Antianginals Flashcards
1
Q
CAD- Coronary Artery Disease
A
- 1 of the leading causes of death in U.S.
- Narrowing or occlusion of a coronary artery
- Narrowing causes myocardial ischemia
2
Q
Atherosclerosis
A
- Most common etiology of CAD
2. Caused by presence of plaque
3
Q
Blood Flow to Heart
A
- Myocardium receives blood via coronary arteries
- Diverge into smaller branches around heart
- Provide continuous supply of 02 & nutrients
4
Q
Angina Pectoris
A
- Acute chest pain due to insufficient 02 to myocardium
- Accompanies physical exertion or emotional excitement
- Caused by increased myocardial 02 demand
5
Q
S/S of Angina
A
- Steady intense pain in anterior chest
- Pain radiating to L shoulder, L arm, spine, jaw
- Fear of impending death
- Pallor, dyspnea, Diaphoresis
- Tachycardia, Elevated BP
Duration usually short, pain diminishes c physical rest
6
Q
Anginal Classification
A
- Stable angina is predictable as to frequency, intensity, duration
a. Usually relieved by rest - Vasospastic Angina caused by spasms of coronary arteries
- Silent angina occurs in absence of angina pain, Rest clears the pain
- Unstable angina when episodes occur more frequently, more intense, DURING PERIODS OF REST!
7
Q
Angina vs Myocardial Infarction
A
- Identify & differentiate the 2 conditions
- Pharmacological Tx differs considerably between conditions
- Myocardial infarction carries a high mortality rate
8
Q
Angina Role of RN
A
- Monitor client condition
- Provide education on prescribed Rx Tx
- Obtain V.S. & medical & Rx Hx.
- Obtain lifestyle & dietary habits
- Obtain description of symptoms & pharm Tx initiated by client
9
Q
Pharm management of Angina
A
- Reduce intensity & frequency of episodes
- Improve exercise tolerance
- 2 Categories of drugs
a. Terminate acute angina episode
b. Decrease frequency of episodes
10
Q
Reduce myocardial demand for 02
A
- Slowing HR
- Reduceing preload
- Reducing contractility
- Llowering BP (REDUCED AFTERLOAD)
11
Q
Nitrate
A
- Potent vasodilator
2. NITROGLYCERIN (Nitrostat)
12
Q
Nitrostat
A
- Mechanism of action: Relax both arterial & venous smooth muscle & dilates coronary arteries
a. Short acting-terminate acute angina episode
b. Long-acting-decrease severity & frequency of episodes - Primary Use: Lowering myocardial 02 demand
- Adverse Effect: Headache, Dizziness, Hypotension, Flushing, Rash
13
Q
Nitrates
A
- Obtain BP & Monitor
- IV nitrate have greatest risk for severe hypotension
- Educate client that alcohol is contraindicated
- Hypotension, withhold
14
Q
Beta-Adrenergic Blocker
A
- Reduces cardiac workload
2. Prophylaxis for chronic Angina
15
Q
Name 1 Beta-Adrenergic Blocker
A
- Inderal- Reduces cardiac workload by slowing HR & Reducing contractility.
- Primary use: Prophylaxis of stable angina
- Adverse Effects: Fatigue, Insomnia, Drowsiness, Impotence, Bradycardia, Confusion
16
Q
Beta-Adrenergic Blocker RN Implication/Teaching
A
- Assess apical HR
- Obtain BP & Continue to monitor
- Monitor Respiratory status
- Monitor glucose levels
- Educate client not to stop abruptly
17
Q
Calcium Channel Blockers
A
- Reduce cardiac workload & dilate coronary arteries
2. Bring more 02 to myocardium
18
Q
CCB Cardizem
A
- Mechanism of action: Reduce cardiac workload by relaxing arteriolar smooth muscle; Dilates coronary arteries
- Primary Use: Lowering BP; Brings more 02 into myocardium
- Adverse Effects: Hypotension, Bradycardia, HF, Constipation, Headache, Dizziness, Edema
19
Q
CCB RN Implication/Teaching
A
- Assess V.S.
- Hold medication if HR below 60
- Obtain Ortho BP
- Assess for signs of HF
- Obtain DW
- Assess bowel function
20
Q
Thrombolytics
A
- Dissolve clots
- Restore circulation to myocardium
- Reteplase
- Discussed several classes ago
21
Q
Reteplase
A
- Mechanism of action: Dissolve clots obstructing coronary arteries
- Primary Use: For restoring circulation to myocardium
- Adverse Effects: Excessive bleeding
22
Q
Reteplase RN Implication/Teaching
A
- Assess for conditions that may place client @ increased risk for bleeding
- Start IV & arterial lines
- Monitor V.S. & intake & output
- Monitor changes in neurological status
- Assess for dysrhythmia
23
Q
Adjunct drugs for myocardial infarctions
A
- Nitrates: Dx of MI, arterial & venous dilitation, relieve coronary artery vasospasm
- Beta-Adrenergic Blockers: Reduce myocardial 02 demand; Slow impulse conduction through the heart.
- Beta-Adrennergic Blockers: Reduce myocardial 02 demand; Slow impulse conduction through the heart
- ACEI: Increased survival for those MI pt administration
24
Q
Lisinopril
A
- Monitor pt condition & provide education
- Obtain & monitor V.S.
- Hx lifestyle, current Drugs, dietary habits
- Frequency & severity of symptoms
