Pharmacology Ch 19

Drugs for Angina, Myocardium Infarction and Stroke

Angina, Myocardium Infarction & Cerebrovascular Accident

____, ____, & ____: Any disturbance in blood flow to vital organs, even for brief periods, can result in life-threatening consequences. All occur when tissue is starved for oxygen - vessels supplying blood become clogged with fatty deposits or clot…

coronary artery disease

CAD stands for…

Coronary heart disease

CAD is also known as…

Coronary artery disease

__________: refers to impaired blood flow in coronary arteries…

Aorta

The myocardium recieves no nutrients or oxygen from the blood travelling thru the heart's chambers, instead it receives its nutrients from the 1st 2 arteries branching off the ______, the right & left coronary arteries further branch to circle the heart & bring a continuous supply of oxygen & nutrients…

Angina

If it’s a moderate restriction of flow (not completely cut off) it’s _________…

MI

If it’s severe or complete loss of blood flow (completely cut off) it’s ________, (which can hv a high risk of sudden death) and can lead to dysrhythmias (abnormal rhythm) and heart failure…

Angina pectoris

__________: acute “chest pain” a symptom caused by insufficient blood supply (oxygen) to a portion of the myocardium (myocardial ischemia)…

Myocardial ischemia

__________: condition where theres insufficient (reduced) blood supply (oxygen) to a portion of the myocardium…

Angina pectoris

_________: classic presentation (signs & symptoms) of this is intense pain in the chest, often moving to the left side of the neck and lower jaw and down the left arm…

Angina

_________: physical exertion and emotional stress are common triggers, usually subsides w/ rest. _______ is rarely fatal, however, pain closely mimics MI, therefore distinguishing between the two is important…

Non-cardiac

Chest pain can also be __________ related, determining underlying cause is essential, ex: anxiety, heartburn, etc…

Atherosclerosis

Most common cause of Angina is __________…

Atherosclerosis

___________: is build up of fatty, fibrous material called plaque in the walls of arteries…

Vasospastic angina

Another cause of Angina is ___________ aka (Prinzmetal's angina) a rare condition that causes chest pain or discomfort while at rest…

Stable

_________ angina: is predictable in its frequency, intensity and duration…

Unstable

_______ angina: episodes that occur during periods of rest…

Lifestyle changes

_____________: may include limiting alcohol consumption to small amounts, not using tobacco, eliminating foods high in cholesterol, saturated or trans fat, maintaining a healthy/optimal weight, reducing salt intake, exercising and reducing stress, and bp blood glucose, blood cholesterol (LDL, HDL) within target ranges…

Surgical invention

If coronary arteries are significantly obstructed then __________ is required, like PTCA or CABG…

Percutaneous Transluminal Coronary Angioplasty

PTCA w/ a stent insertion is a surgical intervention for when ur coronary arteries are significantly obstructed, what does it stand for?…

Coronary Artery Bypass Graft

CABG is a surgical intervention for when ur coronary arteries are significantly obstructed, what does it stand for?…

Angina

_________: the moa of these 3 classes of drugs (Nitrates, Beta blockers & Calcium channel blockers) on the treatment of _______ is to lessen cardiac workload and myocardial oxygen demand…

Angina

The goal of pharmacological treatment of _______ is to reduce frequency of _______ episodes (prevention) and to terminate acute ______ pain (treatment)…

Angina

Nitrates, beta blockers and CCBs will slow hr, reduce preload (dilate veins brings blood back to heart), reduce contractility and reduce afterload (lower bp, peripheral resistance) for __________…

Nitrates

________ it’s drug class moa: dilates veins (reduces preload) and dilates coronary arteries…

Angina

Short acting of nitrates is SL nitro tabs (evry 5 min, up to 3x then go to ER) or spray (nitroglycerin), is to quickly stop acute ________ attacks…

Heart Failure

Long acting of nitrates is po or transdermal patch (tolerance can occur if left on for more than 12 hrs)/cream which also useful in reducing symptoms of _________…

Angina & heart failure

Nitrates are fpr treatment and/or prevention of _______ & ________…

Nitrates

Common adverse effects of this drug class includes: dizziness, reflex tachycardia (from fall in bp), headache, and flushing…

Nitrates

Life-threatening hypotension can occur when ________ is taken with PDE5 inhibitors (Viagra) or alpha blockers (Prazosin)…

Beta-adrenergic blockers

________ are the drug of choice for angina pain, several agents used, both selective and non-selective…

Beta-adrenergic blockers

__________ this drug class's moa: reduces cardiac workload by slowing hr and reducing contractility (helps heart not work as hard)…

Beta-adrenergic blockers

_________: precautions if stopping this drug class abruptly, fatigue, bradycardia, effects on diabetes…

Beta-adrenergic blockers

Patients taking ________ must hv their hr closely monitored, as it can cause it to severely lower bpm, once it nears 50bpm they should be switched to different medication as there at risk for a heart block…

Calcium channel blockers

__________ are used when beta-adrenergic blockers are not tolerated…

Calcium channel blockers

_________ this drug class's moa: reduce cardiac workload by lowering bp & dilating coronary arteries (all ______)…

Diltiazem & verapamil

Only ______ and ______ ccb's hv extra benefit of slow hr (as they work on heart muscles and vessels)…

Calcium channel blockers

_______ are the drug of choice for a type of Angina called vasospastic angina (aka prinzmetal angina, chest pain at rest)…

Calcium channel blockers

Side effects of _______ is headache, dizziness, and edema of ankles and feet..

Calcium channel blockers

There’s interactions of _______ with other cv meds that slow conduction thru av node, particularly digoxin or beta blockers that can potentially cause heart block, heart failure or dysrhythmias….

Myocardial infarction (MI)

________ the result of a sudden occlusion (sudden block) of a coronary artery resulting in myocardial ischemia (lack of blood/oxygen), muscle death will result unless blood supply is quickly restored…

Myocardial infarction

Primary cause of a ________ (aka heart attack) is advanced coronary artery disease (cad) where plaque buildup can severely narrow one or more branches of the coronary arteries…

Myocardial infarction

The goal of pharmacological treatment of _______ is to restore blood supply (perfusion) to the damaged myocardium as quickly as possible thru the use of thrombolytics…

Thrombolytics

For the treatment of MI, restore blood supply (perfusion) to the damaged myocardium as quickly as possible thru the use of __________ (cuts up clots)…

Myocardial infarction

Reduce myocardial oxygen demand w/ nitrates, beta blockers, or ccbs to prevent another _______….

Myocardial infarction

Control or prevent _____-associated dysrhythmias w/ beta blockers or other anti-dysrhythmics…

Post-MI mortality

Reduce _________ w/ aspirin, bet blockers, and ace inhibitors…

Analgesics

Manage severe chest pain and associated anxiety w/ _________…

Headache

To differentiate between a stroke and a MI (heart attack), is a common symptom of _________ with strokes…

ASA

Don’t take _______ if it’s a stroke…

Myocardial infarction

For the emergency treatment of _____ & serious cardiac incidents: 1st action is to take ASA (chew 2 baby aspirin), after nitroglycerin (spray) be administered, morphine can be prescribed for pain relief, & thrombolytics if given within 12hrs of symptoms can help break down blood clots…

Thrombolytics

_______ this drug class's moa: to dissolve clots that are obstructing the coronary arteries…

Thrombolytics

_______ are most effective when administered from 20 minutes to 12 hrs after onset of MI symptoms…

cardiac circulation

Quick restoration of ___________ has been found to reduce mortility…

Anticoagulant or Antiplatelet

After a clot is dissolved like with thrombolytics, _________ or __________ therapy is started…

Myocardial infarction

Drugs used for treatment of ______: beta-adrenergic blockers, antiplatelets & anticoagulant, and angiotensin-converting enzyme (ace) inhibitors…

Myocardial infarction

Goal of ______: reduce cardiac workload, reduce mortality, and manage pain/ patient comfort…

Beta-adrenergic blockers

_________ is the drug class used for the treatment of MI that reduces cardiac workload…

Antiplatelets and anticoagulants

_______ & _______ are the drug classes used for the treatment of MI to dramatically reduce mortality like ASA…

Angiotension-converting enzyme (ACE) inhibitors

_________ is the drug class used for treatment of MI that reduces mortality following a MI…

Beta-blockers

_______ this drug class's moa: to reduce cardiac workload/cardiac oxygen demand which slows hr, decrease contractility, and reduces bp and evidence shows to reduce mortility following a MI…

Bets-blockers

__________ is beneficial to MI as its ability to slow impulse conduction ( ic meaning it sends electrical signals thru out heart that determine heart beat, in a rhythmic pattern) which can help in suppressing dysrhythmias (irregular heart beat), which can be a serious complication of MI…

Anticoagulants

_______ is the drug class that slows the clotting process…

Antiplatelets

________ is the drug class that prevents platelets from sticking together and forming a clot…

ASA 160-324mg

_______ is a specific antiplatelet med and it’s dosage that should be administered as soon as possible if an MI is suspected, as its been found to dramatically reduce mortality…

Antiplatelets and anticoagulants

_______ & _______ are the 2 drug classes that shpuld be initiated after clot is successfully dissolved to prevent formation of a additional thrombi (clot)…

ASA and Clopidogrel

_____ & _____ are the 2 common antiplatelet meds that may be initiated…

Heparin, LMWH or warfarin

For patients at high risk of thrombi formation they may recieve these anticoagulants _______, ______, or _______…

ACE Inhibitors

_______ is a drug class that is also found to reduce mortality following MI, normally begins after thrombolytic therapy after the condition as stabilized…

Morphine

For pain control ______ can be given to ease pain associated w/ severe MI and to sedate the anxious patient…

Myocardial infarction

Post ____ discharge meds include: beta blockers, statin, ace inhibitors and ASA &/or antiplatelets…

Cerebrovascular Accident (CVA)

________ is caused by a thrombus or bleeding from a vessel serving the brain, causing death of neural tissue…

Thrombotic stroke or hemorrhagic stroke

Two main types of cerebrovascular accidents (CVA) includes ______ or ______…

CT scan

A ________ is done to differentiate and diagnosis a thrombotic stroke or a hemorrhagic stroke…

Brain

Symptoms of CVA (thrombotic vs hemorrhagic strokes) are similar and ultimately are dependent on area of _______ affected…

Cerebrovascular accident (CVA)

_____________ symptoms dependent on area of brain affected include: vision loss, paralysis (normally on one side), speech problems, dementia and coma…

40%

Cerebrovascular accidents (CVA) within the first year has a high mortality rate of up to ____…

Stroke

2 main goals for the treatment of _______ includes: 1) preventing _______ thru the use of anticoagulants and antihypertensive agents. 2) restore blood supply to affected portion of the brain as quickly as possible…

Anticoagulants & Antihypertensive agents

_______ & ______ are drugs classes that prevent stroke…

Thrombolytics

_________ is the drug class for treatment of thrombotic stroke, shpuld be administered as quickly as possible after acute stroke as it’ll restore blood supply to affected portion of brain…

4 to 4 ½

For restoration of blood supply to affected portion of brain after acute stroke, thrombolytics must be given within this time window of ________ hours after onset of symptoms…

Antiplatelets/anticoagulants and antihypertensive agents

For the prevention of stroke __________/___________ and _________ are given…

Cerebrovascular accidents (CVA)

Sustained, chronic hypertension is closely related to __________…

Hemorrhagic stroke

Treatment of _________ requires surgical repair of damaged blood vessel…

Coronary Heart Disease (CAD)

_________ is caused by restriction in blood flow to the myocardium…

Angina pectoris

_______ is characterized by severe chest pain caused by lack of sufficient oxygen flow to heart muscle….

Angina

_________ (chest pain) can often be controlled thru positive lifestyle changed and surgical procedures…

Cardiac workload

The pharmacogical management of Angina is achieved by reducing __________…

Nitrates

_________ relieve angina pain by dilating veins and the coronary arteries…

Beta-blockers

________ are sometimes the preferred drugs for reducing the frequency of Angina attacks…

Calcium channel blockers

________ relieve anginal pain by reducing cardiac workload…

Early

The _______ diagnosis and treatment of MI increases the chances of survival…

Thrombolytics

_________ dissolve clots that r blocking the coronary arteries…

Myocardial infarction

Drugs are used to treatvthe symptoms and complications of acute ______…

Aggressive

_______ treatment of cerebrovascular accidents (CVA) can increase survival…