Pharm 236 Ch 50

Front 1

____________ is a clinical syndrome characterized by episodes of chest pain.

Back 1

Angina Pectoris

Front 2

Angina pectois occurs when there is a deficit in _______ oxygen supply in relation to myocardial oxygen demand.

Back 2

Myocardial

Front 3

Angina is most often caused by atherosclerotic plaque in the coronary arteries by may also be caused by coronary ____________

Back 3

vasospasm

Front 4

The development and progression of atherosclerotic plaque is called _______________.

Back 4

Coronary artery disease

Front 5

There are three main types of angina; classic angina, _____________ angina, and unstable angina.

Back 5

variant

Front 6

Used to reduce the frequency and severity of acute anginal episodes.

Back 6

Isosorbide dinitrate (Isordil)

Front 7

Represents a new classification of antianginal medications metabolic modulators used in individuals with chronic angina.

Back 7

Ranolazine (Ranexa)

Front 8

Prototype drug used to relieve acute angina pectoris, prevent exercise induced angina and decrease the frequency and severity of acute anginal episodes.

Back 8

Nitroglycerin (ex. Nitro-bid)

Front 9

Act on contractile and conductive tissues of the heart and on vascular smooth muscle.

Back 9

Calcium channel blockers

Front 10

Used to reduce the frequency and severity of acute attacks of angina

Back 10

Propranolol

Front 11

Describe the typical anginal symptoms for the male:

Back 11

Classic anginal pain is usually described as substernal chest pain of a constricing squeezing or suffocating nature. It may radiate to the jaw neck or shoulder; down the left or both arms; or to the back. The discomfort is sometimes mistaken for arthritis or for indigestion because the pain may be associated with nausea, vomiting, dizziness, diaphoresis, SOB, or fear of impeding doom. The discomfort is usually brief , typically lasting 5 mins or less until the balance of oxygen supply and demand is restored.

Front 12

Describe typical anginal symptoms for the female:

Back 12

Current research indicates that gender differences exist in the type and quality of cardiac symptoms with women reporting epigastric or back discomfort.

Front 13

Define Atherosclerosis

Back 13

Atherosclerosis begins with accumulation of lipid filled macrophages on the inner lining of coronary arteries. Foam cells which promote growth of atherosclerotic plaque, develop in response to elevated blood cholesterol levels. These early lesions progress to fibrous plaques containing foam cells covered by smooth muscle cells and connective tissue. Advanced lesions also contain hemorrhages, ulcerations, and scar tissue. Factors contributing to plaque development and growth include endotherlial injury, lipid infiltration, recruitment of inflammatory cells and smooth muscle cell proliferation. Endotherial injury may be the initiating factor in plaque formation because it allows monocytes, platelets, cholesterol, and other blood components to come in contact with and stimulate abnormal growth of smooth muscle cells and connective tissue in the arterial wall.

Front 14

Describe how the elderly experience anginal symptoms:

Back 14

Older adults may have atypical symptoms of CAD and my experience "silent" ischemia that may delay them from seeking professional help.

Front 15

What are the causes of myocardial ischemia?

Back 15

Myocardial ischemia occurs when the coronary arteries are unable to provide sufficient blood and oxygen for normal cardiac functions. Also known as Ischemic heart disease, CAD, or coronary heart disease, myocardial ischemia may manifest as an acute coronary syndrome with three main consequences. One consequence is unstable angina with the occurrence of pain.

Front 16

Mrs. Smith, age 45, is diagnosed with CAD. She self administers a calcium channel blocker, an antilipidemic, and an antianginal medication. You are responsible for an education plan using non pharmacologic methods for management of her disease process.

Mrs. Smith has these risk factors: Obesity, elevated triglycerides, reduced HDL, hypertension, and elevated fasting glucose. What are these factors indicative of?

Back 16

Metabolic syndrome

Front 17

Mrs. Smith, age 45, is diagnosed with CAD. She self administers a calcium channel blocker, an antilipidemic, and an antianginal medication. You are responsible for an education plan using non pharmacologic methods for management of her disease process.

Mrs. Smith ask you what nonpharmacologic management can do to improve her health and cardiac status. How do you repond?

Back 17

Smoking cessation is a good place for this patient to start. Patients should avoid circumstances known to precipitate acute attacks, and those who smoke should stop.

Front 18

Mr. Newsome is diagnosed with CAD and angina. The physician orders nitrates. You are responsible fr the clients education plan.

Mr. Newsome is fearful that the nitrates will not control his chest pain. He asks you how they will explain the action of nitrates?

Back 18

Organic nitrates relax smooth muscle in blood vessels walls this action produces vasodilation which relieves anginal pain by several mechanisms. First dilation of the veins reduces venous pressure and venous return to the heart. This decreases blood volume and pressure within the heart (preload), which in turn decreases cardiac work load and oxygen demand. Second, nitrates dilate coronary arteries at higher doses and can increase blood flow to ischemic areas which lowers peripheral vascular resistance (after load). This results in lower cardiac work load.

Front 19

Mr. Newsome is diagnosed with CAD and angina. The physician orders nitrates. You are responsible fr the clients education plan.

The physician orders sublingula nitroglycerin. What can you tell Mr. Newsome about this drug? What are the contraindications to the use of sublingual nitroglycerin?

Back 19

When given sublingually nitroglycerin is absorbed directly into the systemic circulation. It acts within 1 to 3 mins and its effects last for 30 to 60 mins. Contra-indicators include hypersensitivity reactions, severe anemia, hypotension, and hypovolemia. The drugs should be used cautiously in the presence of head injury or cerebral hemorrhage because the may increase intercranial pressure.