Antianginals And MI Medications Flashcards
Atherosclerosis
- Most common etiology of CAD
* Caused by presence of plaque
Coronary artery disease
- One of the leading causes of death in United States
- Narrowing or occlusion of a coronary artery
- Narrowing causes myocardial ischemia
Angina pectoris
- Acute chest pain due to insufficient O2 to myocardium
- Accompanies physical exertion or emotional excitement
- Causes increased myocardial oxygen demand
Angina signs and symptoms
- Steady, intense pain in anterior chest
- Pain radiating to left shoulder, left arm, spine, jaw
- Fear of impending death
- Pallor, dyspnea, diaphoresis
- Tachycardia, elevated blood pressure
Therapeutic management of angina
•Therapeutic outcomes
◦Reduce intensity and frequency of episodes
◦ Improve exercise tolerance
2 main ways angina pharmacology works
◦Those that terminate acute angina episode
◦Those that decrease frequency of episodes
Reduce O2 demand by:
- Slowing heart rate
- Reducing preload
- Reducing contractility
- Lowering blood pressure (reduced afterload)
Nitrates prototype
•Prototype drug: nitroglycerin (Nitrostat)
Nitrate action
Mechanism of action: relax both arterial and venous smooth muscle; dilate coronary arteries
◦Short acting-terminate acute angina episode
◦Long-acting-decrease severity and frequency of episodes
Nitrate primary use
•Primary use: for lowering myocardial oxygen demand
Nitrate adverse effects
Adverse effects: hypotension, dizziness, headache, flushing of face, rash
Nitrate implications
- Obtain blood pressure and monitor
- IV nitrates have greatest risk for severe hypotension
- Educate client that alcohol is contraindicated with nitrates
- If hypotension occurs, withhold nitrates
Beta-adrenergic blocker prototype
•Prototype drug: atenolol (Tenormin)
Beta-adrenergic action
Mechanism of action: to reduce the cardiac workload by slowing heart rate and reducing contractility
Beta-adrenergic blocker primary use
•Primary use: for prophylaxis of stable angina
Beta-adrenergic blocker adverse effects
Adverse effects: fatigue, insomnia, drowsiness, impotence, bradycardia, confusion
Beta-adrenergic blocker implications
- Assess apical heart rate
- Obtain blood pressure and continue to monitor
- Monitor respiratory status
- Monitor serum-glucose levels
- Educate client not to stop medications abruptly
Calcium channel blockers prototype drug
•Prototype drug: diltiazem (Cardizem)
Calcium channel blocker action
Mechanism of action: to reduce cardiac workload by relaxing arteriolar smooth muscle; dilate coronary arteries
Calcium channel blocker primary use
Primary use: for lowering blood pressure; bring more oxygen into myocardium
Calcium channel adverse effects
Adverse effects: hypotension, bradycardia, heart failure, constipation, headaches, dizziness, edema
Calcium channel implications
- Assess vital signs
- Hold medication if client hypotensive (heart rate of 60 or below)
- Obtain blood pressure in lying, sitting, and standing positions
- Assess for signs of heart failure
- Obtain daily weights
- Assess bowel functions
Thrombolytic prototype
•Prototype drug: reteplase (Retavase)
•
Thrombolytic action
Mechanism of action: to dissolve clots obstructing coronary arteries
