Chapter 24- Antianginal Drugs

Question 1

Acute coronary syndrome (ACS)

Answer 1

A group of clinical symptoms compatible with acute myocardial schema.

Question 2

Angina pectoris

Answer 2

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

Question 3

Atherosclerosis

Answer 3

A common form of arteriosclerosis involving deposits of fatty, cholesterol-containing material (plaques) within arterial walls.

Question 4

Chronic stable angina

Answer 4

Chest pain that occurs from atherosclerosis that results in long term but relatively stable level of obstruction in one or more coronary arteries.

Question 5

Coronary arteries

Answer 5

Arteries that deliver oxygen to the heart muscle. Get most of nutrients/gases during relaxation. Tachycardia=no relaxation

Question 6

Coronary artery disease (CAD)

Answer 6

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.

Question 7

Ischemia

Answer 7

Inadequate blood supply to an organ. Arteries unable to dilate

Question 8

Ischemic heart disease

Answer 8

Inadequate blood supply to the heart via the coronary arteries.

Question 9

Myocardial infarction (MI)

Answer 9

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

Question 10

Reflex tachycardia

Answer 10

A rapid heartbeat caused by a variety of autonomic nervous system effects, such as blood pressure changes, fever, or emotional stress.

Question 11

Unstable angina

Answer 11

Early stage of progressive coronary artery disease. Really in trouble.

Question 12

Vasospastic angina

Answer 12

Ischemia-induced myocardial chest pain cause by spasms of the coronary arteries.

Question 13

Drugs for Angina/uses

Answer 13

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

Question 14

Nitrates and Nitrites Mech of Action

Answer 14

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

Question 15

Nitroglycerin

Answer 15

Has large first past effect with oral forms-not used because of this.
Used for symptomatic treatment of ischemic heart conditions (angina)

Question 16

Nitrates and Nitrites Indications

Answer 16

Rapid-acting. Acute anginal attacks

Long-acting-prevent anginal episodes (patches)

Question 17

N&N Contraindications

Answer 17

Drug allergy, Severe anemia, Closed-Angle glaucoma. Hypotension, Severe Head injury

Question 18

Nitrates Adverse Effects

Answer 18

Headaches, postural hypotension, tolerance

Question 19

Tolerance

Answer 19

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

Question 20

Nitrates Interactions

Answer 20

Alcohol, B-Blockers, Calcium channel blockers, Phenothiazines, Erectile dysfunction drugs

Question 21

B-Blockers ‘LOL’ Mech of Action

Answer 21

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

Question 22

B-Blockers Indications

Answer 22

Angina, Antihypertensive, Cardiac dysrhythmias, Cardioprotective effects

Question 23

B-Blockers Adverse Effects

Answer 23

Bradycardia, hypotension, altered glucose and lipid metabolism. dizziness, fatigue, mental depression, impotence

Question 24

Calcium Channel Blockers Mech of Action

Answer 24

Ex) Diltiazem hydrochloride (Apo-Diltiaz TZ, Cardizem CD), Nifedipine (Adalat)
Vasodilation, reduce the workload of the heart=decreased myocardial oxygen demand

Question 25

Calcium Channel Blockers Indications

Answer 25

Treatment of coronary artery spasms.

Short term management of atrial fib and flutter (not as effective)

Question 26

Calcium Channel Blockers Adverse Effects

Answer 26

Very acceptable adverse effect and safety profile.

May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea

Question 27

Calcium Channel Blockers Interactions

Answer 27

Cyclosporin.

Grapefruit juice can reduce the metabolism of calcium channel blockers. No grapefruit juice on cardiac meds!

Question 28

Nitroglycerin Nursing Implications

Answer 28

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.

Question 29

Calcium Channel Blockers Nursing Implications

Answer 29

Constipation is a common problem. PT to take adequate fluids and eat high-fibre foods.

Question 30

B-Blockers Nursing Implications

Answer 30

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,

Question 31

Antianginal Nursing Implications

Answer 31

Monitor for Adverse Effects: Allergic reactions, headache, hypotension, dizziness.
Monitor for Therapeutic Effects: Relief of angina, decreased BP