Chapter 21: Angina and Antilipemic Agents

Vocabulary practice flashcards covering organic nitrates, antianginal medications, statins, cholesterol absorption inhibitors, bile-acid sequestrants, fibrates, and PCSK9 monoclonal antibody inhibitors.

Chronic stable exertional angina (Nitroglycerin action)

The condition in which nitroglycerin dilates veins and decreases venous return (preload), thereby reducing myocardial oxygen demand.

Variant (Prinzmetal's) angina (Nitroglycerin action)

The condition in which nitroglycerin prevents or reduces coronary artery spasms to increase myocardial oxygen supply without decreasing oxygen demand.

Reflex tachycardia

A compensatory increase in heart rate triggered by nitrate-induced vasodilation, managed by administering a beta blocker such as metoprolol or a calcium channel blocker such as verapamil.

Nitrate tolerance

A reduction in medication responsiveness from continuous nitrate exposure, prevented by using the lowest therapeutic dose and maintaining an intermittent drug-free period of 8 to 12 hours daily.

Phosphodiesterase type 5 (PDE5) inhibitors

Erectile dysfunction medications that are strictly contraindicated with nitroglycerin because concurrent use intensifies vasodilation and causes life-threatening hypotension.

Sublingual nitroglycerin tablet

A rapid-onset, short-duration organic nitrate placed under the tongue to dissolve at the first indication of chest pain, which must be kept in its original bottle in a cool, dark place.

Translingual nitroglycerin spray

A rapid-acting formulation sprayed directly against the oral mucosa without inhaling, used for treating an acute attack or for prophylaxis prior to exertion.

Anginal attack emergency dosing protocol

A regimen where the client stops activity, rests, takes one sublingual tablet (or spray), waits 5 minutes, repeats up to a maximum of 3 doses across 15 minutes, and calls 911 if pain persists.

Sustained-release oral nitroglycerin capsules

A slow-onset, long-duration formulation taken once or twice daily on an empty stomach with at least 8 oz of water for long-term prophylaxis and swallowed without crushing or chewing.

Nitroglycerin transdermal patch

A slow-onset, long-duration topical patch applied to clean, hairless skin on the chest, back, or abdomen; rotated daily, never cut, and removed at night for at least 10 to 12 hours.

Nitroglycerin topical ointment

A long-acting formulation measured onto applicator paper across 2.5 to 3.5 inches, applied without rubbing into clean hairless skin after removing the previous dose, and handled without touching bare hands.

Ranolazine

An antianginal agent that lowers cardiac oxygen demand and improves exercise tolerance by reducing sodium and calcium accumulation in myocardial cells, used for chronic stable angina.

QT prolongation

A cardiac conduction abnormality caused by ranolazine that increases the risk for torsades de pointes, requiring ECG monitoring and prompt reporting of palpitations, chest pain, or dyspnea.

Torsades de pointes

A dangerous ventricular arrhythmia that can occur when ranolazine is taken with CYP3A4 inhibitors or other medications that prolong the QT interval.

CYP3A4 inhibitors (Ranolazine interaction)

Substances such as grapefruit juice, HIV protease inhibitors, macrolide antibiotics, and azole antifungals that increase ranolazine blood levels and increase the risk for torsades de pointes.

Amlodipine (Ranolazine compatibility)

The only calcium channel blocker permitted for concurrent use with ranolazine because it does not inhibit the CYP3A4 enzyme.

Sotalol (Ranolazine interaction)

An antiarrhythmic agent that concurrently with ranolazine can further prolong the QT interval and is contraindicated for coadministration.

HMG-CoA reductase inhibitors (Statins)

Antilipemic medications that inhibit cholesterol synthesis, decrease LDL and VLDL production, increase HDL synthesis, lower triglycerides, and reduce plaque site inflammation.

Atorvastatin

The prototype statin indicated for primary hypercholesterolemia, prevention of coronary events, and protection against MI and stroke in clients who have diabetes mellitus.

Lovastatin administration

A statin medication that must be taken specifically with meals (with the evening meal) to enhance bioavailability and therapeutic absorption.

Evening dosing of statins

The optimal administration timing for most statin medications because hepatic cholesterol synthesis predominantly occurs during the night.

Hepatotoxicity (Statin complication)

Liver dysfunction manifested by elevated aspartate transaminase (AST) levels, anorexia, vomiting, nausea, and jaundice, requiring baseline testing and discontinuation if values exceed normal ranges.

Myopathy (Statin complication)

Adverse muscle aches, tenderness, and pain associated with elevated creatine kinase (CK) that can progress to myositis or rhabdomyolysis.

Creatine kinase (CK)

A laboratory enzyme documented at baseline and monitored during antilipemic therapy to assess for drug-induced muscle damage and rhabdomyolysis.

Aspartate transaminase (AST)

A hepatic enzyme monitored before and during statin or fibrate therapy to identify drug-induced liver injury.

Rosuvastatin Asian descent precaution

A clinical guideline recommending that rosuvastatin be avoided or prescribed at a reduced dosage in clients of Asian descent due to altered pharmacokinetics.

Grapefruit juice (Statin interaction)

A dietary substance that suppresses CYP3A4 metabolism and significantly elevates blood concentrations of atorvastatin, lovastatin, and simvastatin.

Ezetimibe

The prototype cholesterol absorption inhibitor that blocks the reabsorption of cholesterol secreted in bile and inhibits the absorption of dietary cholesterol from the small intestine.

Apolipoprotein B

A lipid component that, together with LDL and total cholesterol, is significantly decreased by ezetimibe when used alone or with a statin.

Ezetimibe and Bile acid sequestrant interaction

A drug interaction where bile acid sequestrants (such as cholestyramine) interfere with ezetimibe absorption, requiring ezetimibe to be taken 2 hours before or 4 hours after the sequestrant.

Colesevelam

The prototype bile-acid sequestrant administered orally as tablets with food and 8 oz of water to lower circulating LDL cholesterol.

Colestipol

A bile-acid sequestrant supplied in tablet form (which must not be crushed or chewed) or as a powder that requires dissolution in 4 to 8 oz of fluid to prevent esophageal impaction.

Bile-acid sequestrant administration spacing rule

The requirement that interacting medications (e.g., levothyroxine, glipizide, phenytoin, fat-soluble vitamins, oral contraceptives) be taken 1 hour before or 4 hours after a bile-acid sequestrant.

Bile-acid sequestrant GI disturbances

Adverse effects including severe constipation, bloating, and abdominal discomfort, managed by increasing dietary fiber, fluid intake, or taking mild laxatives.

Fat-soluble vitamins (A, D, E, K)

Essential vitamins whose intestinal absorption is significantly hindered by the binding action of bile-acid sequestrants.

Gemfibrozil

The prototype fibrate medication that decreases serum triglyceride levels by increasing VLDL excretion and raises HDL levels by promoting the synthesis of HDL precursors.

Fenofibrate

A fibrate antilipemic agent indicated for the reduction of high plasma triglycerides (VLDL) and elevation of HDL in clients unresponsive to diet or lifestyle changes.

Gemfibrozil administration timing

The schedule requirement to administer oral gemfibrozil exactly 30 minutes prior to breakfast and dinner.

Cholelithiasis (Fibrate complication)

The formation of gallstones caused by fibrates, presenting clinically as right upper quadrant (RUQ) abdominal pain, fat intolerance, and bloating.

Gemfibrozil and Warfarin interaction

A pharmacological interaction where concurrent use increases the risk of bleeding, requiring baseline and periodic prothrombin time (PT) and INR monitoring.

Fibrate and Statin interaction

A high-risk combination of antilipemic drugs that markedly increases the incidence of myopathy, rhabdomyolysis, and liver and kidney injury.

Alirocumab

A PCSK9 monoclonal antibody inhibitor administered via the subcutaneous route to lower LDL levels by binding to low-density lipoprotein receptors.

Evolocumab

A monoclonal antibody agent used as an adjunct to dietary modifications in clients with elevated LDL to lower the risk of CAD death, myocardial infarction, and stroke.

Monoclonal antibody administration protocol

The practice of allowing subcutaneous solutions (alirocumab, evolocumab) to warm to room temperature before injection and rotating injection sites to avoid rash or inflamed tissue.

Hypersensitivity reaction (Alirocumab complication)

An adverse immune response to monoclonal antibody therapy characterized by rash, vasculitis, or urticaria.

Low-density lipoprotein (LDL) target assessment (Alirocumab)

The clinical evaluation period requiring LDL levels to be reassessed within 4 to 8 weeks after initiating PCSK9 inhibitor therapy.

Orthostatic hypotension (Nitroglycerin complication)

A rapid drop in blood pressure upon standing induced by organic nitrates, which clients mitigate by changing positions slowly and sitting or lying down when feeling dizzy.

Isosorbide mononitrate

An oral organic nitrate used for long-term prophylaxis of chronic stable angina that must not be chewed or crushed.

Bile-acid sequestrant contraindications

Preexisting disorders including complete bowel obstruction and pancreatitis caused by high triglycerides where colesevelam is contraindicated.

Simvastatin and Digoxin interaction (with Ranolazine)

A drug interaction occurring when ranolazine is given concurrently, leading to elevated blood concentrations of simvastatin and digoxin and requiring close monitoring for toxicity.