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Pharmacology Exam #2 > Antianginal Agents > Flashcards

Antianginal Agents Flashcards

1
Q

What is angina pectoris?

A

Chest pain when the heart muscle doesn’t get enough oxygen

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2
Q

What are atheromas?

A

fatty substances that clog up your arteries

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3
Q

What is atherosclerosis?

A

Accumulation of atheromas in the artery walls that cause narrowing and lack of elasticity

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4
Q

What is Prinzmetal’s angina?

A

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

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5
Q

What is stable angina?

A

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

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6
Q

What is unstable angina?

A

Imbalance of cardiac oxygen demand vs supply resulting in chest pain
❤️NOT relieved with decrease in activity
❤️increased risk of complete occlusion

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7
Q

What are most deaths from MI caused by?

A

Lethal arrythmias
Ischemic heart tissue is irritated, doesn’t conduct correctly, and can be the cause of a fatal arrythmia

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8
Q

Lifespan Considerations for Antianginal Agents
In Children

A
  • NOT commonly used in children
  • For congenital heart defects and cardiac surgery - nitroglycerin may be used
  • Dosed by age and weight
  • Monitor CLOSELY
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9
Q

Lifespan considerations for Antianginal Agents
In Adults

A
  • 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
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10
Q

Lifespan considerations for Antianginal Agents
In Older Adults

A
  • More likely to experience adverse effects
  • Safety measures for balance and mobility
  • Dose should be started lower
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11
Q

Basic effects of all
Antianginal Agents

A
  • 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
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12
Q

Classes of Antianginal Agents

A
  • Nitrates
  • Beta-Blockers
  • Calcium Channel Blockers
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13
Q

Nitrates
Mechanism of Action

A
  • 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
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14
Q

Nitrates
Indications

A
  • Prevention and treatment of attacks of angina pectoris
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15
Q

Nitrates
Drug Names

A

Isosorbide dinitrate (preventative)
Isosorbide mononitrate (preventative)
Nitroglycerin (preventative and treatment of acute attack)

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16
Q

Nitrates
Contraindications

A

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

17
Q

Nitrates
Adverse Effects

A

(r/t vasodilation and decrease in blood flow)
* 🧠 CNS: Headache, dizziness, weakness
* 🤢 GI: nausea and vomiting
* 💓 CV: hypotension
* Misc: Flushing, pallor, increased perspiration

18
Q

Nitrates
Drug Interactions

A
  • Ergot derivatives (HTN can occur)
  • Heparin (decreased heparin effectiveness)
  • Erectile dysfunction drugs: sildenafil, tadalafil, vardenafil (severe hypotension can occur)
19
Q

Nitrates
Assessment

A

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

20
Q

Nitrates
Nursing Diagnoses/Conclusions

A
  • 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
21
Q

Nitrates
Implementation/Patient Teaching

A
  • 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
22
Q

Beta Blockers
Mechanism of Action

A
  • 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
23
Q

Beta Blockers
Indications

A
  • 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
24
Q

Beta Blockers
Contraindications

A

Absolute:
* Bradycardia
* Heart Block
* Shock

Cautions:
* DM
* Peripheral Vascular Disease
* Asthma/COPD
* Thyrotoxicosis

25
Q

Beta Blockers
Drug Names

A

“-olol”
* Atenolol
* Metoprolol
* Propranolol
* Nadolol

26
Q

Beta Blockers
Adverse Effects

A
  • 🧠 CNS: Dizziness, fatigue, emotional depression
  • 🤢 GI: Nausea, vomiting, diarrhea
  • 💓 CV: CHF, decreased cardiac output, arrhythmias
  • 🫁 Respiratory: bronchospasm, dyspnea, cough
  • Decreased exercise tolerance and malaise
27
Q

Beta Blockers
Drug Interactions

A
  • Antidiabetic Agents (masks diabetic symptoms)
  • NSAIDs (reduces Beta Blockers effectiveness)
28
Q

Beta Blockers
Assessment

A

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

29
Q

Beta Blockers
Nursing Diagnoses/Conclusions

A
  • 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
30
Q

Beta Blockers
Implementation/Patient Teaching

A
  • 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
31
Q

Calcium Channel Blockers
Mechanism of Action

A
  • Inhibits the movement of calcium ions across the membranes of myocardial and arterial muscle cells
  • Alters the action potential and blocks muscle cell contraction
32
Q

Calcium Channel Blockers
Indications

A
  • Prinzmetal’s angina
  • Chronic (stable) angina
  • Effort-associated angina (a type of stable angina)
  • Hypertension
33
Q

Calcium Channel Blockers
Contraindications

A

Absolute:
* Allergy
* Pregnancy & lactation

Cautions:
* Heart block & sick sinus syndrome
* Renal or hepatic dysfunction
* Heart failure (further decrease in cardiac output)

34
Q

Calcium Channel Blockers
Drug Names

A

Nondihydropyridine (coronary artery selective)
* Verapamil
* Diltiazem
(Very Demure…)

Dihydropyridine (vascular selective)
* “-dipine”
* Amlodipine
* Nicardipine
* Nifedipine

35
Q

Calcium Channel Blockers
Adverse Effects

A
  • 💓 CV: hypotension, cardiac arrhythmias
  • 🤢 GI: upset
  • 🔴 Skin: flushing and rash
  • 🧠 CNS: headache, dizziness, fatigue
35
Q

Calcium Channel Blockers
Drug Interactions

A
  • Varies with each drug
  • Diltiazem: Cyclosporine
  • Verapamil: Digoxin, general anesthetics
35
Q

Calcium Channel Blockers
Assessment

A

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

36
Q

Calcium Channel Blockers
Nursing Diagnoses/Conclusions

A
  • 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
37
Q

Calcium Channel Blockers
Implementation/Patient Teaching

A
  • Monitor BP, pulse, rhythm, and cardiac output regularly, especially if on long term therapy
  • Monitor BP very closely if pt is also taking nitrates

Pharmacology Exam #2 (14 decks)

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