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This Concept Map, created with IHMC CmapTools, has information related to: Angina, Current Treatment ???? Hydrochlorothiazide, Possible Drug Therapy ???? Ca Channel Blockers Non DHP, Myocardial Infarction ???? Differences, Nitrates Long-acting Isosorbide Mononitrate, Blockage of Coronary Blood flow Complete occlusion Cell Death, Last 2 weeks can only walk about 4 blocks ???? SOB, Mrs. White ???? Type 2 Diabetes, Angina Possible Drug Therapy, SOB ???? Very Anxious, Prevention of acute and chronic angina, hypertension, and MI Recommended Dosage IR: 20 mg QAM, then 20 mg 7 hours later, Mrs. White ???? Hypertension, Nitrates ???? Decrease Preload and afterload. Vasodilate coronary arteries, relaxes smooth muscle, Beta Blockers ???? Decrease HR, BP, and contractility, Nitroglycerin MOA Nitroglycerin converted to NO, which is a potent vasodilator NO also activates enzyme cyclic guanylate cyclase. Then cGMP will help dephospharylate myosin light chain kinase of smooth muscle, which will lead to Ca release and cause relaxation and vasodilation., Tolerance defined Loss effects of nitrates due to long term administration, ACEi ???? Decrease aortic pressure, afterload, and resistance, Differences Treatment Angina: can be treated with medication MI: medication wont help, Isosorbide Mononitrate Counseling point Avoid alcohol can decrease BP, may cause headaches, Tolerance Prevention Allow a daily nitrate free interval of 8-12 hrs. Make sure to have interval when pt is least likely to experience angina., Nitroglycerin Use Prevention of Angina