Drugs for angina pectoris

Question 1

list the three main families of antianginal drugs

Answer 1

nitrates, beta blockers, and calcium channel blockers.

Question 2

describe the balance between oxygen supply and demand

Answer 2

Normally, when oxygen demand increases there is a proportionate increase in coronary blood flow and oxygen supply so that tissue oxygen levels are maintained during times of increased oxygen demand.
And VV, if there is limited supply, blood flow will be reduced.

Question 3

discuss the cause and treatment for chronic stable angina

Answer 3

cause: CAD (coronary artery disease)
triggers: increase in physical activity, emotional excitement, large meals, cold exposure.

TX: decrease cardiac oxygen demand by using drugs that reduce heart rate, contractility, preload, and/or afterload

Question 3

describe the cause and treatment strategy for chronic stable angina

Answer 3

cause: CAD (coronary artery disease)

treatment strategy: decrease cardiac oxygen demand with drugs that decrease heart rate, contractility, preload, afterload

Question 4

describe the cause and treatment plan for variant angina (Prinzmetal)

Answer 4

cause: coronary artery spasm (restricts blood flow to the myocardium)

treatment plan: reduce incidence and severity of attacks by increasing cardiac oxygen supply with vasodilators.

Question 5

describe the cause and treatment plan for unstable angina

Answer 5

cause: severe CAD complicated by vasospasm, platelet aggregation, and transient coronary thrombi/emboli.
treatment: MEDICAL EMERGENCY, strategy is to maintain o2 supply and decrease o2 demand

Question 6

nitroglycerin: therapeutic actions, AEs, drug interactions, tolerance, sublingual delivery

Answer 6

TA: acts directly on vascular smooth muscle to promote vasodilation.

AEs: headache, orthostatic hypotension, reflex tachycardia

tolerance: can develop rapidly, so use lowest effective dosages, long acting formulations (patch, sustained release), and intermittent scheduling that allows pts. to be 8 hrs drug free.

sublingual delivery: allows for direct absorption through oral mucosa into bloodstream. this allows effects to begin rapidly.

Question 7

explain how a beta blocker would be effective in angina treatment

Answer 7

only first line for angina of effort

reduce pain by decreasing cardiac oxygen demand through blockade of beta 1 receptors in the heart. also cause a modest reduction in afterload to reduce oxygen demand.

Further, heart rate is also slowed, so less demand for O2.

Question 8

explain how a calcium channel blocker would help in angina treatment

Answer 8

used for stable and variant angina

variant angina: promote relaxation of coronary artery spasm, thereby increasing cardiac oxygen SUPPLY

stable angina: promote relaxation of peripheral arterioles and the resultant decrease in afterload reduces cardiac oxygen DEMAND

Question 9

Nitro
calcium channel blockers
beta blockers

effects on pre/afterload?
effects on O2 supply/demand

Answer 9

nitro: decreases preload, decreased oxygen demand

calcium channel blockers: decrease afterload, increase O2 supply

beta blockers: decrease afterload, less demand for O2.

Question 10

explain and be able to teach the major nursing implications for safe administration of nitroglycerin

Answer 10

goal: reduction of the frequency and intensity of anginal attacks.

obtain baseline data from pt.

CAUTION: hypotensive patients
CONTRAINDICATION: use with sildenafil (Viagra) and other PDE5 inhibitors is contraindicated.

Admin:
can do sublingual tablets/powder, sustained oral release capsules, transdermal delivery systems, translingual spray, topical ointment.

Patients must swallow pills/tablets whole if not sublingual.

montior for AE’s: orthostatic hypotension, new onset diabetes, headache, memory loss, cataracts, etc.

PREVENTION OF TOLERANCE: allow the patient at least 8 hours of non medication/day to prevent tolerance.