Anti-Anginal Therapy

Question 1

What are examples of Nitrates?

Answer 1

• nitroglycerin
• isosorbide mononitrate

Question 2

What is Angina?

Answer 2

• Angina Pectoris (Chest Pain)
• Oxygen Supply ≠ Oxygen Demand

Question 3

What are the primary goals of Angina drug therapy?

Answer 3

• prevent ACS (MI, HF, Death)
• prevent myocardial ischemia and ANGINAL PAIN

Question 4

What drugs are used to treat Angina?

Answer 4

• Nitrates - TODAYS TOPIC
• Beta Blockers
• Calcium Channel Blockers (DHPs, NonDHPs)

Question 5

What is Nitroglycerin used to treat?

Answer 5

• Acute AND Chronic Angina
  ~ Dependent upon the formulation of drug

Question 6

What routes are Nitroglycerin given through?

Answer 6

• SL Tablets
• IV drip
• Ointment
• Spray
• Patch

Question 7

What is Isosorbide Mononitrate used to treat?

Answer 7

PREVENTION (for CHRONIC angina)

Question 8

Nitrates/Nitrites adverse effects?

Answer 8

• Headache
• Hypotension
• Tolerance with Chronic Therapy
  ~ Must have nitrate free period

Question 9

Nitrates/Nitrites drug interactions?

Answer 9

PDE-5 Inhibitors:

• Viagra® (sildenafil)
• Cialis® (tadalafil)

Question 10

Nitrates/Nitrites contraindication?

Answer 10

• Severe head trauma- Can increase intracranial pressure
  ~ Remember this causes Headaches!

Question 11

Nitrates/Nitrites nursing considerations?

Answer 11

• Nitroglycerin SL Tablets/Spray PRN
  ~ Tablets are kept in dark/amber vial to protect from LIGHT

Question 12

When and How do you use Nitroglycerin SL Tablets/Spray PRN?

Answer 12

WHEN to use?

• Use if sudden chest pain develops
• Use if going to do something that provokes chest pain (exertional angina)

HOW to use?

• SL spray/tab goes under the tongue
• No food/drinks x 10-15 minute after

Question 13

How do you use Nitroglycerin Patches?

Answer 13

Once daily patches

• Place the patch on a hairless area of skin (chest, back, or abdomen) and rotate sites to prevent skin irritation.
• Remove the patch at night to reduce the risk of developing tolerance to nitroglycerin. Be medication-free 10 to 14 hr/day

Question 14

How do you use Nitroglycerin Ointment?

Answer 14

Remove the prior dose before a new dose is applied

Question 15

IV Nitroglycerin nursing consideration?

Answer 15

• Never stop IV nitroglycerin abruptly (wean off)- rebound hypertension/ischemia can occur
• GENERAL REMINDER: Educate patients to change positions slowly with all nitroglycerin’s due to fall risk

Question 16

What are other drugs that can be used to treat Angina?

Answer 16

REVIEW other drugs:

• Beta Blockers
  ~ Selective: Metoprolol
  ~ Non-selective: Carvedilol, Propranolol, Labetalol
• CCB DHP (selective to arteries) “dipines”
  ~ Amlodipine