antianginals

Question 1

What is angina?

Answer 1

Angina is chest pain or tightness radiating to arm, neck, or back caused by inadequate blood supply due to plaque or coronary artery spasms.

Question 2

What are the 3 types of angina?

Answer 2

1. Classic/stable - most predictable, occurs with stress or exertion.
2. Unstable/preinfarct - progressive severity, occurs more frequently, unrelated to activity.
3. Variant (Prinzmetal/vasospasm) - most concerning for sudden cardiac arrest, occurs at rest.

Question 3

What do antianginals do?

Answer 3

Antianginals increase blood supply to the heart by either increasing oxygen supply or decreasing oxygen demand.

Question 4

What are the nonpharmacologic ways to reduce angina?

Answer 4

• Avoid smoking, heavy meals, extreme temps (<45 or >85), strenuous exercise, emotional upset.
• Do rest and relaxation techniques.

Question 5

What are the 3 types of antianginals?

Answer 5

1. Nitrates
2. Beta-blockers (BB)
3. Calcium Channel Blockers.

Question 6

What is the mechanism of action of nitrates?

Answer 6

Nitrates reduce angina by decreasing venous tone, workload, and oxygen demand, and by promoting vasodilation. They increase blood flow to coronary arteries, reduce ischemia, and act on the smooth muscle of blood vessels causing relaxation and dilation.

Question 7

What are the administration forms of nitrates?

Answer 7

Nitrates can be given SL, PO, IV, ointment, or patch.

Question 8

What is the SL dosage for nitrates?

Answer 8

0.4mg or 1/150 of a grain, take every 5 minutes for 3 doses. If pain persists, call 911.

Question 9

What is the onset of action for each route of nitrates?

Answer 9

SL and IV: 1-3 minutes.
Patch and ointment: 30-60 minutes, duration of patch is 24 hrs with an 8-12 hour removal period.
Ointment goes on every 8-12 hours.

Question 10

What are the key considerations for SL nitrates?

Answer 10

• Tablets are sensitive to light and heat; store in a cool and dark place.
• Come in non-childproof containers for elderly dexterity.
• Avoid swallowing to bypass the 1st pass liver effect for faster absorption directly into the jugular vein and right arm.
• 40-50% absorbed through the GI are inactivated by liver metabolism.

Question 11

What are the side effects of nitrates?

Answer 11

Headache (HA), hypotension, dizziness, weakness, faintness.

Question 12

What are the adverse effects of nitrates?

Answer 12

Rebound angina due to myocardial ischemia if discontinued abruptly, and reflex tachycardia if given too rapidly.

Question 13

What are the drug interactions of nitrates?

Answer 13

Increased risk of severe hypotension with beta-blockers, calcium channel blockers, alcohol, or other vasodilators.

Question 14

What is the mechanism of action of beta-blockers (BB)?

Answer 14

BB decrease heart workload and oxygen demand by lowering heart rate (HR) and contractility. They are most useful in stable angina.

Question 15

What precautions should be taken with beta-blockers (BB)?

Answer 15

Taper dose to avoid rebound tachycardia and recurrent angina pain. Avoid in patients with 2nd/3rd degree heart block.

Question 16

What are the side effects of beta-blockers (BB)?

Answer 16

Hypotension, severe bradycardia, heart block.

Question 17

What is the mechanism of action of calcium channel blockers?

Answer 17

Calcium channel blockers decrease workload and oxygen demand. They are used in the treatment of variant and stable angina, dilate coronary arteries, relax peripheral arterioles, and relieve coronary spasms.

Question 18

What are the side effects of calcium channel blockers?

Answer 18

Bradycardia, dizziness, hypotension, constipation. Nifedipine and amlodipine specifically have a side effect of ankle edema.

Question 19

In these specific calcium channel blockers, what should we be monitoring?

Answer 19

Cardizem and Verapamil: watch for HR and BP reduction because they affect cardiac conduction. Amlodipine and Nifedipine: watch for BP reduction.

Question 20

What are the nursing interventions for all antianginals?

Answer 20

• Monitor vital signs (VS) and blood pressure (BP).
• Check for orthostatic hypotension.
• Offer sips of water before SL or NGT to increase absorption.
• Don’t apply ointment or patch onto areas where defibrillator pads would go (upper right shoulder and below left chest).
• Don’t discontinue the medication abruptly.
• Rotate sites for the ointment and patch.
• Do not use fingers to apply the ointment; wear gloves.