Week 9 - Anti Anginals

Question 1

What is angina pectoris?

Answer 1

Chest pain

When the supply of O2 and nutrients is not enough to meet demands of heart, the muscle aches

Question 2

Ischemia

Answer 2

Poor blood supply to an organ

Question 3

Ischemic heart disease

Answer 3

Poor blood supply to the heart
- atherosclerosis
- CAD

Question 4

MI

Answer 4

Myocardial infarction
- necrosis of cardiac tissue

Question 5

Types of angina (3)

Answer 5

Chronic stable angina

Unstable angina

Vasospastic angina

For sure on exam

Question 6

Chronic stable angina (from google)

Answer 6

Type where angina is present during physical or emotional stress

Relieved by rest or medication

Question 7

Unstable angina (from google)

Answer 7

Chest pain that is unpredictable

Not relieved by Nitroglycerin or rest

MI potential

Question 8

Vasospastic angina (from google)

Answer 8

Severe chest pain due to coronary artery spasms

Typically not resolved by rest

Question 9

Drug categories for angina (3)

Answer 9

Nitrates/nitrites

beta blockers

Calcium channel blockers

Question 10

Therapeutic objectives in angina

Answer 10

Minimize frequency of attacked and decrease duration/intensity of pain

Improve patients functional capacity

Preventt or delay MI

Question 11

Nitrates and nitrites are available in many forms like:

Answer 11

Sublingual
Chewable
Oral capsules
IV
Transdermal
Ointments
Translingual sprays

Question 12

Forms of nitrates/nitrites that bypass the liver / first pass effect

Answer 12

SL, IV, transferral, translingual sprays

Question 13

Nitrates/nitrites: mechanism of action

Answer 13

Causes vasodilation due to relaxation of smooth muscles

Question 14

Nitrates and nitrites: drug effect

Answer 14

Potent dilating effect of coronary arteries

Result: o2 to ischemic tissue

Used to prevent/treat angina

Question 15

Rapid acting forms of nitrates / nitrites
(Form/use)

Answer 15

Sublingual tabs/spray
IV

Used to treat acute anginal attacks

Question 16

Long acting forms of nitrites/nitrates use

Answer 16

To prevent anginal episodes

Question 17

Nitrates and nitrites examples and if they are long/rapid acting

Answer 17

Nitroglycerin (both)
Isosorbide dinitrate (both)

Isosorbide mono nitrate (primarily long acting)

Question 18

Nitroglycerin overview (what is it, use)

Answer 18

Prototype nitrate
Large first pass effect if taken orally

Used for symptomatic treatment of angina

IV form used to treat hypertension, pulmonary edema (with MI)

Question 19

nitrates adverse effects

Answer 19

Headaches
- usually less with continued use

Reflex tachycardia

Postural hypotension

May develop tolerance

Question 20

Tolerance of nitrates

Answer 20

Occurs if you take it all the time or long acting forms

Prevented by allowing a nitrate free period to allow enzyme pathways to replenish

Question 21

Nitrates: contraindications

Answer 21

Allergy
Severe anemia
Glaucoma
Hypotension
Head injury
Use of erectile dysfunction drugs

Question 22

What is the most importance drug used in teh treatment of angina

Answer 22

Nitroglycerin

Question 23

Beta blockers treat:

Answer 23

Angina
MI
Hypertension
Dysrhythmias

Question 24

Examples of anti anginal beta blockers

Answer 24

Atenolol
Metoprolol
Porranolol hydrochloride
Nadolol

Anything ending in “olol”

Question 25

Beta blockers mechanism of action

Answer 25

Block beta 1 receptors on teh heart This decreases heart rate, resulting in decreased o2 demand Decreases myocardial contractility, conserves energy After an MI, there are lots of catecholamines in the heart which irritate it. These block teh effects of catecholamines

Question 26

Catecholamines

Answer 26

Present in the heart after an MI Cause imbalance of supply/demand ratio and cause dsyrhythmias Beta blockers counter these

Question 27

Beta blockers indication

Answer 27

Angina, hypertension, dysrhythmias, MI Headaches

Question 28

Beta blockers contraindications

Answer 28

Systolic HF Conduction disturbances Asthma Diabetes mellitus (can mask hypoglycemia) PAD

Question 29

Beta blockers adverse effects

Answer 29

CV: bradycardia, hypotension Metabolic: hyper/hyporglycemia, hyperlipidemia CNS: dizziness, fatigue, depression MISC: ED, dyspnea

Question 30

Atenolol

Answer 30

Brand name - tenormin Beta1 adrenergic receptor blocker Indication: angina

Question 31

Metoprolol

Answer 31

Trade name - lopresor/betaloc Beta1 adrenergic receptor blocker Basically the same as atenolol Reduces mortality in MI patients

Question 32

Calcium channel blockers for chronic stable angina (examples)

Answer 32

Amlodipine Diltiazem Nifedipine Verapamil hydrochloride

Question 33

Calcium channel blockers mechanism of action

Answer 33

Cause coronary artery vasodilation and peripheral artery vasodilation - decrease systemic vascular resistance Reduce heart workload - decrease o2 demand Decreases myocardial

Question 34

Calcium channel blockers: indication

Answer 34

Angina Hypertension Tachycardia Coronary artery spasm AFIB Migraines

Question 35

Calcium channel blockers contraindications

Answer 35

Allergy Acute MI AV block (unless pacemaker is in place) Hypotension

Question 36

Calcium channel blockers adverse effects

Answer 36

Not many, basically if they express too much Hypotension, palpitations, constipation, nausea

Question 37

Diltiazem hydrochloride

Answer 37

Trade - cardizem, Tiazac Very effect angina treator Used in treatment for AFIB and tachycardia

Question 38

Amlodipine besylate

Answer 38

Trade - norvasc Most popular Ca channel blocker Used for angina and hypertension Oral use only

Question 39

Nursing implications (general with antianginals)

Answer 39

- Complete health history to determine contraindications - obtain vitals - assess for interactions - encourage limited caffeine - tell them to report symptoms - dont drink - dont go in hot tubs too long that would be dumb

Question 40

Nursing implications for nitroglycerin

Answer 40

- teach proper technique - dont chew/swallow SL form - stock up - store in good places - take as needed - lie down if pain

Question 41

Nursing implications for beta blockers

Answer 41

- monitor pulse rates daily and report if <60 - do not abruptly DC - long term, not immediate effect

Question 42

Nursing implications for Ca channel blockers

Answer 42

- constipation is common (drink water)