Angina Drug Therapy

Question 1

Antiplatelet/Anticoagulant Agent

• Aspirin
• clopidogrel >Plavix
• Effient
• warfarin >Coumadin

Answer 1

Platelet inhibitor Contraindications

1. GI Bleeding
2. Allergy to aspirin
3. Asthma pt with sensitivity to NSAIDS

GIVE AS SOON AS HEART ATTACK IS SUSPECTED

Question 2

Nitrates -Short Acting

Answer 2

First line therapy in treatment of angina episode

Dilates peripheral and coronary blood vessels.

1. Dec SVR- Dec venous return to ❤️
2. Reduce cardiac workload
3. Dec myocardial oxygen demand
4. Dilated coronary blood vessels increase oxygen supply to the myocardium

Question 3

Sublingual Nitrogen

Answer 3

Table or Spray

Question 4

Sublingual Nitrogen >Tablet or Spray

Answer 4

1. Usually relieves pain in minutes and has a duration of 30-60mins 2. When chest pain begins, place one pill, or one metered spray under tongue. If no pain relief in 5 mins call EMS. If pain subsides continue taking one dose every 5 mins until pain free or maximum of doses.

Question 5

Sublingual Nitrogen -Education

Answer 5

>Do not take with Viagra >Monitor for OH >Keep meds handy >Prophalactically >S.E: tingle when placed under toungue, HA, dizziness and flushing >Med is in light resistant bottle >Must replace q 6 mos

Question 6

Long Acting Nitrates ***Isordil and Imdur

Answer 6

>Same systemic effects just slowly released over time >S.E: HA (usually Dec over time) *Take Tylenol >Monitor for Hypotension ***8 hour nitrate free time (usually night)

Question 7

Long Acting Nitrates ***Nitroglycerin ointment

Answer 7

1. Dose by the inch 2. Lasts 3-6 hours 3. Place over flat muscular area 4. Avoid hair or scars ***Severe HA if put on the hands

Question 8

Long Acting Nitrates *Transdermal controlled release

Answer 8

Steady therapeutic plasma levels over 24 hr period

Question 9

Beta Blockers

Answer 9

1. Preferred drugs to manage angina *****“lols” 2. Dec myocardial contractility (Heart slows down) Dec HR, SVR, BP 3. Avoid in asthmatics 4. Use caution in diabetes (masks symptoms of hypoglycemia) >S.E: bradycardia, hypotension, wheezing, GI symptoms, weight gain, sexual dysfunction.

Question 10

Calcium Channel Blockers **If can not take Beta Blockers

Answer 10

1. Systemic vasodilation (Dec SVR), Dec myocardial contractility, coronary artery dilation. 2. Causes smooth muscle dilation 3. Potentiates action of Digoxin during the first week of therapy ***Monitor Digoxin levels closely ***Teach S/s of Digoxin toxicity Examples >Procardia, Calan, Cardiazem.

Question 11

Digoxin Toxicity

Answer 11

1. N/V, Anorexia 2. Blurred Vision, photophobia, colored vision, halos around dark objects 3. Fatigue, drowsiness, HA, depression 4. Dysrhythmias, bradycardia, tachycardia, apical-radial pulse deficit, HF

Question 12

ACE Inhibitors

Answer 12

1.Used c pt who are at high risk for cardiac event ***prils 2. Hypotension, loss of taste, COUGH, rash, angioedema 3. ASA and NSAIDs reduce action, DIURETICS enhance action 4. DO NOT USE WITH K SPARING DIURETICS

Question 13

Angiotenson II Receptors Blockers (ARBs)

Answer 13

1. Used if unable to tolerate ACE inhibitors ***artan 2. Hyperkalemia, decreases renal function 3. No bradykinin breakdown = no dry cough 4. Does not reach full effect until 3-6 weeks Examples: olmesartan (Benicar)

Question 14

**Heparin **

Answer 14

1. Blood thinner, given per units (IV or SQ)
2. Abdomen most common SQ site
3. Do not inturrupt or delay
4. Small, short needle, SQ with 0.2 mL of air
5. SQ dose not to exceed 1mL
6. Use TB syringe (mL side)
7. Know S&S of overdose
8. DO NOT ASPIRATE OR MASSAGE
9. **IV FLUSHES: **after each medication administration or every 8-12 hrs

Question 15

What’s the antidote for Heparin OD?

Answer 15

Protamine Sulfate