Pharmacotherapy of Angina Pectoris

Question 1

Angina?

Answer 1

Chest pain, caused by dec. supply and/or demand (dec. heart perfusion and dec. workload of heart). Causes pain d/t ischemia assoc. with angina.

Question 2

Why ischemia??

Answer 2

Plaque formation; atherosclerosis in coronary arteries.

Question 3

Atherosclerosis =

Answer 3

Inflammation… LDL accumulates… fatty streak…plaque continues to grow and forms cap… BLOCKS blood flow… Heart Attack

Question 4

3 types of Angina?

Answer 4

• Chronic stable (i’m fine except for when I walk up the stairs)
• *-Unstable angina (also called pre-infarction or crescendo angina; lingers and changes)
• Vasospastic angina (Comes and goes, no pattern)

Question 5

Nonpharmacologic therapy

Answer 5

Limit alcohol
Limit sat. fats in diet
Lower blood cholesterol
Maintain normal BP
Maintain normal glucose 
Regular exercise
Maintain optimum weight
Tobacco cessation

Question 6

Pharmacologic Management of Angina!

Answer 6

• Organic nitrates
• Beta-adrenergic blockers (dec. hr/contractility/conduction = helps angina by dec. demand)
• CCB (dec. contractility/dec. conduction, vasodilate = dec. demand by dec. afterload/vasodilating) Nefedipine!!
• antiplatelet (dec. formation of clot)
• HMG-CoA reductase inhibitors = statins (dec. LDL, inc. HDL) (…lowers cholesterol which forms angina)

Question 7

COPD and asthma patients won’t get a

Answer 7

nonselective beta blocker

Question 8

pt. w/ diabetes

Answer 8

should have caution on nonselective beta blocker and check glucose more often b/c not sensitive to need to eat.

Question 9

Nurse is caring for a client who is recovering from a MI. The nurse anticipates that the client will be prescribed which medications in order to reduce post-MI mortality?

Answer 9

• Aspirin (anti-platelet)
• Beta Blocker
• ACE inhibitor
• CCB

Question 10

Beta adrenergic antagonists

Answer 10

• dec. HR and myocardial contractility

- reduce CO and workload

Question 11

CCBs

Answer 11

• dilate arterial smooth muscle, reducing BP and dec. cardiac workload.
• some also dec. the heart rate, reducing the workload on the heart, and dilate the coronary arteries (*Nifedipine).

Question 12

Organic Nitrates

Answer 12

BEST vasodilators.

• Dilate veins, reducing the amount of blood returning to the heart.
• Dilate the coronary arteries, bringing more blood to the myocardium.
• Dilate arteries.

Question 13

Organic Nitrates

Answer 13

Nitroglycerin (nitrostat, nitro-bid)

Question 14

Nitroglycerin Routes

Answer 14

Sublingual - under tongue/emergency/for chest pain, take q5min. x3

IV - In hospital… unstable angina

Transdermal - lasts 12hrs 8am-8pm, works slowly for a long time. *maintenance

Question 15

Nitroglycerin (nitrostat)

Answer 15

Routes: PO/SL/buccal/transdermal

Indications:
acute angina (inc. supply/dec. demand)
controlled htn (dec. preload/afterload)
HF (dec. work of heart)
acute MI (inc. supply and dec. demand…get O2)
Acute PE ( decrease in preload, dilate vein)
Hypertensive crisis.

M of A: Relaxes venous and arterial smooth muscle.

Adverse effects: facial flushing, HA, orthostatic hypotension, rash.

Contra:
hypotension, shock, head injury (brain bleed/hemorrhage), pericardial tamponade (can’t relax d/t fluid in pericardial space), glaucoma, viagra.

Prego: C

Question 16

The nurse is teaching a client about the pharmacological management of angina. The nurse plans to include which points in the client teaching?

Answer 16

• Medications dilate the veins so that the heart receives less blood. (organic nitrates)
• The medications cause the heart to contract with less force. (Bblocks/CCB)

Question 17

A client should be instructed to take SL NTG how often if he experiences chest pain?

Answer 17

Every 5 min times 3

Question 18

A patient is being discharged home with a prescription for SL nitroglycerin. The nurse will instruct the patient and family to

Answer 18

Keep the tablets in the original dark bottle.

Question 19

The nurse is admin. SL nitroglycerin to a patient. Prior to admin. the med, the nurse informs the patient that immediately after administration, the patient may exp. what?

Answer 19

-Throbbing HA/dizziness.

Question 20

A patient is being discharged after being treated with nitroglycerin for angina. Which of the following instructions should the nurse include in the teaching plan for the patient?

Answer 20

Recapping the container tightly and in dark container.