Chapter 45: Angina Pectoris Flashcards
Drugs to tx angina
Nitroglycerine
Beta Blocker
Calcium Channel Blockers
Isorbide Mononitrate (or dinitrate)
Ranolazine (Ranexa)
Used to treat angina pectoris
Used in CAD to prevent angina
Angina may lead to myocardial infarction (MI)
First on try lifestyle changes
Medications increase O2 supply by vasodilating coronary arteries
Types of angina
Stable-Occurs with predictable
stress or exertion
relieve by nitro or rest
Unstable- Unpredictable regarding stress/exertion and intensity
-Not relieved by rest or nitro
Variant (Prinzmetal’s)- Vasospasm
Causes: coke, inherited
Tx: CCB
Nitro
Drug of choice fr acute angina
Nitro MOA
Stimulates vascular smooth muscle relaxation resulting in vasodilation. Decreases the pain of angina by decreasing the cardiac O2 demand.
Pretty much works on VV no AA –vasodilation on smooth mm in VV indirectly affects smooth mm in arteries -> more O2 getting to myocardium
Nitro uses
Rapid onset: termination of an ongoing attack and short term prophylaxis before anticipated exertion.
Nitro SE
Headache, orthostatic hypotension, reflex tachycardia
Reflex tachycardia if someone takes to much nitro they can build up tolerance and have tachy
HA will diminish after they use to and their body wont respond as dramatically. Tx HA with NSAIDS or ASA
Can reverse tolerance by holding nitro for short time
Nitro patch: on for 12 hr, off for 12 hr
D/c slowly to prevent reflex tachy
Nitro forms
SL tablets, Translingual spray, transdermal patches, topical ointment
Watch interactions with antihypertensives.
Overuse can lead to tolerance.
Nitro stat SL tablets
Rapid Onset
Should not be chewed, crushed, or swallowed.
They work much faster when absorbed through the lining of the mouth.
Usually give relief in 1 to 5 minutes.
May take 0.3-0.6 mg as needed for a total of 3 doses in 15 min,
If CP persists after 3 doses, Call 911.***
Storage
Keep out of the reach of children.
Sublingual tablets should be kept in the original glass bottle with screw cap.
store the bottle at room temperature, away from heat, moisture, and direct light.
Expires every 6 month.
A tingling feeling under the tongue means it is working.
Nitro prescribing considerations: therapeutic goals
Reduction of the frequency and intensity of attacks
Prescribing considerations: baseline data
Note frequency and intensity of attacks. BP and HR should be noted
Prescribing consideration: monitoring
No routine blood monitoring necessary
Prescribing considerations: identifying high risk patients
Use with caution in hypotensive patients and in patients taking drugs that lower BP
Prescribing considerations: evaluating therapeutic effects
Instruct patients to keep a record of frequency and intensity of attacks and factors that precipitate these attacks
Nitro: min ADR
Use with phosphodiesterase type 5 inhibitors is contraindicated:
avanafil (Stendra®),
sildenafil (Viagra®),
tadalafil (Cialis®),
vardenafil (Levitra®)
Using these medicines together may cause hypotension (blurred vision, dizziness, lightheadedness, or fainting).
If patient is taking these medicines and have an angina attack, they must be instructed to go to the ER right away.
Isorbide Mononitrate and Isorbide Dinitrate trade names
Imdur, Isordil