Sublingual nitroglycerin dosage of 0.4 milligrams.

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23
Q

How long does it take for sublingual nitroglycerin to work?

A

3 to 5 minutes

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24
Q

How long does the anti ischemic affect of sublingual nitroglycerin last?

A

30 minutes

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25
Because of it short duration of action, sublingual nitroglycerine should be combined with what to give a sustained affect?
Oral nitrates
26
A patient with chronic stable Angina with improvements in symptoms after one nitroglycerin may repeat nitroglycerin for a maximum ___________. Then what?
Of three doses. Call 911
27
A patient with acute coronary syndrome for whom nitroglycerin has been prescribed previously should not take more than how many doses in response to chest pain? Then what?
One dose. Call 911 before taking next dose.
28
Nitroglycerin tablets maintain their potency for how long?
Six months after the bottle has been opened.
29
nitroglycerin spray is useful for which kind of patients?
Visual are neurological impairments that would have difficulty handling a small tablet.
30
How is nitroglycerin spray delivered?
A metered dose of 0.4 mg and should be applied to the surface of the tongue.
31
How many doses are in each canister of nitroglycerin spray and how long will it maintain its potency?
200 doses Up to three years
32
Nitrate of choice into a ambulatory population is what?
Oral nitroglycerin
33
Oral nitroglycerin can be taken as either of these choices.
ISDN OR ISMN (ISOSORBIDE DINITRATE) (ISOSOBIDE MONOTRATE)
34
ISDN is extensively metabolize through the____.
Liver
35
Through the liver, more than half of ISDN is converted to ISMN. Because of the bypass effect, what conditions is ISDN not effective for?
Angina or enhancement of exercise capacity in dosage is of less than 20 mg every 4 hours.
36
Does ISMN undergo the hepatic degradation?
No. 100% of it is available after oral dosing.
37
What is the main advantage of ISMN nitrates?
dosing. They can be administered once or twice daily, whereas ISDN must be administered three or four times per day.
38
What is the main disadvantage of ISMN nitrates?
Cost. These preparations cost several times more than the generic ISDN. Consider this when prescribing for patients.
39
Are their distinct advantages between ISDN and ISMN nitrates?
No. There are no distinct advantages in use of one of these preparations over the other.
40
And this nitrate is absorbed through the skin and can be administered as ointment or patches.
Topical nitroglycerin.
41
Dosage of topical nitrglycerin is what?
2%
42
Pre measured nitrglycerin skin patches come in what dosages?
Five, 10, 15, or 20 milligrams per day.
43
The advantage of topical nitrglycerin is what?
The ointment can be removed promptly if any side effects develop.
44
The disadvantage of topical nitroglycerin ointment it is what?
The ointment is a messy, and soil clothing, is seldom dosed consistently each time, and may produce a localized a rash.
45
Why is the nitroglycerin patch preferred over ointment?
It produces a more controlled dose.
46
But what is the worry regarding long-term use of topical nitroglycerin?
Long-term use may lead to nitrate tolerance and decrease therapeutic effect. This is why it is recommended to remove from the skin for 8 to 12 hours daily.
47
How does nitrate tolerance develop?
But nitrate tolerance results from plasma nitrate levels sustained from continued nitrate administration.
48
Why is it important to identify nitrate tolerance?
Because it leads to a reduction in anti ischemic benefits.
49
Combination therapy of beta blockers or calcium channel blockers along with nitrates is indicated why?
To avoid the effects of nitrate tolerance dosing, intervals free of nitrites must occur. Because of this reflex tachycardia can occur. Beta blockers are calcium channel blockers will correct the tachycardia.
50
ISDN nitrates and dosages are
Isordil, Sorbitrate 20 mg every 4 to 6 hours maximum dose 240 mg Onset of action 60-90 minutes Duration of action 4-6 hours
51
ISDN-SR nitrate dosage
Dilatrate-SR | 40 mg every 8-12 hours
52
ISMN meds and dosages
Ismo, Monoket | 20 mg in the AM and 20 mg 7 hours later
53
ISMN-SR NITRATE
Imdur 30-60 mg daily max dose 120-240 mg daily
54
Nitroglycerin ointment 2% dosage
Nitro bid nitrol 0.5 inch every 4 to 6 hours-starting dose Max dose- 4 to 5 inches every 3 to 4 hours Onset of action 30 to 60 minutes Duration of action 3 to 6 hours
55
Nitroglycerin patch dosage
``` Transderm nitro nitro-dur nitrodisc dEPONIT Starting dose 5 mg per 24 hours (0.1 to 0.4 mg per hour) Maximum dose-2 to 3 patches of 15 mg in 24 hours. Onset of duration-30 minutes Duration of action-24 hours ```
56
Calcium channel blockers are used in the treatment of what?
Hypertension and angina
57
They selectively inhibit the influx of what?
Calcium into the calcium L channel in both smooth muscle and myocardial cells
58
Name the 2 classes of Calcium Channel Blockers.
Dihydropyridines (DHP's) | non-dihydropyridines (non-DHP'S)
59
Name some DHP's
``` Amlodipine (Norvasc) Isradipine (DynaCirc) Felodipine (Plendil) Nicardipine (Cardene) Nifedipine (Procardia, Adalat) Nisoldipine (Sular) ```
60
name some non-DHP's
Diphenlalkylamine derivative: (Verapamil [Calan, Covera HS, Isotopin, Verelan]) Benzothiazepine derivative: (diltazem [Cardizem, dilacor, tiazac])
61
DHP's, because they're vascular selective, have little or no effect on what parts of the heart?
The sinus and atrioventricular nodes.
62
DHP's have a rapid VASOdilatory effect which may lead to what problems?
Reflex tachycardia Exacerbation of heart failure it's Stimulation of renin -angiotensin system
63
The undesired affect of DHP's,[ Reflex tachycardia Exacerbation of heart failure and Stimulation of renin -angiotensin system] Are more common among the___________.
Short acting DHP's
64
Patients with what condition should avoid DHP's?
Patients with an acute MI.

NP 614 Test 2 (5 decks)

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