Antianginal Agents Flashcards
What is Angina pectoris?
Pain because the oxygen demand of the heart is not met.
What is Atherosclerosis?
When blood vessels have accumulated several atheroma’s, this leads to swelling, decreased elasticity and an inability to respond to body signals such as vasodilation and constriction.
What is Atheroma?
Fatty tumors that narrow the pathway in arteries. They reduce the adaptability of the vessels and causes them to stiffen
What is Coronary artery Disease (CAD)?
When the arteries that supply blood to the heart become narrowed and oxygen supply to the heart is decreased.
What is Myocardinal infarction?
When a coronary artery is completely occluded and ischemia occurs. This caused cardiac muscles to die and the muscle tissue is replaced with scar tissue.
What is Prinzmetal’s angina?
When a vessel spasm in a coronary artery causes decreased blood flow, leading to chest pain.
What is Pulse Pressure?
When you subtract the diastolic pressure from systolic pressure, this represent the pressure it takes to fill the coronary arteries.
What is stable angina?
When there is chest pain due to an imbalance in cardiac oxygen demand vs supply. This pain is relieved by decreased physical activity.
Unstable angina?
When there is chest pain due to unmet oxygen demands, however pain wont stop even if the person stops their physical activity and rests.
What are the 3 types of angina?
Stable angina - no damage to heart muscles, basic reflexes surrounding the pain restore blood flow - pain decreases when activity decreases.
Unstable angina - episodes of pain occur even at rest. Cell death is not necessary happening but the patient is at an increased risk of complete occlusion. Patient should seek medical attention if pain doesn’t stop after a prolonged time.
Prinzmetal’s Angina - Caused by spasm of the blood vessels and not just by vessel narrowing/ atherosclerosis. Patients will usually experience the same pain at the same time every day, even at rest. May also be having ECG changes.
In all 3 the hearts oxygen demands are not being met.
Explain a myocardial infarction
When a coronary vessels becomes completely occluded it is unable to deliver blood to the cardiac muscle. The area of the muscle that is oxygen deprived becomes ischemic (not getting enough oxygen) and consequently becomes necrotic.
This results in excruciating pain, nausea and severe sympathetic stress reaction.
Arrythmias may develop from ischemia which results in irritable tissue. Most deaths from MI are due to lethal arrythmias.
Women and men experience different symptoms of heart attacks. Men are more likely to experience chest pain, left arm pain and shortness of breath. Women may experience GI upset or jaw pain.
What are the actions of antianginal drugs?
They improve blood delivery to the heart muscle by vasodilation - increased supply of oxygen
Improve blood delivery to the heart by decreasing workload of the heart - decreasing demand for oxygen.
What are some lifespan considerations that we should take into account when it come to antianginal agents and children?
We usually only give these medications for hypertension or arrythmias and these drugs are not commonly used in children.
If used, dose is determined by age and weight.
Patient should be monitored closely
What are some lifespan considerations that we should take into account when it come to antianginal agents and adults?
Activities that may cause angina should be determined and moderated.
Patients should be educated as to when to seek emergency treatment (when medication is not longer working)
Non-pharmacological measures should be educated (weight loss, diet, exercised)
Drugs are known to cross placenta and enter breastmilk.
What are some lifespan considerations that we should take into account when it come to antianginal agents and older adults?
More likely to experience adverse reactions (if taking more than one drug)
Safety measures should be put in place for balance and mobility issues related to the drug effect.
Dose should be started lower.
Name the 3 drug classes of Antianginal drugs.
Nitrates
Beta-Blockers
Calcium Channel Blockers
What are the suffix(es), drug classes and outliers for Nitrates?
Isosorbide dinitrate (prevention)
Isosorbide mononitrate (prevention)
Nitroglycerin (acute)
How does Nitrates work?
They work by dilating the blood vessels and decreasing BP.
What is the action of Nitrates?
They act directly on the smooth muscle to cause relaxation and depress muscle tone of blood vessels. Relax and dilates veins, arteries and capillaries. May also decrease muscle spasms.
Nitrates will NOT have an effect on vessels affected by coronary artery disease, or dead tissue.
Why would we give someone Nitroglycerin?
For prevention and treatment of attacks of angina pectoris.
Nitroglycerin is a nitrate.
What are the suffix(es), drug classes and outliers for Nitrates?
(Nitro/Nitrate)
Isosorbide dinitrate (preventative)
Isosorbide mononitrate (preventative)
Nitroglycerin (preventative & treatment of acute attack)
When should we NOT give Isosorbide mononitrate to a patient?
If the patient have an allergy, severe anemia (due to blood oxygen being low), head trauma or cerebral hemorrhage (vasodilation could cause further bleeding).
Isosorbide mononitrate is a nitrate.
What are some adverse reactions that are seen when we are giving patients Nitroglycerin?
All adverse effects are related to vasodilation and decrease in blood flow.
CNS: Headache, dizziness, and weakness
GI: nausea, vomiting due to decreased blood flow to GI tract.
CV: Hypotension
Misc. : Flushing & sweating (pooling in capillaries), Pallor, increased perspiration
There is also a risk of developing tolerance in long term use which makes the nitrates less effective.
Nitroglycerin is a nitrate
When should we be extra cautious when giving Isosorbide dinitrate to a patient?
In patient who are pregnant or lactating
Patients with hepatic or renal diseases - due to problems with excreting nitrates.
Hypotension, hypovolemia and conditions that limit cardiac output (may be exacerbated by nitrates)
Isosorbide dinitrate is a nitrate.
What are some drug-drug interactions that may be seen with Nitrates?
Ergot derivatives -Hypertension can occur and antianginal effect will be decreased.
Heparin - heparin will become less effective.
Erectile dysfunction drugs : Sildenafil, tadalafil and vardenafil - may cause SEVERE hypotension.
What nursing assessments should be done prior to prescribing a patient Nitrates?
contraindications or cautions
physical assessment: skin for color, intactness, and any signs of redness, irritation, or breakdown
CNS : level of alertness, affect, and reflexes
Respiratory: Monitor respirations and auscultate lungs;
CV: assess pulse rate, blood pressure, heart rate, and rhythm, ECG.
Assess pain (baseline to make sure meds. are helping), including onset, duration, intensity, location, and measures used to relieve it.
Investigate activity level prior to and after the onset of pain.
Monitor liver and renal function tests, complete blood count.
What nursing diagnoses should be made prior to administering Nitroglycerine to a patient?
There may be altered cardiac output related to vasodilation and hypotensive effects.
Injury risk related to CNS or CV effects.
Altered tissue perfusion (total body) related to hypotension or change in cardiac output.
Knowledge deficit regarding drug therapy.
Nitroglycerine is a Nitrate.
What nursing implementations should we be prepared for when we administer Isosorbide mononitrate to patients?
Have the patient lay or sit down prior to administration (BP changes)
Sublingual preparations under the tongue or in the buccal pouch, 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
emergency room.
Give sustained release forms with water, and caution the patient not to chew or crush them.
Long-acting preparations should be administered with plans for nitrate-free intervals.
Rotate the sites of topical forms.
Translingual spray is used under the tongue and not inhaled an keep a record of the number of sprays used if a translingual spray form is used.
Emergency life-support equipment readily available in case of hypotension.
Taper the dose gradually after long-term therapy.
Provide comfort measures.
Provide thorough patient teaching.
Isosorbide mononitrate is a nitrate.
What are the suffix(es), drug names and potential outliers for Antianginal Beta blockers?
“-olol”
Atenolol
Metoprolol
Propranolol
Nadolol
How does beta blockers work?
By blocking the stimulatory effects of the sympathetic nervous system
