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18 Cards in this Set
- Front
- Back
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INTRODUCTION
n THREE MAIN CORONARY ARTERIES –? n RECEIVE ???% OF ALL BLOOD FLOW n CAPTURES ???% OF ALL OXYGEN n CARDIAC MUSCLE HAS LIMITED CAPACITY FOR _______________ |
1 RIGHT CORONARY, 2 LEFT CORONARY ARTERIES
n RECEIVE 4% OF ALL BLOOD FLOW n CAPTURES 10% OF ALL OXYGEN n CARDIAC MUSCLE HAS LIMITED CAPACITY FOR ANAEROBIC METABOLISM |
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ANGINA?
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n IMBALANCE BETWEEN MYOCARDIAL OXYGEN REQUIREMENT VERSUS DELIVERY
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ANGINA ETIOLOGY
6 |
n ATHEROSCLEROSIS
n VASOSPASM (PRINZMETAL) n HYPERTENSION n ANEMIA n THYROTOXICOSIS n CONGESTIVE HEART FAILURE |
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ANGINAL PRECIPITATING FACTORS
6 |
n OVEREATING
n EXERCISE n INTENSE EMOTIONAL STIMULI n EXTREMES OF HEAT AND COLD n MEDICATION: sympathomimetics, anorectic agents, antidepressants n SMOKING |
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THERAPEUTIC ALTERNATIVES
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n INVASIVE
– surgery, angioplasty |
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PHARMACOLOGIC
Angina 2 Does not treat____? |
– Decrease cardiac workload
– Reverse vasospasms – Does not treat underlying pathology |
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NITRATES
3 effects |
n CORONARY ARTERY VASODILATION
n PERIPHERAL ARTERY DILATION n PERIPHERAL VENOUS DILATION |
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NITRATES
PERIPHERAL VENOUS DILATION |
– Decreases pre-load (primary mechanism)
• increases venous pooling, decreasing return to heart • decreases amount of blood to pump • decreases work load • decreases oxygen demand |
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NITRATE USES
2 |
n ACUTE ANGINA - relief of symptom of pain
n PROPHYLACTIC - decreasing incidence of anginal pain by administering medication routinely. – Or administer prior to exertion |
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NITRATE CAUTION
3 |
n TOLERANCE DEVELOPS TO CONSTANT BLOOD LEVELS
n INCREASES INTRA OCULAR PRESSURE n SIDE EFFECTS – Headache – Syncope – Cutaneous flushing |
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n NITRATE SIDE EFFECTS
3 |
– Headache
– Syncope – Cutaneous flushing |
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NITRATE COMPARISON
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n ACUTE ONSET DURATION
n NTG SUBLINGUAL 3 MIN 10 MIN n ISDN DINITRATE 2-5 MIN 1 HR n PROPHYLACTIC n NTG Ointment 1 HR 4-6 HRS n ISOSORBIDE TAB 1/2 HR 6 HRS n NTG PATCH 24 HR 24 HR |
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NITRATE SUBLINGUAL
6 |
n Use lowest dose
n Administer as tablet or spray n 1 dose every 5 minutes for 3 doses maximum n Tablets leave a burning sensation n Store in glass bottle with metal cap n Store in cool non-humid place |
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NITRATE OINTMENT
4 |
n Dosed by the inch
n Remove previous application n Placed on skin surface with good blood supply n Use gloves when applying – To avoid tolerance and hypotension |
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NITRATE PATCH
2 |
n 24 hour onset
n To prevent tolerance remove at bedtime |
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NITRATE INJECTION
n USE 2? n ADMINISTER UTILIZING ? n Decreases ? |
NITRATE INJECTION
n USE – Unstable Angina – Post-cardiac surgery n ADMINISTER UTILIZING NON-PHTHALATE INJECTION TUBING n Decreases pre-load and after-load |
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BETA BLOCKERS
n Pharmacology 3demand n Low dose administration n Abrupt withdrawal exacerbates cardiac ischemia |
BETA BLOCKERS
n Pharmacology – Decrease heart rate – Decreases cardiac work load – Decreases cardiac oxygen demand n Low dose administration n Abrupt withdrawal exacerbates cardiac ischemia |
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CALCIUM CHANNEL BLOCKERS
1 use decreases cardiac work load – VASOSPASM ANGINA - increases oxygen supply by dilating coronary arteries |
CALCIUM CHANNEL BLOCKERS
n USE – CLASSICAL ANGINA - decreases cardiac work load – VASOSPASM ANGINA - increases oxygen supply by dilating coronary arteries |
