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antianginal drugs
Pharm exam 3: vasodilators
Question | Answer |
---|---|
define angina pectoris | chest pain caused by lack of oxygenated blood to heart muscles |
etiology of angina pectoris | narrowing of arteries, hypotension, vasoconstriction, SNS or drugs |
precipitating factors of angina pectoris | exercise, anxiety, cold, heavy meals, smoking |
symptoms of angina pectoris | chest pain persisting for 3-5 minutes; dissipates upon rest |
ECG changes seen in angina pectoris | S-T changes |
management of angina pectoris | education; vasodilating drugs |
effect of vasodilating drugs | cause dilation of blood vessels and tend to lower blood pressure |
Vasodilators are used to treat... | hypertension, coronary disease (angina) or peripheral vascular disease |
where do nitrates act? | directly on smooth muscles of peripheral and coronary vascular bed |
effect of nitrates | peripheral vasodilatation |
how do nitrates decrease preload | venous dilation |
how do nitrates decrease afterload | arterial dilation |
what do nitrates reduce? | work of heart and oxygen requirement |
What do nitrates dilate | large normal coronary artery, not lined with plaque |
Drug of choice of angina | nitrates |
side effects of angina | tachycardia, flushing, severe headache, nausea/vomiting, hypotension, vertigo |
tolerance occurs to what nitrates | long acting; not usually to nitroglycerin (NTG) |
What interacts with nitrates? | alcohol, antihypertensive drugs, aspirin |
Nitrate kinetics | sublingual (Nitrostat) NTG tabletss |
normal dosage for NTG tablets | 0.15-0.6 mg; usually 0.4mg |
How often can nitrates be given | repeated several times a day |
how often do you take nitrates for chest pain | 5 minute intervals x 3 |
Dynamics of nitrates | effect in 2 minutes; peak in 4 minutes; disappears in 10-30 minutes |
can nitrates be taken before exertion? | yes; as prophylaxis |
NTG is inactivated by what? | light, heat, air, moisture, and time |
How often should patients get a fresh supply of nitrates? | every 3-6 months |
Education of storage of NTG | airtight, dark container; avoid keeping close to body; don't store in bathroom |
What should patient do before taking NTG? | sit or lie down |
What does NTG cause besides desired effect? | flushing or headaches - if not; medication is not good |
What to take for headaches with NTG? | Tylenol |
describe NTG spray | metered dose; oral spray; take seated or lying down; do not inhale |
describe NTG sustained release (Nitro-bid) | take on empty stomach with full glass of water, do not cut or chew |
Effect and duration of NTG sustained release | effect 24-45 minutes; duration 4-8 hours |
Onset and duration of NTG patches | onset 30-60 minutes; duration 18-24 hours |
Education for NTG patches | wear gloves to apply; rotate site and wash skin; remove old patch when replacing new |
When to remove NTG patch | from 8-12 hr/day; before defibrillation; when replacing old patch |
When to use NTG IV | acute situation with unrelieved angina |
NTG IV onset | immediate |
Use what monitoring devices with NTG IV | pump and cardiac, blood pressure monitor |
Beta-adrenergic Blocker prototype | propranolol (Inderal) |
Where does propranolol (inderal) act? | heart receptors |
effect of propranolol (inderal) | decreased HR; decreased force of contraction, decreased myocardial oxygen demand |
adverse effects of propranolol (inderal) | slowed heart rate; lowers BP; contributes to impotence |
calcium channel blocker prototype | verapamil (Calan) |
action of verapamil (Calan) | inhibit release of intracellular calcium |
effect of verapamil (Calan) | decrease force of myocardial contraction = decrease heart oxygen demand; dilate coronary artery to increase oxygen supply |
use of verapamil (Calan) | long term prevention of angina |
side effects of verapamil (Calan) | hypotension, arrhythmias, heart failure |