Angina <3 Flashcards
angina is caused by what?
lack of O2 to heart –> anaerobic metabolism –> lactic acid buildup
angina drugs do which 2 things? (broad)
- decrease O2 demands of heart
2. increase O2 supply
3 main families + other for angina drugs
- organic nitrates
- Beta blockers
- calcium channel blockers
- other: ranolazine
prototype for organic nitrates
nitroglycerin
MOA of nitroglycerin
-in stable angina
+
-vasospasm
in stable angina: decrease O2 demand by VASODILATION
in vasospasm: increase O2 supply by relaxing coronary arteries
forms of nitroglycerin
- oral (1st pass effect)
- sublingual
- buccal
- patch
- IV
what is the short acting nitroglycerin?
isosorbide dinitrate
what is the long acting nitroglycerin?
isosorbide mononitrate
patient teaching/considerations for SL nitroglycerin
- don’t pour into hands
- don’t store in bathroom (b/c of humidity)
- keep in dark package
what is half life of nitroglycerin?
5-7 minutes (hence why we administer q5mins)
how long does nitroglycerin last?
up to 1 hour
what drug-drug interaction can cause life-threatening hypotension and CV collapse?
nitroglycerin + erectile dysfunction drugs
when should SL nitroglycerin be taken?
ONSET of chest pain
protocol for SL nitroglycerin administration at home
1 tablet at onset of chest pain
wait 5 mins
still have chest pain? call 911 + take 2nd dose
wait 5 minutes
still have chest pain? take 3rd dose + hope that EMS is almost there :)
protocol for SL nitroglycerin administration in hospital
check BP + HR + assess give 1 tablet wait 5 minutes still have chest pain? check BP + HR + assess give 2nd tablet wait 5 minutes still have chest pain? check BP + HR + assess give 3rd dose
difference is checking BP/HR + assessing before administering doses
pt education for nitroglycerin
- no ETOH - severe hypotension
- rotate patch site - avoid irritation
- have “drug free” periods - avoid tolerance + tachyphylaxis (@ night is good time)
common SE of nitroglycerin
- HA (usually improves)
- hypotension
- orthostatic hypotension
- tachycardia
nursing considerations for nitroglycerin
- wear gloves (patch or paste)
- wipe off skin before applying defib pads (can burn)
prototype for beta blockers for angina
metoprolol
MOA of beta blockers for angina
reduce O2 cardiac demand by decreasing HR, contractility + contraction
what is 1st line tx for chronic stable angina?
beta blockers
“betas are the BEST!”
(Reduces death risk post MI)
what should you know as a nurse with beta blockers?
- take BP + HR (apical)
- avoid with asthma + COPD
- diabetics: close BG monitoring
- don’t stop suddenly
- monitor for bradycardia + AV block
prototype for calcium channel blockers for angina
diltiazem (acting on heart and vessels)
MOA of diltiazem for angina
relaxes smooth muscles –> vasodilation
+ works on heart: decreased HR, conduction, contractility
