Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
18 Cards in this Set
- Front
- Back
|
Exertional angina
|
due to obstruction of the coronary vessels by atherosclerotic plaques. Brought on by exertion
|
|
|
Variant angina
|
due to spasms of the vascular smooth muscles leading to the heart which temporarily narrow the artery. Usually does not progress to a MI.
|
|
|
List the 3 drug classes used to treat extertional angina?
|
a. Nitrates
b. B-blockers c. Calcium channel blockers |
|
|
List the determinants of myocardial oxygen demand & how each class of drugs used to treat exertional angina modifies demand.
|
a. HR—faster rate requires more O2
b. Heart muscle contractivity—stronger contractions require more O2 c. Preload—increased blood volume in ventricle just prior to contraction (venous) d. Afterload—increased resistance the ventricles must pump against (atrial |
|
|
Recognize signs/symptoms of exertional angina attacks.
|
a. Pain/discomfort—pressure, squeezing, burning,or tightness in chest, starting behind breastbone
b. Pain can radiate to or begin in arms, sho, neck, jaw, throat or back c. May feel like indigestion d. May have nausea, fatigue, shortness of air, sweating, lightheaded, weak |
|
|
Discuss proper management of exertional angina attacks
|
a. Prophylactic therapy to prevent attacks
i. B-blockers—prevent attacks but also improve morbidity/mortality ii. Daily nitroglycerin and/or CCB b. SL nitroglycerin for acute attacks. Pt should carry it with them & to PT appts c. Antiplatelet therapy—prescribed to reduce risk of MI & stroke d. A statin and/or cholesterol lowering drugs will be prescribed to reduce total cholesterol, LDL& increase HDL as well as reduce risk of MI/Stroke & improve M/M |
|
|
List the 2 drug classes used to treat variant angina & why these are effective but β-blockers are not.
|
CCB & daily nitroglycerin
|
|
|
Discuss the mechanism of action, therapeutic uses, & side effects of the nitrates.
|
a. Mech—venous dilator. Nitrates are converted to nitric oxide (NO) that acts at a cellular level through a chain of chemical reactions to ultimately relax vascular smooth muscle. Reduced arteriolar & venous tone= decrease preload& decreased afterload & decreased myocardial O2 demand. Promote increased blood flow to deep myocardial muscle
b. Therapeutic—angina? c. SE—flushing,venous pooling, headache, hypotension & orthostatic hypotension (dizziness, lightheadedness) |
|
|
Discuss why some patients may be instructed to provide themselves with a daily nitrate-free interval
|
a. To avoid tolerance (tolerance= needs higher and higher level to induce complete response)
b. Tolerance can develop after only a few days of continual use |
|
|
Distinguish between the nitrate formulations that treat acute attacks vs. those used prophylactically
|
a. Acute
i. Nitroglycerin sublingual tablets & sublingual spray ii. Nitroglycerin topical ointment b. Prophylactically i. Nitroglycerin transdermal patches ii. Nitroglycerin sustained release capsules iii. Isosorbide dinitrate & isosorbide mononitrate tablets |
|
|
Discuss patient instructions for using sublingual nitroglycerin
|
a. Dissolve 1 tablet under tongue; may repeat every 3-5 minutes until pain is relieved or until 3 tablets have been taken. Contact physician or call 911 if pain persists
|
|
|
B-blockers on exercise tolerance?
|
reduce O2 demands of heart by decreasing myocardial oxygen requirement during exertion and stress
|
|
|
CCB on exercise tolerance?
|
reduce heart rate and contractility, reduce afterload, reduce myocardial O2 demand
|
|
|
Nitrates on exercise tolerance?
|
venous & arteriole dilators, reduce O2 demand by decreasing preload & afterload
|
|
|
List prophylaxis for angina?
|
b-blockers, CCBsor long acting nitroglycerin
|
|
|
Acute attacks for angina meds
|
SL nitroglycerin
|
|
|
aspririn and statein for angina?
|
anti-platelet drugs & med to reduce cholesterol
|
|
|
13. Discuss exercise recommendations for patients with angina (e.g. benefits vs risks; intensity of exercise)
|
a. Benefit of exercise outweighs risk. Fitness improves exercise tolerance, reduces symptoms, improves M&M
b. At cell—exercise improves endothelial function, increases nitric oxide release, reduces inflammation, and decrease triglycerides &increases HDL c. Low intensity aerobic training 3x/week initially→may progress as tolerated d. An exercise stress test can determine a safe exercise prescription including target HR e. Avoid physical exertion in very hot, cold, humid f. Stop activity immediately if sx occur g. Use SL nitroglycerin if available |
