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21 Cards in this Set

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Angina Pectoris:
Lack of oxygen to the heart cells causing discomfort. It is a symptom of CAD, AKA ischemic heart disease.
Atherosclerosis or spasm of the arteries = reduced blood flow through coronary arteries.
Chronic stable angina:
Impulsed by physical exertion or stress, lasts a few minutes, relieved by nitroglycerin SL.
Unstable angina:
Unpredictable; changes in:
1) ease of onset
2) frequency
3) duration
4) intensity
Caused by a combo of atherosclerotic narrowing, vasospasm, & thrombus formation.
Variant angina:
Occurs at rest, specified by ECG changes, cause by vasospasm of a coronary artery reducing blood flow.
Testing for a type of angina pectoris is diagnosed by?
Combo of:
1) Hx
2) ECG changes during attack
3) Exercise tolerance w/ or without thallium-201 (radioisotope) scintigraphy (2D).
What are the actions of Nitrates?
Oldest effective therapy; coronary vasodilators that do not increase total coronary blood flow. Relieve angina by:
1)Inducing relaxation of peripheral vascular smooth muscle = dilatation of arteries & veins. This reduces venous blood return (preload) to the heart = decreased oxygen demand.
2)Increase myocardial oxygen supply by dilating large coronary arteries & redistributing blood flow = enhanced oxygen supply to ischemic areas.
What are the actions of beta-adrenergic blockers?
Reduce myocardial oxygen demand by blocking the beta adrenergic receptors in the heart, preventing stimulation from NE & E that would normally cause an increased HR.
Also reduce BP
What are the actions of calcium channel blockers?
Inhibit the movement of Ca ions across a cell membrane. Tx of angina:
1)Decreases workload = less O2 demand.
2)Increase myocardial blood supply by coronary artery dilation.
3)Inhibiting smooth muscle contraction.
4)Dilate blood vessels = decreased resistance to blood flow.
AKA calcium ion antagonists, slow channel blockers, & calcium influx inhibitors.
Dilation of peripheral vessels reduces?
The workload of the heart.
Coronary artery dilation?
Improves coronary blood flow.
What are the actions of angiotensin-converting enzyme (ACE) inhibitors?
They prevent thrombus formation by inhibiting angiotensin-converting enzymes, that cause the endothelial walls of coronary arteries to dilate & minimize platelet aggregation.
Major breakthrough in the tx of CAD! See pages 374-376.
What is the rationale for using HMG-CoA reductase inhibitors (statins) to treat angina attacks?
Because atherosclerosis causes narrowing/closure of the coronary arteries, which induces angina & MIs.
What is the nursing assessment required to evaluate an anginal attack?
1)PQRSTU; What activities precipitate an attack? Relieved by rest? After eating? Fatigue, SOB, related w/indigestion/nausea?
2)Medication Hx
3)Mental status
4)Cardiovascular: palpitations, HR, BP, CAD Hx, check peripheral perfusion, smoke?
5)Nutrional Hx: special diet, high cholesterol, eating cause fatigue/SOB? Edema in ankles?
What are the actions of the Fatty Oxidase Enzyme Inhibitor ranolazine (Ranexa)?
It is an enzyme modulator that shifts the metabolism within myocardial cells to reduce the oxygen required to generate energy for muscle contractions. Demand for O2 reduced = O2 imbalance/demand diminished = reduced myocardial ischemia/sx.
How would the nurse educate a pt about anginal therapy?
1)Teach S&S of hypotension that may occur with nitrates.
2)Dizziness/faintness can be relieved by increasing muscular activity (flexing/relaxing muscles in legs).
3)Resting for 10 to 15 minutes after med is taken to manage hypotension.
4)Lightheadedness or fainting can occur when taking nitroglycerin; teach safety measures of orthostatic hypotension.
5)Headaches after nitro, should subside within 20-30 minutes.
See page 411 for additional info.
What lab value should be considered in a premedication assessment for calcium ion antagonist drugs?
Lab values for hepatoxicity.
How many hours do the transmucosal tablets release nitroglycerin?
3 to 5
Following administration of a nitrate the patient may experience?
hypotension
remember dilation!
How long should a patient wait after removing an old Nitro-Dur patch before applying a new one?
12 to 24 hours
The most effective agents for relieving ischemia & angina are:
Beta blockers, calcium antagonists, & nitrates.
Ca ion antagonists:
Dilate coronary arteries and peripheral blood vessels, thereby increasing myocardial blood flow & decreasing workload.