Pharmacology Ch. 46 Antianginal Agents

Angina A. causes death of heart muscle cells. B. is pain due to lack of oxygen to myocardial cells. C. cannot occur at rest. D. is not treatable.

B. is pain due to lack of oxygen to myocardial cells.

Angina pectoris

"suffocation of the chest"

Adverse effects of calcium channel blockers (Diltiazem)

-Hypotension -Cardiac arrhythmias -GI upset -Skin reactions -Headache

Which leads to narrowing of the lumen of the artery and ultimately loss of distensibility and responsiveness? Atheromas Atherosclerosis Myocardial infarction Prinzmetal angina

Atheromas

Which is a beta-blocker? Verapamil Nadolol Nitroglycerin Nifedipine

Nadolol

Indication of nitrates (nitroglycerin)

Prevention and treatment of attacks of angina pectoris

Unstable and stable angina both show

a blockage is present

The nurse is educating a patient who has been prescribed calcium channel blockers. What will the nurse include in the teaching? "You will need to come in every 6 months so we can conduct lung function tests." "Don't drink excessive amounts of water, as this drug will make you urinate more frequently." "Because this drug may upset your stomach, it's a good idea to have small, frequent meals." "Avoid taking over-the-counter medications for pain while you are taking this drug."

"Because this drug may upset your stomach, it's a good idea to have small, frequent meals."

What is a severe sympathetic stress reaction?

A sudden feeling of nearing death "I feel like I am going to die!" lol me

MOA of beta blockers (Metoprolol)

Blocks beta-adrenergic receptors in the heart and kidneys, decreases the influence of the SNS on these tissues; decreases cardiac output and the release of renin.

Indication for calcium channel blockers (Diltiazem)

Prinzmental's angina Chronic angina Effort-associated angina Hypertension

MI =

cell death/ damage

What characterizes ASCVD?

progressive narrowing of coronary arteries leading to decreased delivery of oxygen to cardiac muscle cells -hardening of arteries

-oma means

tumor or growth

indication for beta blockers (Metoprolol)

-Long-term management of angina pectoris caused by atherosclerosis. -Sometimes used in combination with nitrates to increase exercise tolerance. -Propranolol and metoprolol can also be used to prevent reinfarction in stable patients 1 to 4 weeks after MI.

athero- means

fatty

MOA of nitrates (nitroglycerin)

-Act directly on smooth muscle to cause relaxation and depress muscle tone -Relax and dilate veins, arteries, and capillaries. -Main effect seems to be related to drop in blood pressure. -decreases preload, reduces cardiac workload and oxygen demand

Stable angina

No damage to the heart muscle. -Basic reflexes surrounding the pain restore blood flow. -relieved with rest and nitrates

Angina

Pain in response to lack of oxygen in the heart muscle

Prinzmetal angina

Seems to be caused by spasms of the blood vessels, not just by vessel narrowing. -relived by ca channel blockers (suppress) and nitrates

Angina =

pain

Atherosclerosis

narrowing of the heart vessels -hardening and blockage

Prinzmetal angina occurs as a result of A. electrolyte imbalance. B. a spasm of a coronary vessel. C. decreased venous return to the heart. D. a ventricular arrhythmia.

B. a spasm of a coronary vessel.

Coronary artery disease results in A. an imbalance in cardiac muscle oxygen supply and demand. B. delivery of blood to the heart muscle during systole. C. increased pulse pressure. D. a decreased workload on the heart.

A. an imbalance in cardiac muscle oxygen supply and demand.

Calcium channel blockers are effective in treating angina because they A. prevent any CV exercise, preventing strain on the heart. B. block strong muscle contractions, causing vasodilation. C. alter the electrolyte balance of the heart, preventing arrhythmias. D. increase the heart rate, making it more efficient.

B. block strong muscle contractions, causing vasodilation.

_____ is caused by an accumulation of cholesterol plaque in arteries and can lead to peripheral arterial disease, MI, and ischemic stroke.

ASCVD "Coronary Artery Disease"

What condition indicates the need to administer nitroglycerin? Headache Dizziness Chest pain Palpitations

Chest pain

Which finding is not an adverse effect of nitroglycerin? Hypotension Constipation Headache Weakness

Constipation

A nurse would recognize that increased monitoring would be recommended if a patient was taking both verapamil and which medication? A. Oral contraceptives B. Cyclosporine C. Digoxin D. Barbiturate anesthetics

D. Barbiturate anesthetics

Nitrates are commonly used antianginal drugs that act to A. increase the preload on the heart. B. increase the afterload on the heart. C. dilate coronary vessels to increase the delivery of oxygen through those vessels. D. decrease venous return to the heart, decreasing the myocardial workload.

D. decrease venous return to the heart, decreasing the myocardial workload.

unstable angina

Episodes of ischemia (reduced blood flow) occur even when at rest. -leads to MI

Actions of Antianginal Drugs

Help restore the appropriate supply-and-demand ratio in oxygen delivery to the myocardium. Improve blood delivery to the heart muscle by dilating blood vessels. o Increasing the supply of oxygen Improve blood delivery to the heart muscle by decreasing the work of the heart. o Decreasing the demand for oxygen

Routes for Nitroglycerin

IV Sublingual- dissolves under the tongue Translingual Spray Transmucosal Tablet Oral, SR Tablet Topical Ointment Transdermal -A tiny amount of med (topical/patch) is given continuously

MOA of calcium channel blockers (Diltiazem)

Inhibit the movement of calcium ions across the membranes of myocardial and arterial muscle cells, altering the action potential and blocking muscle cell contraction. -Results in loss of smooth muscle tone, vasodilation, and decreased peripheral resistance

How does nitroglycerin work? It vasoconstricts veins, arteries, and capillaries. It increases myocardial contractility. It vasodilates veins, arteries, and capillaries. It increases metabolic demand.

It vasodilates veins, arteries, and capillaries.

A patient is receiving nitroglycerin sublingually. How should the nurse instruct the patient to take this medication? Swallow the pill whole. Chew the pill quickly. Mix the pill in juice. Let the pill dissolve under the tongue.

Let the pill dissolve under the tongue.

Which is the nitrate of choice to treat an acute anginal attack? Isosorbide dinitrate Isosorbide mononitrate Nitroglycerin Propranolol

Nitroglycerin

Which type of angina occurs when there is a drop in blood flow caused by arterial spasm rather than when there is narrowing from a blockage? Stable Unstable Prinzmetal Myocardial

Prinzmetal

Adverse effects of nitrates (nitroglycerin)

Related to the vasodilatation and decreased in blood flow CNS - Headache, dizziness, and weakness GI - Nausea, vomiting CV - Hypotension Misc. - Flushing, pallor, increased perspiration (cold, clammy, sweating)

Adverse effects of beta blockers (Metoprolol)

Related to their blockage of the sympathetic nervous system. CNS - Dizziness, fatigue (feeling tired, lazy), emotional depression GI - Nausea, vomiting, colitis (inflammation of colon) CV - CHF, decreased cardiac output, and arrhythmias Respiratory - Bronchospasm, dyspnea, and cough

Signs and symptoms of Myocardial infarction

Remember the mnemonic: CRUSHING Chest pain (intense, heavy, excruciating) Radiating chest pain that goes to left arm, jaw, back Unrelieved by nitroglycerin or rest (chest pain) Sweating (cold) Hard to breathe (shortness of breath) Increased heart rate, blood pressure or irregular heart rate Nausea with vomiting Going to be anxious and scared -may be caused by arrhythmia, sometimes leads to fatal death

A nurse is administering nitroglycerin to a patient. What is the priority intervention? Stay with the patient. Monitor vital signs every 15 minutes. Send the patient to the cardiac catheterization lab. Encourage incentive spirometry.

Stay with the patient.

Atheromas

fatty tumors in the endothelial lining of arteries -plague and cholesterol build up in the vessel and creates blood clot

Angina can be overwhelming for pts because...

it affects activities of daily living, making it hard to breathe and move when performing simple tasks. Ex. having to leave the restroom for air when taking a shower.

What happens if a coronary vessel becomes completely occluded and is unable to deliver blood to the cardiac muscle (the area of muscle that depends on that vessel for oxygen)?

it becomes ischemic and then necrotic, leading to MI

Prinzmentals angina shows

vessels pathologically contract or close for no particular reason.