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;
59 Cards in this Set
- Front
- Back
|
PAIN THAT OCCURS WHEN THERE IS INSUFFICIENT CORONARY BLOOD FLOW TO MEET MYOCARDIAL OXYGEN DEMAND
|
ANGINA
|
|
|
THE INSUFFICIENT CORONARY BLOOD FLOW IN ANGINA CAUSES WHAT SYMPTOMS
|
CHEST PAIN AND PRESSURE
|
|
|
CAUSES OF ANGINA INCLUDE WHAT?
|
ATHEROSCLEROSIS, CORONARY ARTERY SPASM AT THE SITE OF A LESION, PLATELET AGGREGATION AND THROMBOSIS OR EMBOLI, CORONARY VASOCONSTRICTION
|
|
|
CHRONIC STABLE ANGINA
|
RELIEVED BY REST OR SL NITROGLYCERIN
|
|
|
UNSTABLE OR CRESCENDO ANGINA
|
RECENT CHANGE IN FREQUENCY OR SEVERITY; MAY BE LESS RESPONSIVE TO SL NITRO; LAST LONGER THAN 30 MIN AND LESS ASSOCIATED WITH EXERTION
|
|
|
VARIANT OR PRINZMETAL ANGINA
|
SPASM OF THE CORONARY ARTERY, SYMPTOMS UNPREDICTABLE; HAPPEN AT REST USUALLY IN THE EARLY MORNING; FEMALES UNDER 50 WITH NO FIXED STENOSIS
|
|
|
THE DETERMINANTS OF DECREASED O2 SUPPLY
|
1. DECREASED O2 CONTENT (ANEMIAS) 2. DECREASED CORONARY BLOOD FLOW (HYPOTENSION, NITRATES AND NON-DHP CCB)
|
|
|
THE DETERMINANTS OF INCREASED 02 DEMAND
|
1. WALL STRESS (PRELOAD)- DHP'S RELIEVE B/C THEY ARE VASODILATORS 2. HEART RATE- THE FASTER IT IS THE MORE O2 YOU NEED (BETA BLOCKERS, NON DHP CCB-DECREASE THE DEMAND FOR OXYGEN BUT DO NOT IMPROBE OXYGEN DELIVERY) 3. CONTRACTILITY- INOTROPE- B BLOCKERS AND NON-DHP CCB (DECREASE)
|
|
|
NON MODIFIABLE RISK FACTORS FOR ANGINA
|
GENDER, AGE, AND FAMILY HISTORY
|
|
|
MODIFIABLE RISK FACTORS FOR ANGINA
|
HYPERCHOLESTEROLEMIA, HTN, DM, SMOKING
|
|
|
WHAT CONTROLS CARDIAC BLOOD FLOW?
|
CONTROLLED BY THE SMOOTH MUSCLE IN ARTERIOLAR AND VENOUS SYSTEMS OF THE HEART
|
|
|
MOA OF NITRATES IN ANGINA
|
RELAX SMOOTH MUSCLE IN VASCULATURE (ESP VEINS) REDUCING PRELOAD AND DECREASING CORONARY VASOCONSTRICTION OR SPASM , AND THUS INCREASING OXYGEN DELIVERY
|
|
|
MOA OF CCB'S IN ANGINA
|
REDUCE PERIPHERAL VASCULAR RESISTANCE (ARTERIOLES) ESPECIALLY AND REDUCE CORONARY ARTERY TONE
|
|
|
MOA OF B BLOCKERS IN ANGINA
|
DECREASE O2 DEMAND BUT DO NOT INCREASE OXYGEN DELIVERY
|
|
|
WHAT DRUG IS USED TO STOP OR ABORT ACUTE ANGINA ATTACKS?
|
SUBLINGUAL NITRATES (THEY AVOID FIRST PASS EFFECT)
|
|
|
WHAT DRUGS ARE USED IN STABLE ANGINA TO PREVENT FURTHER ATTACKS?
|
BETA BLOCKERS, CALCIUM CHANNEL BLOCKERS, AND LONG ACTING NITRATES (IN ORDER OF USE)
|
|
|
WHAT ARE THE DRUGS USED FOR UNSTABLE ANGINA?
|
BETA BLOCKERS, CCB, LONG ACTING NITRATES, AND ALSO ASPIRIN OR PLAVIX (CLOPIDOGREL)
|
|
|
HOW SHOULD YOU TREAT ALL NEW ONSET ANGINA?
|
AS A RULE OUT MI
|
|
|
THE DRUG OF CHOICE FOR RELIEF FROM ACUTE ANGINA ATTACKS
|
NITRATES
|
|
|
COMMON ADVERSE REACTIONS TO NITRATE
|
HEADACHE--PATIENT NORMALLY BUILDS TOLERANCE IN A FEW WEEKS, HYPOTENSION, FLUSHING, REFLEX TACHYCARDIA
|
|
|
IF A PERSON WITH ANGINA IS HAVING REFLEX TACHYCARDIA, WHAT DRUG USED CONCOMITANTLY MAY PREVENT IT/
|
BETA BLOCKERS OR CCB
|
|
|
WHAT IS NEEDED DAILY IN ORDER TO PREVENT A PATIENT FROM DEVELOPING TOLERANCE TO NITRATES?
|
A NITRATE FREE PERIOD OF 10-12 HOURS
|
|
|
WHAT IS THE ACTION OF NITRATES IN ANGINA?
|
RELAX SMOOTH MUSCLE IN VASCULATURE (VEINS ESPECIALLY) REDUCING PRELOAD AND DECREASING CORONARY VASOCONSTRICTION OR SPASM THUS INCREASING OXYGEN DELIVERY
|
|
|
WHAT IS THE ACTION OF CCB'S IN ANGINA?
|
REDUCE PERIPHERAL VASCULAR RESISTANCE (ARTERIOLES ESPECIALLY) AND REDUCE CORONARY ARTERY TONE
|
|
|
HOW DO BETA BLOCKERS WORK IN ANGINA?
|
DECREASE OXYGEN DEMAND
|
|
|
WHAT IS THE ONSET AND DURATION OF NITOGLYCERIN?
|
1-3 MINUTES AND 30-60 MINUTES DURATION
|
|
|
WHY DO YOU HAVE TO REPLACE NITROGLYCERIN AFTER SIX MONTHS FROM OPENING?
|
TABS ARE SENSITIVE TO LIGHT, HEAT, MOISTURE, AND AIR
|
|
|
WHAT IS THE DOSE FOR NITROGLYCERIN?
|
ONE TABLET EVERY FIVE MINUTES AS NEEDED; MAX DOSE IS 3 TABLETS IN FIFTEEN MINUTES; IF PAIN HASN'T STOPPED AFTER 3RD TABLET, CALL 911
|
|
|
ADVANTAGE OF NITOGLYCERIN SPRAY (NITROLINGUAL) TO TABLETS
|
SPRAY DOES NOT LOSE ITS POTENCY WHEN IT IS OPENED (MORE STABLE)
|
|
|
WHAT IS IV NITROGLYCERIDE USED FOR?
|
USED FOR ANGINA UNRESPONSIVE TO OTHER NITRATES; ALSO USED FOR BP CONTROL AND CHF
|
|
|
WHY DO WE NOT USUALLY USE ISOSOBIDE DINITRATE IN PLACE OF NITROGLYCERIN?
|
SLOWER ONSET (2-5 MINUTES), DURATION OF ACTION 1-2 HOURS; MAY BE USED PROPHYLACTICALLY BEFORE ACTIVITIES LIKELY TO CAUSE AN ACUTE ATTACK
|
|
|
WHAT ARE NITROGLYCERIN SUSTAINED RELEASE TABLETS AND CAPSULES USED FOR?
|
USED TO PREVENT ANGINA AS WELL AS STOP ACUTE ATTACKS
|
|
|
WHAT IS THE FIRST LINE AGENT FOR REDUCING ANGINA EPISODES?
|
BETA BLOCKERS
|
|
|
MOA OF BETA BLOCKERS IN ANGINA
|
REDUCE MYOCARDIAL OXYGEN DEMAND BY DECREASING CATECHOLAMINE MEDICATED INCREASES IN HR, BP, AND MYOCARDIAL CONTRACTILITY
|
|
|
CONTRAINDICATIONS FOR BETA BLOCKERS IN ANGINA
|
NOT FOR USE IN ASTHMA AND COPD PATIENTS; SEVERE BRADYCARDIA; PERIPHERAL VASCULAR DISEASE AND CLAUDICATION (POOR CIRCULATION)
|
|
|
WHAT BETA BLOCKERS DO YOU AVOID IN ANGINA?
|
AVOID AGENTS WITH INTRINSIC SYMPATHOMIMETIC ACTIVITY BECAUSE THEY INCREASE OXYGEN DEMAND
|
|
|
WHY DOES ATENOLOL HAVE LESS CNS SIDE EFFECTS IN ANGINA?
|
BECAUSE IT IS A BETA 1 SELECTIVE AGENT AND BECAUSE IT IS ALSO WATER SOLUBLE
|
|
|
WHAT ARE THE TWO BETA 1 SELECTIVE DRUGS USED FOR ANGINA?
|
ATENOLOL (TENORMIN) AND METOPROLOL (LOPRESSOR)
|
|
|
WHAT ARE THE TWO NONSELECTIVE BETA BLOCKERS APPROVED FOR USE IN ANGINA?
|
PROPRANOLOL (INDERAL) AND NADOLOL (CORGARD)
|
|
|
MOA OF CCB IN ANGINA
|
INHIBIT ENTRANCE OF CALCIUM INTO CARDIAC AND SMOOTH MUSCLE CELLS OF THE CORONARY AND SYSTEMIC ARTERIAL BEDS RESULTING IN VASODILATION; RESULT IS A DECREASE IN THE MYOCARDIAL OXYGEN DEMAND AND AN INCREASE IN MYOCARDIAL OXYGEN SUPPLY
|
|
|
WHAT DO THE NON-DHP CCB'S DO IN ANGINA?
|
THEY ALSO DECREASE MYOCARDIAL CONTRACTILE FORCE, LOWERING O2 DEMAND OF THE HEART
|
|
|
WHAT DRUG IS USED FOR A PATIENT WITH HF AND HTN?
|
AMIODIPINE (NORVASC)
|
|
|
WHAT IS THE ONLY CCB APPROVED FOR USE IN HF?
|
AMIODIPINE (NOT USED FOR HF, BUT RATHER TO TREAT OTHER CONDITIONS LIKE HTN IN HF PATIENTS)
|
|
|
MOST USED CCB (DHP)
|
NIFEDIPINE (PROCARDIA AND ADALAT)
|
|
|
THE CLASSIC CCB USED IN ANGINA
|
DHP'S B/C OF THEIR ARTERIOLAR VASODILATION (IMPROVE AFTERLOAD)
|
|
|
THE SELECTION OF THE MULTIPLE DRUGS USED FOR ANGINA NORMALLY DEPENDS ON WHAT?
|
THE PATIENT'S OTHER DISEASES
|
|
|
WHY ARE DILTIAZEM AND VERAPAMIL PREFERRED CCB'S FOR ANGINA?
|
BECAUSE THEY PRODUCE LESS REFLEX TACHYCARDIA
|
|
|
IF A PATIENT WITH ANGINA ALSO MIGHT HAVE AN AV BLOCK, WHAT DRUG IS USED?
|
NIFEDIPINE OR ANOTHER DHP (BECAUSE THEY DO NOT AFFECT AV NODE CONDUCTION---NON-DHP'S SLOW IT DOWN)
|
|
|
IF A PATIENT HAS A HISTORY OF ATRIAL TACH, FLUTTER, OR FIBRILLATION, WHAT CCB WOULD YOU USE FOR ANGINA?
|
VERAPAMIL OR DILTIAZEM
|
|
|
CCB'S CAN BE USED FOR BOTH VASOSPASTIC AND CHRONIC ANGINA. T OR F
|
TRUE
|
|
|
WHEN WOULD YOU USE CCB'S IN PRINZMENTAL'S ANGINA?
|
WHEN OTHER B BLOCKER USE IS NOT RECOMMENDED
|
|
|
ADVERSE REACTIONS OF VERAPAMIL IN ANGINA PATIENTS
|
BRADYCARDIA, CONSTIPATION, MONITOR FOR SIGNS HF, WILL INCREASE DIGOXIN PLASMA CONCENTRATION
|
|
|
SIDE EFFECTS OF NIFEDIPINE IN ANGINA
|
MAY CAUSE PERIPHERAL EDEMA, MAKES ANGINA WORSE IN 10% OF PATIENTS
|
|
|
WHAT IS THE SAFEST CCB TO ADD TO A BETA BLOCKER IN ANGINA PATIENTS?
|
AMIODIPINE
|
|
|
WHAT IS THE MOST LIKELY CCB TO CAUSE A HEART BLOCK IN PATIENTS WITH ANGINA THAT ALSO NEED HTN TREATMENT?
|
VERAPAMIL DUE TO THE COMBINED DEPRESSANT EFFECTS ON CONTRACTILITY OR AV CONDUCTION
|
|
|
WHAT DO YOU USE FOR PATIENTS WITH ANGINA AND ASTHMA OR COPD?
|
NITRATES OR CCB; DO NOT USE BETA BLOCKER AT ALL
|
|
|
WHAT DO YOU USE FOR PATIENTS WITH ANGINA AND DIABETES?
|
NITRATES OR CCB'S
|
|
|
WHY DO WE NOT USE B BLOCKERS IN PATIENTS WITH DIABETES AND ANGINA?
|
THE BETA BLOCKERS MASK HYPOGLYCEMIA SO WE USE NITRATES OR CCB'S
|
|
|
MEDICAL MANAGEMENT OF UNSTABLE ANGINA (ORDER OF DRUGS)
|
USE NITRATES FIRST; THEN ADD B BLOCKER UNLESS CONTRAINDICATED; THEN ANTICOAGULATION (ASPIRIN AND HEPARIN); THEN ADD CCB'S ONLY IF SYMPTOMS ARE NOT RELIEVED BY NITRATES AND B BLOCKER
|
