Chapter 24- Antianginal Drugs Flashcards
Acute coronary syndrome (ACS)
A group of clinical symptoms compatible with acute myocardial schema.
Angina pectoris
Chest pain occurring when the heart’s supply of blood carrying oxygen and energy-rich nutrients is insufficient to meet the demands of the heart.
Oxygen demands influenced by: HR, Contractility, Caffeine, Exercise, Stress
Atherosclerosis
A common form of arteriosclerosis involving deposits of fatty, cholesterol-containing material (plaques) within arterial walls.
Chronic stable angina
Chest pain that occurs from atherosclerosis that results in long term but relatively stable level of obstruction in one or more coronary arteries.
Coronary arteries
Arteries that deliver oxygen to the heart muscle. Get most of nutrients/gases during relaxation. Tachycardia=no relaxation
Coronary artery disease (CAD)
Any one of the abnormal conditions that can affect the arteries of the heart and produce pathological effects, especially a reduced supply of oxygen and nutrients to the myocardium.
Ischemia
Inadequate blood supply to an organ. Arteries unable to dilate
Ischemic heart disease
Inadequate blood supply to the heart via the coronary arteries.
Myocardial infarction (MI)
Death of cardiac tissue.
Gross necrosis of the myocardium following interruption of blood supply; it is almost always caused by atherosclerosis of the coronary arteries and is commonly called heart attack.
Damage can cause the heart to not work properly (contractions)
Often caused by clots
Severe spasm of the coronary artery blocking block flow
Reflex tachycardia
A rapid heartbeat caused by a variety of autonomic nervous system effects, such as blood pressure changes, fever, or emotional stress.
Unstable angina
Early stage of progressive coronary artery disease. Really in trouble.
Vasospastic angina
Ischemia-induced myocardial chest pain cause by spasms of the coronary arteries.
Drugs for Angina/uses
Nitrates and Nitrites, B-Blockers, Calcium channel blockers.
Increase blood flow to Ischemic heart muscles, decrease myocardial oxygen demands, or both.
Minimize frequency of attacks
Improve PT’s functional capacity
Prevent or delay the worst possible outcome-MI
Nitrates and Nitrites Mech of Action
Most common routes: Transdermal patches- long term.
Transdermal sprays-Fast acting.
Cause vasodilation=reduced myocardial oxygen demand
Nitrates cause dilation of coronary vessels.
Nitrates alleviate coronary artery spasms
Nitroglycerin
Has large first past effect with oral forms-not used because of this.
Used for symptomatic treatment of ischemic heart conditions (angina)
Nitrates and Nitrites Indications
Rapid-acting. Acute anginal attacks
Long-acting-prevent anginal episodes (patches)
N&N Contraindications
Drug allergy, Severe anemia, Closed-Angle glaucoma. Hypotension, Severe Head injury
Nitrates Adverse Effects
Headaches, postural hypotension, tolerance
Tolerance
Occurs in PT’s taking nitrates in long-acting forms.
Regular nitrate free periods to allow enzyme pathways to replenish-remove patch at bedtime for 8 hours, then apply a new patch in the morning
Nitrates Interactions
Alcohol, B-Blockers, Calcium channel blockers, Phenothiazines, Erectile dysfunction drugs
B-Blockers ‘LOL’ Mech of Action
Ex) Metoprolol (Lopressor SR)
B1-Adrenergic receptors on the heart are blocked- Decreased HR, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart.
Dose dependent
After an MI, catecholamines irritate the heart, causing an imbalance in the supply-and-demand ratio and even leading to the life-threatening dysrhythmias. B-blockers block the harmful effects of catecholamines
B-Blockers Indications
Angina, Antihypertensive, Cardiac dysrhythmias, Cardioprotective effects
B-Blockers Adverse Effects
Bradycardia, hypotension, altered glucose and lipid metabolism. dizziness, fatigue, mental depression, impotence
Calcium Channel Blockers Mech of Action
Ex) Diltiazem hydrochloride (Apo-Diltiaz TZ, Cardizem CD), Nifedipine (Adalat)
Vasodilation, reduce the workload of the heart=decreased myocardial oxygen demand
Calcium Channel Blockers Indications
Treatment of coronary artery spasms.
Short term management of atrial fib and flutter (not as effective)
Calcium Channel Blockers Adverse Effects
Very acceptable adverse effect and safety profile.
May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea
Calcium Channel Blockers Interactions
Cyclosporin.
Grapefruit juice can reduce the metabolism of calcium channel blockers. No grapefruit juice on cardiac meds!
Nitroglycerin Nursing Implications
Instruct PT in proper technique for taking SL, and never to chew or swallow the SL form.
Drug loses its potency after about 3 months after bottle has been opened-should have a burning sensation.
Site rotation and removal of old medication.
Instruct PT to take nitrates as needed at first hint of anginal pain.
Monitor Vital signs.
Take SL tablet and wait 5 minutes, no relief than take a second, no relief in another 5 minutes take a third SL tablet, after 3 tablets, or 15 minutes if no relief of chest pain call 911! New recommendation: after 1 dose and no relief call 911!
Discard parenteral solution that is blue, green, or dark red.
Calcium Channel Blockers Nursing Implications
Constipation is a common problem. PT to take adequate fluids and eat high-fibre foods.
B-Blockers Nursing Implications
Monitor pulse, Dizziness or fainting should be reported. Never to be abruptly discontinued. These medications are for long term prevention of angina, not for immediate relief,
Antianginal Nursing Implications
Monitor for Adverse Effects: Allergic reactions, headache, hypotension, dizziness.
Monitor for Therapeutic Effects: Relief of angina, decreased BP
