chapter 17
Post on 01-Jan-2016
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Coronary artery disease (CAD) results from atherosclerosis
Clinical symptoms caused by narrowing of the vessels inadequate delivery of blood, nutrients,
and oxygenLocalized muscle injuryA shift from aerobic to anaerobic
metabolismIncreased lactic acid
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Pain produced (angina pectoris)When the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the muscle aches
Aggravated with stress or exercise
Drugs treat by dilating coronary blood vessels
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Angina pectoris : chest painaffects ~ 9.8 million Americans/year
More prevalent in older menThe more vessels involved, the poorer the prognosis
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Used to treat coronary artery disease
Coronary artery disease: inadequate delivery of blood, nutrients, and oxygen to the tissues
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Three main objectives: ◦Minimize frequency, duration, and intensity of episodes◦Offer few side effects◦Prevent myocardial infarction—death
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Minimize the frequency of attacks
Improve the client’s functional capacity
Prevent or delay heart disease
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Acetylsalicylic acid (ASA)NitratesCalcium channel blockers Beta blockersAngiotensin II receptor blockers
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Nitroglycerine◦Forms: sublingual, buccal, chewable, tablets, ointments, patches, spray, and intravenous
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Causes central and peripheral vasodilatation◦Relaxes smooth muscles
Potent dilating effect on coronary arteries
Used for prophylaxis and acute treatment of angina
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Large first-pass effect when taken orally
Transdermal—very effective IV form effectively used for:◦Hypertension◦Congestive heart failure◦Ischemic pain, myocardial infarction ◦Pulmonary edema
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Do not leave the patient when he or she is changing positions after starting a new prescription for nitro◦Nitroglycerin is intended to cause rapid vasodilation -> dizziness with position change◦Nitro paste: remove med from patient’s skin and wash/dry before reapplying◦Always wear gloves when applying nitro topically
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Example of long-acting nitrate◦Isosorbide dinitrate (Isordil)
Provides:◦Acute relief of angina
◦Long-term prophylaxis of angina
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Headache Diminish in intensity
and frequency with use Tachycardia Postural hypotension Dermatitis Tolerance
Long-acting form can become ineffective
Solution◦Remove patch or cream at night for 8 hours◦Take the oral form for 16 hours a day
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Additive hypotension with use of:◦Alcohol◦Beta blockers◦Calcium channel blockers◦Phenothiazines
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Reduces calcium ion influx:◦Reduction of myocardial oxygen consumption◦Coronary artery dilation
Example: VerapamilSide effects◦Dizziness, flushing, supraventricular arrhythmias
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Block the beta receptors◦Reduce heart rate ◦Reduce contractility◦Reduce blood pressure
Example◦Atenolol
Side effects◦Flushing, bradycardia, and bronchospasm
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Angiotensin II receptor blockers◦Block adrenergic receptors, or ◦Direct action Interfere with epinephrine action
Sympathetic nervous system is not stimulated◦Result: decreased blood pressure
Side effects◦Orthostatic hypotension
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Inhibits platelet clumping◦Given as a preventive agent◦Given when a person is experiencing a myocardial infarction
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Patients should carry IDTeach smoking/tobacco cessation, med use
Assess angina attacksTeach: nitroglycerine (NTG) most effective when taken at the beginning of an angina episode
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