week 4

angina pectoris

angina pectoris

acute chest pain due to insufficient O2 to myocardium

stable angina

relieved with rest

what are lifestyle changes for angina? (4)

• limit alcohol

• limit smoking

• exercise

• diet

what drug terminates acute angina episodes?

nitroglycerin

how do nitrates work?

relaxes both arterial and venous smooth muscle; dilate coronary arteries

WHICH

reduces the hearts workload and lowers oxygen demand

what do short-acting nitrates do?

terminate acute angina episodes

what do long-acting nitrates do?

decrease severity and frequency of episodes

what are the potential adverse effects of nitroglycerin? (4)

• hypotension

• dizziness

• headache

• flushing of face

What should you teach a patient for using Nitroglycerin at home? (5)

• take one tablet every 5 minutes until pain is relieved.

• do not take more than 2 doses, and call EMS of chest pain is not relieved.

• place SL tab or spray under tongue.

• lie down before taking.

• wait 24 hours before taking sidenafil or a phosphodiesterase-5 inhibitor (viagra lol)

How do beta blockers work?

reduce the cardiac workload by slowing heart rate and reducing contractility.

what are the potential adverse effects of beta blockers? (5)

• fatigue

• drowsiness

• bradycardia

• insomnia

• confusion

what is atenolol (Tenormin)?

a beta blocker

how do calcium channel blockers work?

inhibit the transport of calcium into myocardial cells, and relaxes arteriolar smooth muscle

this reduced cardiac workload and brings more O2 into the myocardium

what is diltiazem (Cardizem)?

calcium channel blocker

what are potential adverse effects of calcium channel blockers? (5)

• hypotension

• bradycardia

• constipation

• headaches

• dizziness

what causes myocardial infarction to occur?

when a coronary artery becomes completely occluded

what do thrombolytics do?

“clot busters”

dissolve clots obstructing coronary arteries

what is important to remember about thrombolytics?

they have a narrow margin of safety

what is reteplase (Retavase)?

thrombolytic

what medication for angina has the highest risk of hypotension?

iv nitrates

what is contraindicated with nitrates?

alcohol

what teaching should be given to a patient taking beta-adrenergic blockers?

do not stop taking medications abruptly

what should the nurse do for a patient taking calcium channel blockers? (4)

• hold medication if HR is 60 or less.

• obtain BP.

• obtain daily weights.

• assess bowel function.

what should the nurse do for a patient taking thrombolytics? (4)

• assess patients risk of bleeding.

• foley catheter.

• monitor intake and output.

• assess for dysrhythmia.

what are the three factors that work together to effect blood pressure?

• cardiac output

• blood volume

• peripheral resistance (diameter of arterioles)-

remember: pump, fluid, and pipes.

change in one = change in others

what medications lower blood pressure by effecting the blood volume (THE FLUID!!) (1)

• diuretics

how do diuretics lower blood pressure?

increases urination > decreases blood volume > decreases blood pressure

what is the renin-angiotensin-aldosterone system?

a hormone system that regulates blood pressure

what are the 5 primary classes of anti-hypertensive agents?

• diuretics

• angiotension-converting enzyme (ACE) inhibitors

• angiotension II receptor blockers

• beta-adrenergic antagonists

• calcium channel blockers

where do potassium-sparing diuretics work on the nephron?

distal tubule

what is the mechanism of action of potassium-sparing diuretics?

aldosterone inhibitor (excretes H2O and Na+ but not K+)

what are possible adverse effects of potassium-sparing diuretics? (3)

• hyperkalemia (too much potassium)

• gynecomastia (man boobs)

• dysrhythmias

what drug class is spironolactone (Aldactone)?

potassium-sparing diuretic

what drug class is furosemide (Lasix)?

loop diuretic

what is the mechanism of action for loop diuretics?

inhibits the reabsorption of salts in the kidneys

where do loop diuretics work on the nephron?

loop of henle

what are potential adverse effects of loop diuretics? (4)

• hypokalemia

• postural hypotension

• dehydration

• ototoxicity

what class of drug is hydrochlorothiazide?

thiazide diuretic

what is the mechanism of action for thiazide diuretics?

inhibits NaCl cotransporter

what are potential adverse effects of thiazide diuretics? (4)

• hypokalemia

• electrolyte depletion

• dehydration

• hypoglycemia

what should be monitored with patients taking diuretics? (3)

• potassium levels

• electrolyte levels

• blood glucose and uric acid levels

how do calcium channel blockers decrease blood pressure?

block calcium ion channels > cause vasodilation > decreases BP

what medications lower blood pressure by effecting peripheral resistance (diameter of arterioles) THE PIPES! (3)

• calcium channel blockers

• ACE inhibitors

• angiotensin II receptor blockers (ARBS)

what is important to know about calcium channel blockers?

cannot consume grapefruit juice!! it will cause the medication to release very fast and may cause an overdose

what class of drug is Nifedipine?

calcium channel blocker

what class of drug is enalapril (Vasotec)?

ACE inhibitor

what is the mechanism of action for ACE inhibitors?

reduces angiotension II (vasoconstrictor) and aldosterone level to lower BP

what are potential adverse effects of ACE inhibitors? (4)

• orthostatic hypotension

• first dose effect (rapid drop in BP)

• fetal toxicity

• angioedema (swelling of lips/mouth)

what is a common side effect of ACE inhibitors?

dry cough

what is important to know about ACE inhibitors? (3)

• cannot consume grapefruit juice

• first dose may cause rapid drop in BP

• adverse effect of angioedema (watch for swelling in mouth)

how do angiotensin II receptor blockers (ARBs) lower blood pressure?

blocks the effect of angiotensin II (a chemical that narrows blood vessels)

how do beta-adrenergic blockers decrease blood pressure?

decreases heart rate and contractility (force)

what medications lower blood pressure by effecting cardiac output (the PUMP!!) (2)

• beta-adrenergic blockers

• cardiac glycosides

what causes left-sided heart failure? (3)

1. blood accumulates in the left ventricle because it cannot efficiently pump blood into circulation

2. causes LV to hypertrophy (thicken and enlarge)

3. blood backs up into lungs

what causes right-sided heart failure? (3)

1. caused by left-sided heart failure

2. blood backs up into lungs

3. causes peripheral edema and organ engorgement

what is preload?

volume of blood in ventricles at the end of diastole

what is afterload?

resistance left ventricle must overcome to circulate blood (increased afterload = increased cardiac workload)

what conditions increase afterload? (2)

• hypotension

• vasoconstricion

what condition increases preload?

• heart failure

what is frank-starling law?

the more fibers are stretched, the more forcefully they will contract (like a rubber band)

what do ACE inhibtors do to treat heart failure?

reduce afterload by decreasing blood pressure and reducing blood volume (dilates veins)

how do beta-adrenergic blockers treat heart failure?

they have an inotropic effect, so they decrease heart contractility, therefore reducing the workload of the heart

what class of drugs is metropolol?

beta-adrenergic blocker

what are possible adverse effects of beta-adrenergic blockers? (5)

• fluid retention

• worsening of heart failure

• hypotension

• bradycardia

• heart block

why would we be concerned if a patients pulse is below 50 while taking beta-adrenergic blockers?

heart block

how do diuretics treat heart failure? (3)

1. increase urine flow

2. reduce blood volume and cardiac workload

3. reduce edema and pulmonary congestion

what should be monitored in patients taking diuretics for heart failure? (3)

• monitor sodium intake

• weight loss

• fatigue and muscle cramps

how do cardiac glycosides treat heart failure?

increases force of heartbeat, slows heart rate, which increases efficacy of heart muscle

what class of drug is digoxin (Lanoxin)?

cardiac glycoside

what are potential adverse effects of cardiac glycosides? (3)

• neutropenia (low WBCs)

• dysrhythmias

• digoxin toxicity

what are symptoms of digoxin toxicity? (4)

• problems with NS

• nausea + vomiting

• confusion

• visual disturbances

what should not be taken within 2 hours of cardiac glycosides? (2)

• antidiarrheals

• antacids

what should patients be taught when taking cardiac glycosides? (4)

• know signs/symptoms of toxicity

• monitor pulse rate

• report weight gain

• eat foods high in potassium (low K+ = more at risk for toxicity)

what medication is used short term, in emergency situations, to treat heart failure, because it is toxic?

phosphodiesterase inhibitors

what are the 3 types of lipids?

• triglycerides (95% of diet)

• phospholipids (2% of diet)

• steroids (cholesterol)

what are lipoproteins?

special carriers of lipid molecules bc the lipid molecules aren’t water soluble

what are the types of lipoproteins, and which is good / bad?

• high-density lipoprotein (HDL)

  protective effect against CVD

• low-density lipoprotein (LDL)

  associated with CVD

REMEMBER: LDL = LOUSY, HDL = HERO

what is hyperlipidemia?

high levels of lipids in the blood

what is hypercholesterolemia?

elevated blood cholesterol

what is dyslipidemia?

abnormal levels of lipoproteins, either excess or deficient

what determines our ability to metabolize lipids?

genetics

how are lipid disorders diagnosed?

blood work

what is primary dyslipidemia?

genetic

what is secondary dyslipidemia?

acquired

what medications / supplements treat lipid disorders? (6)

• statins

• fibrates

• resins

• ezetimibe

• fish oil

• metamucil

what lifestyle changes can help manage lipid disorders? (5)

• maintain weight

• exercise

• reduce saturated fats and cholesterol

• increase soluble fiber

• reduce or eliminate tobacco use

what do HMG-CoA reductase inhibitors (statins) do?

reduce serum-lipid levels

what drug class is atorvastatin?

HMG-RoA reductase inhibitor

what are potential adverse effects of HMG-RoA reductase inhibitors? (statins) (4)

• headache

• muscle or joint pain

• heartburn

• rhabdomyolysis (sign = muscle pain)

what is important to remember about statins? (4)

• can interact with other meds + grapefruit

• monitor liver function tests

• do not use when pregnant or breastfeeding

• watch for signs of GI upset

what drug class is cholestyramine (Questran)?

bile acid resin

how do bile acid resins work?

binds with bile acids, increasing cholesterol excretion in stool

what are potential adverse effects of bile acid resins? (2)

• bloating

• constipation

what does nicotinic acid do?

reduces triglycerides and increases HDL levels

what are potential adverse effects of nicotinic acid? (6)

• flushing

• hot flashes

• excess gas

• diarrhea

• heptatotoxicity

• gout

what should be monitored in patients taking nicotinic acid? (3)

• liver function

• uric acid levels (gout)

• blood-sugar levels

what is the big effect to remember about medications to treat lipid disorders?

all can cause GI distress

what are fibric-acid agents used to treat?

severe hypertriglyceridema

what medication class is gemfibrozil (Lopid)?

fibric-acid agent

what are potential adverse effects of fibric-acid agents? (2)

• GI distress

• bleeding with patients on anticoagulants