Antianginal Drugs Flashcards
Atenolol
Functional Classification
Antihypertensive, antianginal
Atenolol
Mechanism of Action
Completely blocks stimulation of beta-adrenergic receptor within vascular smooth muscle; produces negative chronotropic activity (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, negative inotropic activity decreases O2 consumption in myocardium; decreases action of renin-aldosterone-angiotensin system at high doses, inhibits Beta2-receptors in bronchial system at higher doses
Atenolol
Uses
Mild to moderate hypertension, prophylaxis of angina pectoris; suspected or known MI (IV use); MI prophylaxis
Atenolol
Contraindications
Pregnancy (D), hypersensitivity to Beta-blockers, cardiogenic shock, 2nd- or 3rd-degree heart block, sinus bradycardia, cardiac failure, Raynaud’s disease, pulmonary edema
Atenolol
Side Effects
CNS: Insomnia, Fatigue, Dizziness, Mental Changes, memory loss, hallucinations, depression, lethargy, drowsiness, strange dreams, catatonia
CV: PROFOUND HYPOTENSION, BRADYCARDIA, CHF, Cold Extremities, Postural Hypotension, 2nd- or 3rd-degree Heart Block
EENT: sore throat; dry, burning eyes; blurred vision; stuffy nose
ENDO: increase hypoglycemic response to insulin
GI: Nausea, Diarrhea, vomiting, MESENTERIC ARTERIAL THROMBOSIS, ISCHEMIC COLITIS
GU: impotence, decreased libido
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA PURPURA
INTEG: rash, fever, alopecia
RESP: BRONCHOSPASM, dyspnea, wheezing, pulmonary edema
Atenolol
Nursing Considerations
ASSESS:
- I&O, weight daily; watch for CHF (rales/crackles, jugular vein distention, weight gain, edema)
- Hypertension: BP, pulse q4hr; note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes (<50 bpm); ECG
- Baselines in renal/hepatic studies before therapy begins
Atenolol
Overdose Treatment
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, dextrose for hypoglycemia, digoxin, O2, diuretic for cardiac failure, hemodialysis
Diltiazem (Cardizem)
Functional Classification
Calcium Channel Blocker, antiarrhythmic class IV, antihypertensive
Diltiazem (Cardizem)
Chemical Classification
Benzothiazepine
Diltiazem (Cardizem)
Mechanism of Action
Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node conduction times, dilates peripheral arteries
Diltiazem (Cardizem)
Uses
PO: Angina pectoris due to coronary artery spasm, hypertension
IV: atrial fibrillation, flutter, paroxysmal supraventricular tachycardia
Diltiazem (Cardizem)
Contraindications
Sick sinus syndrome, AV heart block, hypotension <90mmHg systolic, acute MI, pulmonary congestion, cardiogenic shock
Diltiazem (Cardizem)
Side Effects
CNS: Headache, Fatigue, Drowsiness, dizziness, depression, weakness, insomnia, tremor, paresthesia
CV: DYSRHYTHMIA, Edema, CHF, bradycardia, hypotension, palpitations, HEART BLOCK
GI: Nausea, vomiting, diarrhea, gastric upset, Constipation, increased LFTs
GU: nocturia, polyuria, ACUTE RENAL FAILURE
INTEG: Rash, flushing, photosensitivity, burning pruritus at inj site
RESP: rhinitis, dyspnea, pharyngitis
Diltiazem (Cardizem)
Nursing Considerations
ASSESS:
- CHF: dyspnea, weight gain, edema, jugular venous distention, rales; monitor I&O ratios daily, weight
- ANGINA: location, duration, alleviating factors, activity when pain starts
- DYSRHYTHMIAS: cardiac status: BP, pulse, respiration, ECG and intervals PR, QRS, QT; if systolic BP <50 bpm, hold dose, notify prescriber
Diltiazem (Cardizem)
Overdose Treatment
Atropine for AV block, vasopressor for hypotension
Isosorbide dinitrate and Isosorbide mononitrate
Functional Classification
Antianginal, Vasodilator
Isosorbide dinitrate and Isosorbide mononitrate
Chemical Classification
Nitrate
Isosorbide dinitrate and Isosorbide mononitrate
Mechanism of Action
Relaxation of vascular smooth muscle, which leads to decreased preload, afterload, which is responsible for decreasing left ventricular end-diastolic pressure, systemic vascular resistance, and reducing cardiac oxygen demand
Isosorbide dinitrate and Isosorbide mononitrate
Uses
Treatment, prevention of chronic stable angina pectoris
Isosorbide dinitrate and Isosorbide mononitrate
Contraindications
Hypersensitivity to this product or nitrates; severe anemia, increased intracranial pressure, cerebral hemorrhage, acute MI
Isosorbide dinitrate and Isosorbide mononitrate
Side Effects
CNS: Vascular Headache, Flushing, Dizziness, weakness, faintness
CV: Postural Hypotension, tachycardia, COLLAPSE, syncope, palpitations
GI: nausea, vomiting, diarrhea
INTEG: pallor, sweating, rash
MISC: twitching, hemolytic anemia, METHEMOGLOBINEMIA, tolerance
Isosorbide dinitrate and Isosorbide mononitrate
Nursing Considerations
ASSESS:
- ANGINAL PAIN: duration, time started, activity being performed, character
- BP, pulse, respirations during beginning therapy
- Tolerance if taken over long period
- Headache, lightheadedness, decreased BP; may indicate need for decreased dosage
Metoprolol (Lopressor)
Functional Classification
Antihypertensive, antianginal
Metoprolol (Lopressor)
Chemical Classification
Beta1-Blocker
Metoprolol (Lopressor)
Mechanism of Action
Lowers BP by Beta-blocking effects; reduces elevated renin plasma levels; blocks Beta2-adrenergic receptors in bronchial, vascular smooth muscle only at high doses; negative chronotropic effect
Metoprolol (Lopressor)
Uses
Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure
Metoprolol (Lopressor)
Contraindications
Hypersensitivity to Beta-blockers, cardiogenic shock, heart block (2nd, 3rd degree), sinus bradycardia, pheochromocytoma, sick sinus syndrome
Metoprolol (Lopressor)
Side Effects
CNS: Insomnia, Dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue
CV: Hypotension, BRADYCARDIA, CHF, Palpitations, dysrhythmias, CARDIAC ARREST, AV BLOCK, PULMONARY/PERIPHERAL EDEMA, CHEST PAIN
EENT: sore throat; dry, burning eyes
GI: Nausea, Vomiting, colitis, cramps, Diarrhea, constipation, flatulence, dry mouth, Hiccups
GU: impotence
HEMA: AGRANULOCYTOSIS, EOSINOPHILIA, THROMBOCYTOPENIA, PURPURA
INTEG: rash, purpura, alopecia, dry skin, urticaria, pruritus
RESP: BRONCHOSPASM, dyspnea, wheezing
Metoprolol (Lopressor)
Nursing Considerations
ASSESS:
- ECG directly when giving IV during initial treatment
- I&O, weight daily; check for CHF (weight gain, jugular venous distention, crackles, edema, dyspnea)
- BP during initial treatment, periodically thereafter; pulse q4hr; not rate, rhythm, quality
- Apical/radial pulse before administration; notify prescriber of any significant changes or pulse <50 bpm
- Baselines of renal, hepatic studies before therapy begins
- Skin turgor, dryness of mucous membranes for hydration status
Metoprolol (Lopressor)
Overdose Treatment
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis, administer vasopressor
Nitroglycerin
Functional Classification
Coronary Vasodilator, antianginal
Nitroglycerin
Chemical Classification)
Nitrate
Nitroglycerin
Mechanism of Action
Decreases preload and afterload, which are responsible for decreasing left ventricular end-diastolic pressure, systemic vascular resistance; dilates coronary arteries, improves blood flow through coronary vasculature, dilates arterial and venous beds systemically
Nitroglycerin
Uses
Chronic stable angina pectoris, prophylaxis of angina pain, CHF, acute MI, controlled hypotension for surgical procedures, anal fissures
Nitroglycerin
Contraindications
Hypersensitivity to this product or nitrites; severe anemia, increased intracranial pressure, cerebral hemorrhage, closed-angle glaucoma, cardiac tamponade, cardiomyopathy, constrictive pericarditis
Nitroglycerin
Side Effects
CNS: Headache, Flushing, Dizziness
CV: Postural Hypotension, tachycardia, COLLAPSE, syncope, palpitations
GI: nausea, vomiting
INTEG: pallor, sweating, rash
Nitroglycerin
Nursing Considerations
ASSESS:
- PAIN: duration, time started, activity being performed, character
- Orthostatic BP, pulse prior to and after administration
- Tolerance if taken over long period
- Headache, lightheadedness, decreased BP; may indicate a need for decreased dosage
Atenolol
Chemical Classification
Beta-Blocker, Beta1-, Beta2-blocker (high doses)
