So, let’s go back to those categories of the common drugs that we use to treat chest pain.
They do one of two things. If you look at your notes, you see that you’ve got nitrates in the middle, right?
There’s -- I mean you’ve got a bottle of meds in the middle.
They’re not just nitrates, nitrates are one of those in there,
but the medications that we used most commonly to treat chest pain going to one of the two categories.
These are a vasodilator or they’re cardiac depressants.
Now, the cool thing is calcium channel blockers fall into both categories.
Nitrates are vasodilators.
So, when they vasodilate, less blood returns back up to the heart, lower afterload, less work on the heart.
Calcium channel blockers dilate coronary arteries that’s awesome for supply,
but they can also directly suppress the heart rate, so they’re cardiac depressants.
Beta blockers of course definitely are cardiac depressants
because they suppress the heart rate, they directly decrease the heart rate.
So, this is a really good slide, I was so excited when I saw what the artist did
because they broke this down beautifully for you.
We think of the most common drugs, you’re gonna think nitrates, calcium channel blockers, and beta blockers.
And look at the categories we have in there for you. Nitrates are the only ones on vasodilators?
Nope. Nitrates and calcium channel blockers bridge that gap,
for cardiac depressants, you’ve got calcium channel blockers again and beta blockers.
Okay. I know that’s a really detailed chart that you have up there, but it’s a great cheat sheet.
So, write yourself a note when you’re cruising yourself.
This is great, and I hope we’ve even some questions for you to help you practice on just remembering
because in vasospasms, we use nitrates and calcium channel blockers.
For fixed stenosis, we use both of those, but we also use beta blockers
and we consider some types of procedures like angioplasty or stents.
If we have a clot, a thrombosis, we used drugs called, thrombolytics.
Now, they’re high risked drugs, but they’re high-valued drugs.
So, they boom. They break up any clot in your body, which can sometimes be problematic,
but if they’re given quickly enough like we have to give it
within a short period of time with patients that has symptoms, they can restore a life.
I can remember when I was in the hospital in Glendale,
were there was a young mother who came in, and she’d actually suffered a clot in her brain, a stroke.
And she had a complete left-sided weakness.
Now, she was a mom of three and everyone was really upset to see this event for this patient,
but when she received a thrombolytic, she walked out of that hospital completely restored.
It still gives me goosebumps to even think about that.
So, thrombolytics, that’s a happy ending to the story.
I’ve also had patients that have, unfortunately not survive that treatment,
because it was a high risk for bleeding in your head.
So, I really would rather think about that single mom, who’s spending all that time with her kids now,
because she received it at the right time and had a fantastic result.
So, for clots, we’re gonna use something that bursts that clot if it’s appropriate and we think it’s a safe.
And then, antiplatelet drugs, things that stop a clot from getting bigger and for new clots forming.
Now, I know somebody has the chest pain is caused because of high heart rate,
beta blockers and calcium channel blockers are gonna help us.
Now, before I tell you the answer, I want you to pause and think.
Why would beta blockers and calcium channel blockers be used for chest pain that’s caused by a high heart rate?
I hope you got it because remember, beta blockers and some of the calcium channel blockers, directly decrease the heart rate.
So, good work if you got it. No problem if you didn’t.
Just write yourself a note on there, remember, they directly decrease heart rate.
Because that means you’re gonna have to educate the patient,
“Hey, you have to take the pulse before you take this medication.”
In NCLEX or testing world, if the pulse is less than 60, we hold the medication and contact the health care provider.
We teach the patient the same thing.
Now, doctors might write other orders and they might write a number that’s even lower than 60,
but for NCLEX world and testing world, 60 is the magic minimum heart rate
before you give the medication that would decrease that heart rate.
Now, if the cause of the chest pain is increased afterload,
that means the heart is having to work really hard to pump that blood out to the rest of the body,
they already gave them beta blockers, calcium channel blockers
and some anti-hypertensive drugs to help decrease that afterload.
If the cause of chest pain is increased preload,
we’re gonna give them beta blockers, calcium channel blockers, and our friend, ranolazine, the new one.
Okay. So, don’t just clause over on this chart. I want you to write yourself a note, come back to this chart and review it.
After you’ve watched the rest of the videos and asked yourself why.
Why do we use nitrates for vasospasms, and how would that fix the problem?
So, make sure you can answer the question, what is a vasospasm?
What would it look like if I was a vessel? Why would we choose to use nitrates and calcium channel blockers?
And why don’t we use beta blockers?
So, those are the types of questions if you question and asked yourself while you’re studying.
I promise you the information will stick because when you understand the why,
you go well beyond the memorizing just facts and figures and you’ll be able to keep it straight in your mind.