LAB - 7.2 - CAD & Antianginal Drugs Flashcards
is characterized by narrowing or occlusion of a coronary artery.
Coronary Artery Disease (CAD)
The narrowing deprived cells of oxygen and nutrients, also known as
myocardial ischemia.
If ischemia develops over a long period of time, the heart may compensate for its inadequate blood supply, and the client may experience no symptoms.
NA
As CAD progresses, the myocardium does not receive enough oxygen to meet the metabolic demands of the heart, and symptoms of angina begin to appear.
NA
Persistent myocardial ischemia may lead to
heart attack (MI)
The most common etiology of coronary artery disease (CAD) in adults is ___, the presence of plaque – a fatty, fibrous material within the walls of the coronary arteries.
atherosclerosis
Plaque develops progressively over time, producing varying degrees of intravascular narrowing, and a situation that results in partial or total blockage of the vessel
NA
Lat: “strangling of the heart”
Angina Pectoris
Chest pain from reduced bloodflow to the heart (myocardial ischemia)
Angina Pectoris
Squeezing or heaviness in the chest that spreads to the head, neck, arms, chest, abdomen
Angina Pectoris
Not the same as a heart attack
Angina Pectoris
Caused by the narrowing of one or more arteries of the heart (due to blockage, vasospasms, anemia)
Angina Pectoris
Types of Angina:
Stable angina
Unstable Angina
Variant Angina
most common form of Angina
Caused by a fixed obstruction of plaque
Predictable, consistent pain patterns
Stable angina
type of angina that is unpredictable, pain patterns change
More severe and lasts longer
Does not respond to rest or medications
A medical emergency as it often preceds a heart attack
Unstable Angina
types of unstable angina
Obstructive angina
Microvascular Angina
this type of angina is more common in women
Microvascular Angina
this type of angina can occur at rest
Occurs mostly at night
Severe, but responds well to medications
Caused by vasospasms
Variant Angina
These drugs can work to improve blood delivery to the heart muscle
Antianginal Drugs
Antianginal Drugs can work to improve blood delivery to the heart muscle in one of 2 ways:
By dilating blood vessels ( increasing the supply of oxygen)
By decreasing the work of the heart (decreasing the demand for oxygen)
Anti-Angina Drugs come in many different forms:
tablets and capsules that are swallowed;
tablets that are held under the tongue, inside the lip, or in the cheek until they dissolve;
stick-on patches; and sprays
are drugs that act directly on smooth muscle to cause relaxation and to depress muscle tone. Because the action is direct, these drugs do not influence any nerve or other activity, and the response is usually quite fast.
Nitrates
Commonly used Anti-Angina Drugs:
Isosorbide dinitrate (Isordil)
Isosorbide mononitrate (Imdur)
Nitroglycerin (Nitrostat, Nitro-Bid)
Adverse Effects of Anti-Angina Drugs
CNS: Headache, dizziness, weakness
GI: Nausea, vomiting, incontinence
Cardiovascular: Hypotension which can be severe and must be monitored; reflex tachycardia that occurs when blood pressure falls; syncope and angina which could be exacerbated by the hypotension and changes in cardiac output
The usual protocol for administering nitroglycerin tablets for chest pain is to administer ___ tablet every __ minutes (STAT or PRN?) for chest pain for a total dose of ___ tablets. Onset of action is within minutes while duration of action is ___ minutes.
one
5
as needed
three
1-3
30-60
Nursing Interventions or Anti-Angina Medications
Give sublingual preparations under the tongue or the buccal pouch, and encourage the patient not to swallow.
Offer sips of water before giving sublingual nitroglycerin because dryness may inhibit drug absorption
Ask the patient if the tablet “fizzles” or burns, which indicates potency.
Always check on the expiration date and protect the medication from heat and light.
Instruct the patient that a sublingual dose may be repeated in 5 minutes if relief is not felt, for a total of 3 doses; if pain persists, the patient should go to an emergency room to ensure proper medical support if an MI occur.
Education for Anti-Agina Transdermal Patch
Wash hands thoroughly before and after applying.
Apply the patch to the chest, inner side of the upper arm, or shoulder.
Clean and dry the skin before applying the patch. If necessary, hair may be removed by clipping.
To avoid skin irritation, change the treatment site daily. Do not apply to irritated or damaged skin
If the patch becomes loose, remove it and apply a new patch at a different site.
After you remove the used patch, fold the sticky side together and throw away.
This patch should only be worn for up to 12 to 14 hours a day, or as directed by your doctor so that the client will have a 10 to 12 hour “nitrate-free” period each day. This is referred to as a pharmacological vacation away from the medication. This will prevent client tolerance to nitrates.
