Antianginal Agents Flashcards
What is angina pectoris?
Chest pain when the heart muscle doesn’t get enough oxygen
What are atheromas?
fatty substances that clog up your arteries
What is atherosclerosis?
Accumulation of atheromas in the artery walls that cause narrowing and lack of elasticity
What is Prinzmetal’s angina?
Vasospasm in coronary arteries resulting in lack of oxygen to the heart and chest pain.
Typically at night when at rest
Not associated with atherosclerosis
What is stable angina?
Inbalance of cardiac oxygen demand vs. supply resulting in chest pain.
💚RELIEVED when activity is decreased
💚No damage to heart muscle
💚basic reflexes surrounding the pain restore blood flow
What is unstable angina?
Imbalance of cardiac oxygen demand vs supply resulting in chest pain
❤️NOT relieved with decrease in activity
❤️increased risk of complete occlusion
What are most deaths from MI caused by?
Lethal arrythmias
Ischemic heart tissue is irritated, doesn’t conduct correctly, and can be the cause of a fatal arrythmia
Lifespan Considerations for Antianginal Agents
In Children
- NOT commonly used in children
- For congenital heart defects and cardiac surgery - nitroglycerin may be used
- Dosed by age and weight
- Monitor CLOSELY
Lifespan considerations for Antianginal Agents
In Adults
- Determine and AVOID activities that cause angina
- Teach pt when to seek emergency treatment
- Teach non-pharmacologic measures (weight loss, diet, exercise, etc)
- Drugs DO cross placenta and enter breastmilk
Lifespan considerations for Antianginal Agents
In Older Adults
- More likely to experience adverse effects
- Safety measures for balance and mobility
- Dose should be started lower
Basic effects of all
Antianginal Agents
- Improve blood delivery to the heart muscle by dilating blood vessels: inreasing the supply of oxygen
- Improve blood delivery to the heart muscle by decreasing the work of the heart: decreasing the demand for oxygen
Classes of Antianginal Agents
- Nitrates
- Beta-Blockers
- Calcium Channel Blockers
Nitrates
Mechanism of Action
- Acts directly on the smooth muscle to cause relaxation and depression of muscle tone of blood vessels
- Relaxes and dilates veins, arteries, and capillaries
- Decreases Blood Pressure
- has no effect on vessels affected by Coronary Artery Disease
Nitrates
Indications
- Prevention and treatment of attacks of angina pectoris
Nitrates
Drug Names
Isosorbide dinitrate (preventative)
Isosorbide mononitrate (preventative)
Nitroglycerin (preventative and treatment of acute attack)
Nitrates
Contraindications
Absolute:
* Allergy
* Severe anemia (decreased cardiac output could cause increase in oxygen issues)
* Head trauma or cerebral hemorrhage (dilated BVs could cause further bleeding)
Cautions:
* Pregnancy and Lactation
* Hepatic or renal disease
* Hypotension, hypovolemia, and conditions that limit cardiac output
Nitrates
Adverse Effects
(r/t vasodilation and decrease in blood flow)
* 🧠 CNS: Headache, dizziness, weakness
* 🤢 GI: nausea and vomiting
* 💓 CV: hypotension
* Misc: Flushing, pallor, increased perspiration
Nitrates
Drug Interactions
- Ergot derivatives (HTN can occur)
- Heparin (decreased heparin effectiveness)
- Erectile dysfunction drugs: sildenafil, tadalafil, vardenafil (severe hypotension can occur)
Nitrates
Assessment
History:
* Check for contraindications and cautions
Physical:
* Inspect skin for color, intactness, and any signs of redness, irritation, or breakdown (for topical ointment)
* Assess level of alertness, affect, and reflexes
* Monitor respirations and lung sounds
* Assess pulse rate, blood pressure, heart rate, and rhythm
* ECG
* Assess pain
* Investigate activity level before and after onset of pain
Labs:
* liver and renal function tests
* CBC
Nitrates
Nursing Diagnoses/Conclusions
- Altered Cardiac Output (r/t vasodilation and hypotensive effects)
- Injury risk (r/t CNS or CV effects)
- Altered tissue perfusion (r/t hypotension or change in cardiac output)
- Knowledge deficity
Nitrates
Implementation/Patient Teaching
- Have the patient lay down or sit down prior to administration (due to hypotension risk)
- Give sublingual preparations under the tongue or in the buccal pouch
- Instruct the patient that the sublingual dose may be repeated every 5 minutes for a total of 3 doses if relief is not felt. If 3 doses do not work –> go to the emergency room
- Give SR forms with water; do NOT chew or crush them
- Long acting preparations should be administered with plans for nitrate-free breaks
- Rotate the sites of topical administration
- Make sure that translingual spray is used UNDER the tongue and NOT inhaled
- Keep a record of the number of sprays used with translingual form
- Have emergency life support equipment readily available
- Taper the dose gradually after long term therapy - abrupt stop could cause MI
- Explain importance of follow up appointments
Beta Blockers
Mechanism of Action
- Blocks beta-adrenergic receptors in the heart and kidneys
- Decreases the influence of the SNS on heart and kidneys
- Decreases cardiac output and the release of renin
Beta Blockers
Indications
- Long term management of angina pectoris caused by atherosclerosis
- Used in combination with nitrates to increase exercise tolerance
- Prevent re-infarction in stable patients 1-4 weeks after MI
Beta Blockers
Contraindications
Absolute:
* Bradycardia
* Heart Block
* Shock
Cautions:
* DM
* Peripheral Vascular Disease
* Asthma/COPD
* Thyrotoxicosis
Beta Blockers
Drug Names
“-olol”
* Atenolol
* Metoprolol
* Propranolol
* Nadolol
Beta Blockers
Adverse Effects
- 🧠 CNS: Dizziness, fatigue, emotional depression
- 🤢 GI: Nausea, vomiting, diarrhea
- 💓 CV: CHF, decreased cardiac output, arrhythmias
- 🫁 Respiratory: bronchospasm, dyspnea, cough
- Decreased exercise tolerance and malaise
Beta Blockers
Drug Interactions
- Antidiabetic Agents (masks diabetic symptoms)
- NSAIDs (reduces Beta Blockers effectiveness)
Beta Blockers
Assessment
History:
* Contraindications and Cautions
Physical:
* level of orientation and sensation
* Pulse, BP, HR
* ECG
* Respirations and lung sounds
* Abdomen and bowel sounds
* Urine output
Labs:
* Electrolyte levels
* Renal and hepatic function tests
Beta Blockers
Nursing Diagnoses/Conclusions
- Impaired comfort (r/t CNS, GI, and systemic effects)
- Altered Cardiac output (r/t CV effects)
- Altered tissue perfusion (r/t CV effects)
- Injury Risk (r/t CNS effects)
- Activity Intolerance (r/t sympathetic blocking)
- Knowledge deficit
Beta Blockers
Implementation/Patient Teaching
- Do not stop drugs abruptly, taper over 2 weekss
- Continuously monitor pts receiving IV form of these drugs
- Give oral forms of metoprolol with food
- Monitor BP, pulse, rhythm, and CO regularly
- Rise slowly
- No driving until CNS effects are known
Calcium Channel Blockers
Mechanism of Action
- Inhibits the movement of calcium ions across the membranes of myocardial and arterial muscle cells
- Alters the action potential and blocks muscle cell contraction
Calcium Channel Blockers
Indications
- Prinzmetal’s angina
- Chronic (stable) angina
- Effort-associated angina (a type of stable angina)
- Hypertension
Calcium Channel Blockers
Contraindications
Absolute:
* Allergy
* Pregnancy & lactation
Cautions:
* Heart block & sick sinus syndrome
* Renal or hepatic dysfunction
* Heart failure (further decrease in cardiac output)
Calcium Channel Blockers
Drug Names
Nondihydropyridine (coronary artery selective)
* Verapamil
* Diltiazem
(Very Demure…)
Dihydropyridine (vascular selective)
* “-dipine”
* Amlodipine
* Nicardipine
* Nifedipine
Calcium Channel Blockers
Adverse Effects
- 💓 CV: hypotension, cardiac arrhythmias
- 🤢 GI: upset
- 🔴 Skin: flushing and rash
- 🧠 CNS: headache, dizziness, fatigue
Calcium Channel Blockers
Drug Interactions
- Varies with each drug
- Diltiazem: Cyclosporine
- Verapamil: Digoxin, general anesthetics
Calcium Channel Blockers
Assessment
History:
* Cautions and Contraindications
Physical:
* Inspect skin for color and integrity
* Pulse, BP, HR, rhythm
* ECG
* Check perfusion throughout
* Respirations and lung sounds
Labs:
* Renal and hepatic function tests
Calcium Channel Blockers
Nursing Diagnoses/Conclusions
- Altered Cardiac Output (r/t hypotension & vasodilation)
- Injury Risk (r/t CNS & CV effects)
- Altered tissue perfusion (r/t hypotension or change in cardiac output)
- Knowledge deficit
Calcium Channel Blockers
Implementation/Patient Teaching
- Monitor BP, pulse, rhythm, and cardiac output regularly, especially if on long term therapy
- Monitor BP very closely if pt is also taking nitrates
