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angina pectoris
symptomatic manifestation of ischemic heart disease characterized by a severe squeezing of pressure-like chest pain and brought on by exertion or stress
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ateriosclerosis
thickening and loss of elasticity of arterial walls; sometimes called "hardening of the arteries"
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atheromas
hard plaque formed within an artery
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coronary artery disease
condition that occurs when the arteries that supply blood to the heart muscle become hardened and narrowed
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hyperlipidemia
increased concentration of cholesterol and triglycerides in the blood that is associated with the development of atherosclerosis
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ischemia
deficient blood supply to an area of the body.
myocardial ischemia results in angina and myocardial infarction
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ischemic heart disease
any condition in which heart muscle is damaged or works inefficiently because of an abscence or relative deficiency of its blood supply
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necrosis
cell death that may be caused by lack of blood and oxygen to the affected areas
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plaque
hardened lipid streak within an artery formed by deposits of cholesterol, lipid meterial, and lipophages
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thrombus
stationary blood clot
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vasospasm
spasms that constrict blood vessels to reduce blood flow
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symptoms of angina
described as severe squeezing or pressure-like chest pain; sometimes radiating to the arms, shoulder, neck, or jaw; sometimes described as severe heartburn or indigestion
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angina is a symptom of what?
ischemic heart disease
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It is estimated that among 5% of Canadians aged 12+ who have heart disease, 1.9% have angina.
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People with a history of heart disease, hypertension, and diabetes are at risk for angina.
Lifestyle is also a significant risk for devoloping angina
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Angina is often classified as a chronic disease of lifestyle because many of the risks for developing the condition are related to lifestyle. Risk factors include:
smoking, overeating, diet high in cholesterol and salt, excessive alcohol consumption, obesity, lack of exercise.
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stress is also a risk factor for angina
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high dietary cholesterol is a contributing factor for the development of what disease? what can this cause?
coronary artery disease can cause myocardial ischemia
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arherosclerosis
disease of the coronary arteries that results in the buildup of lipid streaks in arteries
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there are 3 types of angina varying according to their pattern and ability to be relieved by medication
stable, unstable, and variant or vasospasmatic
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in all types of angina, there is an imbalance between blood supplied to the heart muscle and the need for blood and oxygen
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the symptoms of angina occur when the blood supplied to the heart is insufficient to meet the heart's need for O2
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stable (exertional) angina: blood and O2 meet needs under typical conditions, but inadequate during periods of exercise; rest and antianginal meds treat acute symptoms; symptoms subside after 5 mins.
brought on by physical exertion, smoking, eating heavy meals, exposure to extreme changes in temp., emotional stress
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unstable angina: may occur at rest, without physical exertion, and may result when embolus partially or completely occludes an artery
a serious condition requiring medical evaluation because may precede a mayocardial infarction; symptoms not relieved by rest or antianginal meds may last up to 30 mins
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variant angina: caused by vasospasm of the coronary arteries; spasms reduce the opening of the artery, decreasing the blood and O2 to heart; occurs at rest, during night, or early morning.
unlike unstable angina, can be relieved by antianginal meds; symptoms may often exceed 5 mins.
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lifestyle changes can reduce the risk for angina as well as decrease the frequency and severity of symptoms and prevent or slow the progression of angina to myocardial infarction or death
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drugs used in the treatment of angina are administered to increase the blood and oxygen supply to the heart and to decrease the workload of the heart
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recommended lifestyle changes are:
- take frequent breaks
- avoid eating foods high in salt and cholesterol
- eat smaller portions
- learn techniques to control stress
- advocate workplace and community changes to facilitate lifestyle change
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increased blood supply can be accomplished by dilating blood vessels or by reducing vasospasms
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decreased workload for heart is accomplished by slowing the heart rate, reducing the demand for oxygen.
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drugs therapy for angina is focused on treatment and prevention of cardiovascular diseases that often accompany angina
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drugs may be adminstered to persons who have angina to treat comorbid conditins such as:
- hypertension
- hyperlipidemia
- atherosclerosis
- atherothrombosis
- myocardial infarction
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the ________ are the oldest class of drugs used to treat acute symptoms of angina
organic nitrates
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__________ dilate blood vessels and increase supply of oxygen to the heart
organic nitrates
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nitrates that are commonly used in the treatment and prevention of angina are:
nitroglycerine, isosorbide dinitrate, isosorbide mononitrate
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nitrates (mechanism of action)
dilate veins, reduce heart muscle tension, decrease oxygen demand
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most nitrates are prodrugs, converted in the body to nitrous oxide which activate enzyme that inhibits a protein, blocking calcium channel, resulting in blockade of muscle contraction, relaxing blood vessels.
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nitrates produce venodilation, which decreases caradiac preload (reduces fluid back up in ventricles) and the work needed to pump blood out of ventricles
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nitroglycerin dosage forms include
- parenteral
- SL tabs
- buccal tabs
- lingual spray
- oral tabs and caps
- ointments
- transdermal patches
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parenteral, SL tabs, and lingual spray dosage forms are designed to deliver nitroglycerin quickly and used treat acute symptoms of angina
other doaage forms deliver meds over extended period intended to prevent symptoms of angina
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nitroglycerin is lipid solubale, easily passes cell membrane and is subject to extensive 1st-pass metabolism and only 10% of oral dose is available to produce effect
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nitroglycerine should always be dispensed without a safety cap for easy access
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tech alert!!
a fatal drop in blood pressure can occur when phosphodiesterase (Viagara), vardenafil (Cialis), and tadafil (Levitra) (treatment for ED) are administered to patients taking nitroglycerine
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nitroglycerine is volatile and loses potency on exposure to air, light, and moisture.
packaged by manufacturers in amber glass bottles and should be dispensed in the manufacturer's original container
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isosorbide diniatrate is formulated for acute use (SL & chew tab) and prevention (extended tabs)
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nitrate ADRs
hypotension, facial flushing, dizziness, headaches, nausea and vomiting, weakness, fatigue
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to minimize the risk for development of tolerance to nitrates, it is important ________
to have a 10-12 hour drug-free period each day
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________ occurs when there is an imbalance between the heart's demand for oxygen and the oxygen supply
angina pectoris
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β-blockers are administered to reduce the heart's demand for oxygen
achieved by decreasing the heart rate, thereby reducing the heart's demand for oxygen
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______ are also indicated for the treatment of hypertension and post myocardial infarction and for the prevention of migraines
β-blockers
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β-blockers decrease the frequency and severity of _____
stable(exertional) angina
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β-blockers bind to β-receptor sites and block activity of SNS on cardiac smooth muscle
heart contractility is reduced and heart rate is slowed
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β-blocking drugs used to treat stable angina include
cadioselective β-blockers
nonselective mixed β1/β2 blockers
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β-blocker are formulated in immediate and long-lasting dosage forms
T1/2 ranges from 3-4 hrs (propranol) to as long as 24 hrs (nadolol)
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β-blocker ADRs
dizziness, fatigue, bradycardia, hypotension, impotence, heart block, occasional insonmia,
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β-blocker can produce bronchospasm, so their use is contraindicated in persons with asthma
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β-blockers are easily identified because their generic name ends in _____
"-olol"
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use of β-blockers also contraindicated in persons with diabetes because their action to decrease heart rate masks one of the principal signs of _____
hypoglycemia
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abrupt discontinuation of β-blocker should be avoided as this can produce _____
tachycarcia and sudden increase in heart workload
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CCBs are easily identified because their generic name ends in ______
"-dipine"
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Calcium channel blockers (CCBs) are used in the treatment of ______ and _____ angina
variant, stable
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CCBs are effective in treating variant angina because of their ability to _______
reduce vasospasms that restrict the flow of blood and oxygen
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in stable angina, CCBs improve exercise tolerance by decreasing heart rate and the force of contraction of heart muscle
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CCBs are effective in the treatment of stable angina alone and in combination with nitrates or β-blockers
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CCBs block calcium channels, suppress depolarization, and reduce contraction of heart muscle
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3 classes of CCBs
- dihydropyridines
- phenylalkylamines
- benzothiazapines
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dihydropryidines
- nifedipin
- nicardipine
- nimodipine
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phenylalkylamines
verapamil
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benzothiazapines
diltiazem
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_______ and ______ reduce heart O2 consumption by decreasing heart rate and heart contractions
phenylakylamines, benzothiazepines
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______ are selective for blood vessels, so they are able to increase blood and O2 supply without slowing down heart or contractions or increasing the risk of heart block
dihydropyridines
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