Antianginal Drugs Flashcards
What causes chest pain in Pts? What is an example of an activity that increases demand of O2?
Increases demand of O2 w/ decrease supply of O2
Exercising
What type of drugs increase the supply of O2?
Beta blockers and dilators
What are the 3 types of angina?
Exertional/stable
Variant/prinzmetal
Unstable
What is another name for exertional angina?
Stable angina
What is another name for variant angina?
Prinzmetal angina
How is exertional/stable angina occur? What activity usually causes it?
Plaque build up in coronary arteries
Exercise
How does variant/prinzmetal angina occur? When can it happen?
Caused by spasms in coronary artery
Can happen 24/7
How does an unstable angina occur? What if the Tx for it?
When a vessel is almost completely occluded
Angioplasty CABG(coronary artery bypass graft)
What are the 4 goals of drugs used to Tx angina?
Minimize attacks
Improve pt capacity
Prevent MI
decrease heart workload
What is the difference between NO and N2O? What does it cause?
NO=nitric oxide, causes vasodilation
N2O=laughing gas, causes sedation
Why do you have to be sparing w/ nitrates?
Because tolerance can develop
Why is nitrates indicated for stable angina?
Because it causes vasodilation to increase blood to get through partial occlusion
What is ACS stand for?
Acute coronary syndrome
Why are nitrates indicated for ACS?
Because it decreases the workload
What are two conditions that are considered ACS?
Unstable angina and acute MI
Why is nitrate indicated for CHF?
Decrease the preload
Why are nitrates indicated for hypertensive emergencies?
Decreases BP thru vasodilation
What is the course of action for a pt who has chest pain w/ a Hx of coronary disease and is prescribed nitro?
Stop Sit down Take 1x nitro PRN wait 5 min Call 911 Take 1x nitro PRN wait 5 min Take 1x nitro PRN
What is the max dose of nitro a pt can take?
3 doses
What drugs should be used for quick onset? How are they given?
Nitrostat-SL
Nitrolingual-pump spray
True of false: nitrobid ointment is given prophylatically?
True
What does prophylactically mean?
Prevention
How is nitrobid ointment given? What PPE is needed?
Apply to chest of abdomen and lay occlusive dressing on top
Gloves
What helps a pt from bldg up tolerance to nitrobid ointment?
Drug free period at night
At what times is nitrobid ointment given to a pt?
QAM
6hrs later
True or false: transdermal-nitro is used prophylactically?
True
How does a pt not build up tolerance to transdermal-nitro?
Remove during sleep
Where does a pt apply a transderm-nitro patch?
Upper arms or torso
What is the onset and duration of nitrobid IV?
Quick onset
Short duration
What kind of bags and tubing should be used when delivering nitrobid IV?
Specific non-PVC plastic IV bag and tubing
If nitrobid IV is not a clear solution or is discolored, what should be done?
Discard solution
When a pt is taking nitrates, what must a nurse educate them on(3)?
Activities that increase risk of angina
ADR
Contraindications
What are the activities that increase risk of angina?
Overexertion
Emotional upset
Over-eating
What are the ADR of nitrates?
HA
Flacial flushing
Orthostatic hypotension
Syncope
What are the contraindications for nitrates?
Hypotension
Coadministered w/ PDE5 inhibitors (ED drug)
Increased intracranial pressure
How do nondihydropyridines act as an anti angina medication?
Negative inotropic effect
Negative chronotropic effect
Vasodilator
What does nondihydropyridine a work directly on?
Heart and arteries
How does dihydropyridine prevent angina?
Dilating arteries
What is the preferred therapy for exertional angina?
SL nitrate
Nitrate spray
What Rx are used for a pt w/ exertional angina and HTN?
CCB or beta-blockers
What is the preferred therapy for variant angina? If that does work then what is done?
CCB
Add a nitrate
What is the preferred therapy for unstable angina?
Anticoagulant therapy
All drugs
Nitro
How long does potency last for nitroglycerin?
About 3mo after bottle has been opened
What preserves the potency of nitroglycerin?
Storing the medication in a airtight, dark glass bottle w/ metal cap
When using a patch or ointment nitroglycerin, what should be done in the location of placing the Rx?
Site rotation
Removal of old medication
In order to reduce tolerance to a nitroglycerin what should be done?
Allow for a nitrate-free period
What should a pt not do who has just taken nitro?
Don’t drive
Contraindication for beta blockers?
<60 HR
What is an ADR of beta-blockers?
Dizziness
Syncope
What is a common problem w/ pt who take CCBs? How can this be resolved?
Constipation
Increase fiber and fluid intake
