Pharmacology for Pharmacy Technicians, 4th Edition PDF

Pharmacology for th Pharmacy Technicians, 4 Ed by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd 1 Chapter 17 Treatment of Angina 2  Lesson 17.1...

Pharmacology for th Pharmacy Technicians, 4 Ed by Kathy Moscou PhD RPh MPH and Karen Snipe CPhT AS BA MEd 1 Chapter 17 Treatment of Angina 2  Lesson 17.1 Angina 1. Learn the terminology associated with the treatment of angina. 2. List the symptoms of and risk factors for angina. 3. Explain the role of coronary artery disease in the development of angina. 4. Identify lifestyle changes that reduce the risk for angina. 3 Key Terms Angina pectoris Symptomatic manifestation of ischemic heart disease characterized by a severe squeezing or pressure-like chest pain and brought on by exertion or stress. Arteriosclerosis Thickening and loss of elasticity of arterial walls; sometimes called “hardening of the arteries.” Atheromas Hard plaque formed within an artery. Atherosclerosis Process in which plaques (atheromas) containing cholesterol, lipid material, and lipophages are formed within arteries. Coronary artery disease Condition that occurs when the arteries that supply blood to the heart muscle become hardened and narrowed. Embolus A moving blood clot. Hyperlipidemia Increased concentration of cholesterol and triglycerides in the blood that is associated with the development of atherosclerosis. Ischemia Deficient blood supply to an area of the body. Myocardial ischemia results in angina and myocardial infarction. Ischemic heart disease Any condition in which heart muscle is damaged or works inefficiently because of an absence or relative deficiency of its blood supply. Necrosis Cell death that may be caused by lack of blood and oxygen to the affected areas. Myocardial infarction Also referred to as a “heart attack.” Results in heart muscle tissue death and is caused by the occlusion (blockage) of a coronary artery. Thrombus Stationary blood clot. Vasospasm Spasms that constrict blood vessels and reduce the flow of blood and oxygen. 4  Overview of Angina (1 of 2) Risk factors: ⮚ Heart disease ⮚ Hypertension ⮚ Diabetes ⮚ Obesity ⮚ Stress 5  Overview of Angina (2 of 2) Risk factors ⮚ Lifestyle: Smoking Overeating Diets high in cholesterol Diets high in salt Excessive alcohol consumption Lack of exercise 6  Angina (1 of 3) Severe squeezing or pressurelike chest pain Pain radiating to arms, shoulders, neck, or jaw Sometimes described as severe heartburn or indigestion 7  Angina (2 of 3) Imbalance between blood supplied to the heart muscle and the need for blood and oxygen Symptoms occur when blood supplied to the heart is insufficient to meet heart’s need for oxygen 8  Angina (3 of 3) Coronary artery disease: ⮚ High dietary cholesterol is a contributor ⮚ Cholesterol, lipid material, and lipophages deposited within arteries Atherosclerosis: ⮚ Lipid streaks harden into plaques (atheromas) ⮚ Atheromas can increase in size and reduce blood flow 9  Types of Angina Stable angina: ⮚ Symptoms with physical exertion, smoking, eating heavy meals, exposure to extreme changes in temperature, and emotional stress ⮚ Symptoms relieved by rest Unstable angina: ⮚ Symptoms without exertion and when an embolus occludes an artery Variant or vasospastic angina: ⮚ Symptoms caused by vasospasm of coronary arteries ⮚ Symptoms at rest, during the night, or early morning 10 Nonpharmacological Treatment of Angina Lifestyle changes: ⮚ Frequent rest breaks if necessary, to avoid angina that is caused by exertion ⮚ Avoid foods high in salt and cholesterol ⮚ Eat small portions ⮚ Learn techniques to manage stress ⮚ Advocate for workplace and community-wide changes that facilitate lifestyle change: Nutritious food choices in cafeterias 11  Lesson 17.2 Drugs Used to Treat Angina 5. List and categorize medications used to treat angina. 6. Describe mechanism of action for each classification of drugs used to treat angina. 7. Identify significant drug look-alike/sound-alike issues. 8. List common endings for drug classes used in the treatment of angina. 9. Identify warning labels and precautionary messages associated with medications used to treat angina. 12 Poll 13 Drugs Used in the Treatment of Angina Nitrates: ⮚ Isosorbide dinitrate: Acute and extended-release forms ⮚ Isosorbide mononitrate: Long-acting metabolite of isosorbide dinitrate Used for prevention only ⮚ Nitroglycerin: Acute and extended-release forms 14  Nitrates (1 of 2) Dilate blood vessels (arteries and veins) Increase supply of oxygen to the heart Most are prodrugs Converted in the body to nitrous oxide, causing vascular relaxation 15  Nitrates (2 of 2) Adverse reactions: ⮚ Vasodilation ⮚ Hypotension ⮚ Facial flushing ⮚ Dizziness ⮚ Headache ⮚ Nausea and vomiting ⮚ Weakness ⮚ Fatigue 16 Look-Alike/Sound-Alike Drugs: Nitrates Isordil, Isuprel, and Inderal Imdur and Imuran Monoket and Monopril Nitro Bid and Nicobid Nitroderm and Nicoderm Nitrol and Nizoral Nitrostat, Nilstat, and Hyperstat 17  Beta-Adrenergic Blockers (1 of 3) Atenolol Metoprolol Nadolol Propranolol 18  Beta-Adrenergic Blockers (2 of 3) Reduce heart’s demand for oxygen Bind to beta-receptor sites and block activity of the sympathetic nervous system Decrease heart rate, reducing workload of heart Decrease frequency and severity of stable (exertional) angina 19  Beta-adrenergic Blockers (3 of 3) Adverse reactions: ⮚ Dizziness ⮚ Fatigue ⮚ Bradycardia ⮚ Hypotension ⮚ Impotence ⮚ Heart block 20  Look-Alike/Sound-Alike Drugs: Beta-Adrenergic Blockers Atenolol, albuterol, and timolol Tenormin, Norpramin, and thiamine Metoprolol, metolazone, metaproterenol, and misoprostol Toprol-XL and Topamax Corgard, Coreg, and Cognex Inderal, Isordil, Toradol, Imdur, Adderall, Enduron, Enduronyl, Inderal LA, and Inderide 21  Calcium Channel Blockers (1 of 3) Dihydropyridines: ⮚ Amlodipine ⮚ Nicardipine ⮚ Nifedipine Nondihydropyridines: ⮚ Benzothiazepines (diltiazem) ⮚ Phenylalkylamines (verapamil) 22  Calcium Channel Blockers (2 of 3) Block L-type voltage-dependent calcium channels Suppress depolarization Reduce contraction of heart muscle Dihydropyridines: ⮚ Selective for blood vessels ⮚ Do not slow heart rate 23  Calcium Channel Blockers (3 of 3) Adverse reactions: ⮚ Dihydropyridines: Dizziness Flushing Headache Peripheral edema ⮚ Nondihydropyridines: Heart block and heart failure Bradycardia Constipation 24  Look-Alike/Sound-Alike Drugs: Calcium Channel Blockers Norvasc, Norvir, and Vasocor Amlodipine and amiloride Cardizem, Cardura, Cardene, Cardizem SR, Cardene SR, and Cardizem CD Tiazac, Tigan, and Ziac Nicardipine, nifedipine, and nimodipine Procardia, Procardia XL, and Cartia XT Covera HS and Provera Verelan, verapamil, and Voltaren 25 Tech Note: Common Syllables and Endings Nitrates share the common syllables of “nitro” or “nitra” in brand or generic names Beta-adrenergic blockers share the common ending of “-olol” Generic names of dihydropyridine calcium channel blockers end in “-dipine” 26  Other Drug Classifications Angiotensin-converting enzyme inhibitors (ACEIs) Anticoagulants Antiplatelet drugs Glycoprotein IIb/IIIa drugs Antihyperlipidemics 27  Warning Labels Nitrates: ⮚ Take on empty stomach (isosorbide dinitrate) ⮚ Swallow whole (sustained and extended release) ⮚ Avoid alcohol Beta-adrenergic blockers ⮚ May cause dizziness ⮚ Use caution when driving or performing tasks requiring alertness ⮚ Avoid abrupt discontinuation Calcium channel blockers ⮚ May cause dizziness ⮚ Limit caffeine and alcohol 28 Poll 29 Questions? 30