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25 Cards in this Set
- Front
- Back
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What are the ways to administer NTG? What is the most common?
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Sublingual - most common
Oral Patch IV |
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What is a concern for nitroglycerin administration?
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If it's too old, it's no good.
Light, moisture damage it. |
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Why is nitroglycerin hard to administer orally?
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Extensive first pass metabolism by liver
If get straight into bloodstream, can work faster and not go into portal circulation right away. To solve, oral administration is with high doses |
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What is a common use of NTG?
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Instant relief from angina
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What is the mechanism of NTG?
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Direct formation of NO --> vasodilation
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What are the side effects of NTG?
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Secondary to vasodilation
Hypotension Headache Flushing/sweating Dizziness Reflex inreased SV, HR |
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What drug-drug interactions are important for NTG?
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Alcohol (esp. high doses)
Antihypertensive drugs Sildenafil, vardenafil, tadalafil |
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What are complications of nirate overdose?
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Hypotension and reflex sympathetic activation
Vasoconstriction and reflex sympathetics aren't enough to counter the peripheral vasodilation |
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What do you do in the case of a NTG overdose?
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Maintain cerebral blood flow
Saline |
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In px. with angina, what is the 3-dose 911 rule?
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If you take three doses and the angina is not relieved, all 9-1-1!
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What are the physiological effects of beta blockers?
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Decreased contractility
Decreased HR Decreased renin release |
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When should you use beta blockers as antianginals?
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Use as prophylaxis for nitrate induced reflex cardiac stimulation
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What are contraindications for beta blockers?
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vasospastic angina
Severe heart failure Bradycardia A-V block Asthma |
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What is the function of Ca channel blockers?
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To stop Ca from going inside the cells...duh
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What are the two main classes of CCBs?
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Nondihydropyridines
Dihydropyridines |
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What are some of the Non-dihydropyridines?
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Verapamil
Diltiazem |
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Where do the Non-dihydropyridines act?
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Myocardial and vascular SM
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What is the physiological activity of Non-dihydropyridines?
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Decrease:
HR Contractility vasoconstriction/spasm |
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What is the impact of Non-dihydropyridines on conduction of the heart?
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Slow down AV conduction - don't give at same time as beta blockers!
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What is the effect of Non-dihydropyridines on HR?
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No tachycardia!
Don't just vasodilate - also depress heart activity |
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What are situations in which you'd use the Non-dihydropyridines?
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Angina prophylaxis
Decreasing vsaospasm |
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What are some drug-drug interactions of Non-dihydropyridines?
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Don't use with other cardiac depressants
Don't use with other hypertensives --> hypotension Don't use with other drugs metabolized by CYP3A4 |
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What is the difference between the Non-dihydropyridines and the dihydropyridines?
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Non-dihydropyridines block Ca channels in the heart AND vascular SM, while
Dihydropyridine blocks ONLY the Ca channels in vascular SM |
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What is a problem with dihydropyridines that isn't there with Non-dihydropyridines?
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Reflex cardiac stimulation
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What is an example of the dihydropyridines?
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Nifedipine
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