Week 2 Flashcards
(30 cards)
Antihistamines have anticholinergic effects, which are contraindicated in which patients
patients with narrow-angle glaucoma, severe liver disease, or urinary retention, and asthma
what is angina pectoris
acute cardiac pain caused by inadequate myocardial blood flow
-It’s chest pain (heart isn’t getting enough blood/O2)
what are the two possible causes of angina pectoris?
- Plaque or blood clot occlusions
2. Coronary artery spasms (artery is spasming such that O2/blood cannot be delivered to heart)
Classic symptoms of angina include
◦ Chest tightness or pressure with pain radiating down left arm
◦ Referred jaw or neck pain
◦ May have SOB, diaphoresis, pallor, clammy skin, GI symptoms (the chest pain can mimic GERD)
◦ Usually lasts a few minutes; may lead to MI
(NB: pts w/ an underlying chronic illness may not show classic symptoms)
What is one of the most important questions to ask your pts with angina?
“have you ever felt pain like this before?”
3 types of angina pectoris
- Classic (stable)
- Unstable (pre-infarction)
- Variant (prinzmetal, vasospastic)
what is classic (stable) angina
Occurs w/ stress or emotion due to coronary artery narrowing or partial occlusion (somebody who has known cardiac disease, probably is on meds, they prly know how to treat it already (e.g. decrease/increase meds, etc)
what is unstable (pre-infarction) angina?
This is when you worry!
-Occurs frequently (increasingly so) over course of a day with ↑ severity due to coronary artery narrowing or partial occlusion (raise red flags, contact HCP!)
what is variant (prinzmetal, vasospastic) angina?
Occurs with REST, caused by vasospasm (can occur spontaneously). Some meds can have this side effect of vasospasm in the heart (e.g. some chemo drugs cause this)
what are the 3 types of antianginal drugs
- Nitrates: basically decrease O2 demand (e.g. vasodilators)
- Beta-blockers
- Calcium channel blockers
(basically these all decrease the O2 demand)
How do antianginal drugs work?
-They increase myocardial blood flow by either increasing O2 supply OR Decreasing O2 demand (they work to get the scales back in balance)
what’s the BASIC principle how nitrates work
**Reduces myocardial oxygen demand
They increase the vasodilation in the vasculature (both arteries and VENOUS (mostly)). By doing this, they decrease the myocardial ischemia (decrease heart’s workload, decrease preload)
what’s the most common side effect of NTG?
headache most common!
Also decr BP, dizziness, lightheadedness
Adverse effects of NTG
- Rebound effect of myocardial ischemia if NTG ointment or patch isn’t tapered over several wks
- Reflex tachycardia can occur if NTG given too rapidly (likely due to compensatory mechanism when BP drops)
- Life threatening: Circulatory collapse (this is why we always need to monitor PTs very closely)
NTG: Drug interactions
Enhanced hypotensive effect if given with:
◦ Beta-blockers
◦ Calcium channel blockers
◦ Antihypertensives
◦ Alcohol
(also may decrease effects of heparin)
(also contraindicated w/ viagra and Cialis)
what is the action of beta blockers
Block the beta1 (heart) and beta2 (bronchodilation) receptor sites
↓ effects of SNS by blocking action of catecholamines( Epinephrine & norepinephrine)
↓ HR & BP
Uses of beta blockers
◦ Antianginal
◦ Antidysrhythmic
◦ Antihypertensive
Calcium channel blockers are effective for
◦ Classic (stable) angina: ↓ O2 demand by relaxing peripheral arterioles
◦ Variant (vasospastic) angina: Relaxes coronary arteries
Other uses: Some dysrhythmias, HTN
what is the FIRST drug you give to treat HTN
a diuretic
How to treat African Americans with HTN
African-Americans get HTN at earlier age & have higher mortality than Caucasian-Americans
◦ Beta-blockers & ACE inhibitors LESS effective
◦ Use Alpha1 blockers & calcium channel blockers effective
◦ Respond to diuretics as initial monotherapy (only if it doesn’t work do you start w/ a different medication)
Asians and HTN drug therapy
Asians twice as sensitive to beta-blockers & other antihypertensives than are Caucasians (Usually need lower dosage)
what’s another name for HMG CoA Reductase Inhibitor drugs?
Statins
what are the drugs for treating HTN?
- Diuretics (should be used first)
- Beta (adrenergic) blockers
- Centrally acting Alpha2 Agonists (work opposite of how we would think of agonists in SNS. Inhibits norepinephrin. Used for PTs who have HTN that is resistant to other HTN drugs)
- Alpha (adrenergic) blockers
- Calcium channel blockers – by blocking amt of Ca+ going into cell–>vasodilation
- Angiotensin Converting Enzyme (ACE) Inhibitors
- Angiotensin II Receptor Blockers (ARBs) – (in PTs who are unable to tolerate ACE, give ARB. less coughing)
- Direct Renin Inhibitor – In PTs who can’t tolerate ACE or ARB, give direct renin inhibitor (rare)
What are the two types of dysrhythmias
- Atrial (arrhythmia in the atria)
• Prevent proper filling of ventricles
• Decrease CO by 1/3 (bc atria is not squeezing fully)
• Risk of stroke and TIA (bc of blood forming in the chambers of the heart, usually these clots start in the L atrium) - Ventricular (arrhythmia in the ventricles)
• Life-threatening
• Ineffective ventricular filling results in decreased or absent CO
• Ex. Premature Ventricular Complexes (PVC), ventricular tachycardia, and ventricular fibrillation
• Follow BCLS & ACLS algorithm
