Antianginals Flashcards
Describe stable angina?
Activity with cardio needs cause chest pain and the increase of demand will subside with rest
Describe unstable angina?
Chest pain that occurs without any cardio activity.
Describe prinzmetals angina?
angina that is caused by spasms in the coronary artery
Describe how angina develops in general.
The lumens in the arteries narrow to the point where the demand starts exceeding the supply.
With angina, what is still happening if the patient still has pain?
Ischemia, injury, or infarction
This is why the goal is no pain
What other medications are used to treat angina?
Beta blockers (decrease demand) - decrease in hr reduces demand
Calcium channel blockers (increase supply) - vasodilation makes oxygen more available
What is the 1st line drug for angina?
Oxygen
Increases supply to meet demand
What is the initial dosing of oxygen for angina?
2L nc even if sats are at 100%
When should you watch out for the use of oxygen with?
COPD (usually outweighs risks)
What is the mechanism of action for organic nitrates?
direct vasodilation of veins and arteries
- reduces preload and afterload and increases oxygen supply
What is the primary therapeutic use of organic nitrates?
angina episodes and chronic treatment of angina related to coronary artery disease
How can organic nitrates be administered?
PO, sublingual, translingual spray, ointment, IV
What are some adverse effects of using organic nitrates?
Orthostatic hypotension/hypotension
Reflex tachycardia - in response to decreased CO from vasodilation
HA - due to vasodilation
Tolerance
What are some nursing considerations in regards to organic nitrates?
Monitor BP when administering
give ibuprofen or acetaminophen for HA if not contraindicated
Be sure to give lowest dose possible to achieve affect
Should you stop administering organic nitrates in an emergency situation for a HA?
NO NO NO
What BP and HR level is the cut off point for administration of organic nitrates?
What is another way to prevent tolerance with organic nitrates?
With chronic management it is best to make sure that the patient has periods of time where the medication isnt in their system. (usually this is overnight)
Describe the process of sublingual administration of organic nitrates.
Have the patient stop activity
Put one pill under the tongue, tell the patient not to swallow
Tell the patient a tingling sensation is normal and that it means the medication is still potent
Wait 5 minutes and assess HR and BP and pain (to see if they need more)
(if at home the patient should call 911 if the pain isnt gone after 1 dose)
If vitals are in safe range and pain is still there give another dose
MAY GIVE UP TO # DOSES 5 MINUTES APART
If pain doesnt go away after 3 doses call rapid response team or follow protocols for hospital
GOAL FOR 0 PAIN
if you are ambulating a patient in the hallway and they begin to have chest pain what do you do?
stop ambulation, grab a wheelchair and wheel patient back to the room
What is organic nitrate translingual spray used for?
administer like SL (for acute episodes
What is sustained oral release organic nitrates used for?
chronic management (dont crush or chew)
When using transdermal patches what are some things to remember?
Apply to hairless, clean, dry skin
remove old patch
rotate sites
remove at night (for tolerance)
What are some key things to remember when using topical ointment?
WEAR GLOVES
REMOVE OLD PATCH
this form is very hard to dose
With IV organic nitrates what are some things to remember?
uses glass bottle and special tubing (interacts with plastic)
titrate slowly (like 5 minutes)
be sure to assess HR and BP as well as pain between doses
monitor ecg
not normally used unless in critical care
What are some patient teaching points for organic nitrates?
Check expiration dates (potency)
Remove transdermal patches at night, rotate sites
stop activity when experiencing pain
Can repeat sublingual 3 times, 5 minutes between each dose, call 911 if not relieved after the 1st
Wash hands if using a paste
Fizzing means the sublingual tabs are still potent
keep pills in original bottle (protects from light) out of the bathroom (protect from heat)
Do not stop oral tablets abruptly
Avoid alcohol (hypotensive effect)
