Antianginal Agents Flashcards
Coronary Artery Disease - definitions
Atheromas: fatty tumors in the intima of the heart vessels
Atherosclerosis: narrowing of the heart vessels
Angina Pectoris: suffocation of the chest
Myocardial Infarction: cells in the myocardium become necrotic and die
Types of Angina
Stable: no damage to heart muscle; basic reflexes surrounding the pain restore blood flow
Unstable: episodes of ischemia occur even when at rest
Prinzmetal’s Angina: caused by spasm of the blood vessels, not just by vessel narrowing
Acute Myocardial Infarction
If a coronary vessel becomes completely occluded and is unable to deliver blood to the cardiac muscle the area of muscle that depends on that vessel for oxygen becomes ischemic and then necrotic - resulting in excruciating pain, nausea and severe sympathetic stress reaction
Actions of Antianginal Drugs
Improve blood delivery to the heart muscle by dilating blood vessels - increasing the supply of oxygen
Improve blood delivery to the heart muscle by decreasing the work of the heart - decreasing the demand for oxygen
Children
Use of antianginal agents across the lifespan
Not commonly found in children
congenital heart defects and cardiac surgery - nitroglycerin may be used
dosed by age and weight
monitor closely
Adults
Use of Antianginal agents across the lifespan
Determine and avoid activities that cause angina
Teach when to seek emergency treatment
Teach non-pharmacological measures (weight loss, diet, exercise, etc)
Drugs do cross placenta and enter breastmilk
Older Adults
Use of antianginal agents across the lifespan
More likely to experience ADE
safety measures for balance and mobility
dose should be started lower
Nitrates
Help restore the appropriate supply and demand ratio in oxygen delivery to the myocardium when rest is not enough
Isosorbide dinitrate
Isosorbide mononitrate
Nitroglycerin
Nitrates - action/indication, contraindications, caution
Action: act directly on smooth muscle to cause relaxation and depress muscle tone of blood vessels
Indications: prevention and treatment of attacks of angina pectoris
Contraindications: allergy, severe anemia, head trauma or cerebral hemorrhage, pregnancy/lactation
Caution: hepatic or renal disease, hypotension, hypovolemia, conditions that limit cardiac output
Nitrates - ADEs, Interactions
ADE- related to the vasodilation and decreased blood flow - CNS - headache, dizziness and weakness; GI - nausea/vomiting; CV - hypotension; Misc. - flushing, pallor increased perspiration
DDIs- ergot derivatives, heparin, sildenafil, tadalafil, vardenafil
Nitrates - Nursing Considerations
Assess: History and physical exam, known allergy; early MI, head trauma, cerebral hemorrhage, hypotension, hypovolemia, anemia or low cardiac output states, current status of pregnancy or lactation
Nursing Diagnoses: Decreased cardiac output r/t vasodilation and hypotensive effects; risk for injury related to CNS or CV effects; Ineffective tissue perfusion r/t hypotension or change in cardiac output; deficient knowledge
Implementation: have patient lay down or sit down prior to administration, give sublingual preparations under the tongue or int he buccal pouch; instruct patient that a sublingual dose may be repeated in 5 minutes if relief is not felt for a total of 3 doses, if pain persists the patient should go to the ER; give SR forms with water, caution patient not to chew or crush; rotate sites of topical forms; make sure that translingual spray is used under the tongue and not inhaled; keep record of the number of sprays used; have emergency life support equipment readily available; taper dose gradually after long term therapy; patient teaching
Beta Blockers
“-olol”
Block the stimulatory effects of the sympathetic nervous system
Actions: Blocks beta adrenergic receptors in the heart and kidneys, decreases the influence of the SNS on these tissues, decreases cardiac output and the release of renin
Indications: Treats stable angina pectoris and hypertension, prevents reinfarction in MI patients; treats stable CHF
Atenolol, metoprolol, propranolol, nadolol
Beta blockers - contraindications/cautions, ADEs, DDIs
Contraindications: Bradycardia, heart block, cardiogenic shock, asthma or COPD, pregnancy/lactation
Caution: DM, PVD, Thyrotoxicosis
ADE- related to their blockage of sympathetic nervous system: CNS - dizziness, fatigue, emotional depression; GI - nausea/vomiting, colitis; CV - CHF, decreased cardiac output, arrhythmias; Respiratory - bronchospasm, dyspnea, cough
DDI- clonidine, NSAIDs
Beta Blockers - Nursing Considerations
Assess: History and physical exam, allergies; level of orientation and sensory function, monitor cardiopulmonary status, including pulse, blood pressure and respiratory rate, LS, ECG, BS; monitor results of lab tests (electrolyte levels)
Nursing Diagnoses: Decreased cardiac output r/t CV effects; ineffective tissue perfusion r/t CV effects; risk for injury r/t CNS effects; risk for activity intolerance r/t suppression of sympathetic nervous system; deficient knowledge regarding drug therapy
Implementation: Do not stop drugs abruptly after chronic therapy, taper gradually over two weeks; continuously monitor in a patient receiving IV form; monitor BP, pulse, rhythm, and cardiac output; thorough patient teaching
Calcium Channel Blockers
Actions: Inhibit the movement of calcium ions across the membranes of myocardial and arterial muscle cells altering the action potential and blocking muscle cell contraction
Indications: Prinzmetal’s Angina
Drugs: Amlodipine, diltiazem (prototype), nicardipine, nifedipine, verapamil
Contraindications: Allergy, heart block or sick sinus syndrome, renal or hepatic dysfunction, pregnancy/lactation
