Antianginal Drugs

Question 1

Angina Pectoris (Chest Pain)

Answer 1

• When the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle “aches”
• The heart requires a large supply of oxygen to meet the demands placed on it

Question 2

Drugs for Angina

Answer 2

Nitrates/nitrites
Beta blockers
Calcium channel blockers

Question 3

Therapeutic Objectives

Answer 3

• Minimize the frequency of attacks and decrease the duration and intensity of anginal pain
• Improve the patient’s functional capacity with as few adverse effects as possible
• Prevent or delay the worst possible outcome: MI

Question 4

Types of Angina

Answer 4

• Chronic stable angina (also called classic or effort angina)
• Unstable angina(also called preinfarction or crescendo angina)
• Vasospastic angina(also called Prinzmetal or variant angina)

Question 5

Ischemia

Answer 5

Poor blood supply to an organ

Question 6

Ischemic heart disease

Answer 6

• Poor blood supply to the heart muscle
• Atherosclerosis
• Coronary artery disease

Question 7

Myocardial Infarction

Answer 7

• Necrosis, or death, of cardiac tissue

- Disabling or fatal

Question 8

Beta Blockers

Drugs

Answer 8

atenolol (Tenormin)
metoprolol (Lopressor)
propranolol (Inderal)
nadolol (Corgard)

Question 9

Beta Blockers: Indications

Answer 9

Angina
Antihypertensive
Cardiac dysrhythmias
Cardioprotective effects, especially after MI
Some used for migraine headaches, essential tremors, and stage fright

Question 10

Calcium Channel Blockers

Drugs

Answer 10

verapamil (Calan, Isoptin)
diltiazem (Cardizem)
nifedipine (Procardia)
amlodipine (Norvasc)
nicardipine (Cardene)

Question 11

Calcium Channel Blockers: Mechanism of Action

Answer 11

Cause coronary artery vasodilation
Cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance
Reduce the workload of the heart
Result: decreased myocardial oxygen demand

Question 12

Calcium Channel Blockers: Indications

Answer 12

Angina
Hypertension
Supraventricular tachycardia
Coronary artery spasms (Prinzmetal angina)
Short-term management of atrial fibrillation and flutter

Question 13

Calcium Channel Blockers: Adverse Effects

Answer 13

Limited
Primarily relate to overexpression of their therapeutic effects
May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea, other adverse effects

Question 14

Calcium Channel Blockers

Nursing Implications

Answer 14

Constipation is a common problem; instruct patients to take in adequate fluids and eat high-fiber foods

Question 15

Beta Blockers

Nursing Implications

Answer 15

• Patients taking beta blockers should monitor pulse rate daily and report any rate lower than 60 beats per minute or symptoms of relative bradycardia
• Instruct patients to report dizziness or fainting
• Inform patients that these medications should never be abruptly discontinued
• Inform patients that these medications are for long-term prevention of angina, not for immediate relief