Chapter 23: Antianginal Drugs Flashcards
ischemia
damaged cells/tissue as the result of inadequate oxygen supply
Angina Pectoris
chest pain that occurs when the heart’s supply of blood carrying oxygen is insufficient to meet the demands of the heart.
atherosclerosis
common form of arteriosclerosis involving deposits of fatty, cholesterol-containing material (plaques) within the arterial walls that can slow or block blood flow to the tissues.
myocardial infarction
- commonly called a heart attack
- occurs when blood flow through coronary arteries to myocardium is blocked so that part of the heart muscle cannot receive any of the blood-borne nutrients. if it’s not reversed immediately, the area of the heart dies and becomes necrotic.
myocardial infarction is almost always caused by
atherosclerosis of the coronary arteries
coronary artery disease (CAD)
any one of the abnormal conditions that can affect the arteries of the heart and produce various pathologic effects, especially a reduced supply of oxygen and nutrients to the myocardium
damage to a large enough area of the myocardium can be
disabling or fatal
Atherosclerosis: Process of Injury
- endothelial damage
- fatty streak
- fibrous plaque
- complicated lesion
There are three classic types of angina pectoris:
- stable angina
- unstable angina
- prinzmetal angina
Acute Coronary Syndrome
sudden obstruction of coronary blood flow.
O2 demand/needs > O2 supply
What happens after a myocardial infarction?
- scar tissue replaces necrotic area
- contractility is lost
- abnormal wall motion
- electrical malfunction
- changes in cardiac pressures
- changes in volumes in cardiac chambers
What can result from the changes to the heart due to myocardial infarction?
dysrhythmias and congestive heart failure
Two classifications of MI
- transmural MI (highest risk for complications)
- subendocardial MI
Women and Coronary Artery Disease
- women have different signs and symptoms of myocardial infarction (MI) (c/o flu like symptoms)
- in-hospital mortality post-MI is higher in women than in men
chronic stable angina
- atherosclerosis is the primary cause.
- can be triggered by exertion or other stress.
- pain is commonly intense but subsides within 15 minutes of either rest or appropriate antianginal drug therapy
unstable angina
- usually the early stage of progressive coronary artery disease.
- often ends in MI
- pain increases in severity as does the frequency of attacks
prinzmetal angina
r-esults from spasms in the layer of smooth muscle that surrounds coronary arteries.
-pain occurs at rest without any precipitating cause. no regular pattern.
Three main classes of drugs used to treat angina pectoris:
- nitrates/nitrites
- beta blockers
- calcium channel blockers
Three main therapeutic objectives of antianginal drug therapy
- minimize the frequency of attacks and decrease the duration and intensity of anginal pain
- improve the patients functional capacity with as few adverse effects as possible
- prevent or delay the worst possible outcome, MI
Available forms of nitrates
- sublingual
- chewable tablets
- oral capsules/tablets
- intravenous solutions
- transdermal patches
- ointments
- translingual sprays
Mechanism of Action: Nitrates
Relaxation of smooth muscles → dilate all blood vessels → O2 to heart muscle
Nitrates are used to treat
stable, unstable and prinzmetal angina
What are the two types of forms of nitrates?
- rapid-acting forms
- long-acting forms
rapid-acting forms
- acute angina
- include sublingual tables; intravenous infusion
long-acting forms
PREVENT anginal episodes
The following are the rapid- and long-acting nitrates available for clinical use:
- isosobide mononitrate (Imdur) (primarily long acting)
- isosobide dinitrate (Isordil) (both rapid and long acting)
- nitroglycerin (both rapid and long acting)
Adverse effects of Nitrates
- Headaches (Usually diminish in intensity and frequency with continued use.)
- Reflex tachycardia
- Postural hypotension
- Tolerance may develop
Discuss the Nursing Process focus on Patient-Centered Care (pp. 370-374)
Assessment Nursing Diagnoses Planning Implementation Evaluation