Week 10 Antianginal Flashcards
1
Q
what is Angina
A
chest pain
2
Q
children considerations
A
- Antianginals are not indicated for any condition commonly found in children
- In congenital heart defects or cardiac surgery, nitroglycerin may be used
3
Q
Adult considerations
A
- Recognize which activities tend to precipitate an anginal attack and avoid those circumstances
- Educate on how to use the drug and how much to take before seeking emergency care
- Nitro 1 tab q5 min, max of 3 tabs
- Stress the importance of other measures to help reduce their risk of CV disease (wt loss, diet, exercise, smoking cessation)
- Antianginal drugs should NOT be used during pregnancy
4
Q
Older adult considerations
A
- More likely to develop adverse effects associated w/ the use of these drugs; arrhythmias, hypotension, heart disease
- More likely to have renal or hepatic impairment
- Start at a lower dose than recommended and then increase dose gradually
5
Q
Nitrate prototype drug
A
nitroglycerin
6
Q
beta blocker prototype drug
A
metoprolol
7
Q
calcium channel blocker prototype drug
A
diltiazem
8
Q
Therapeutic action: Nitrates
A
- Relaxes vascular smooth muscle> decrease in venous return and decrease in arterial BP> reduced left ventricular workload and myocardial oxygen consumption
9
Q
indications: Nitrates
A
- Acute angina, prophylaxis of angina, IV treatment of angina unresponsive to beta blockers, periop hypotension, HF associated with acute MI
10
Q
pharmacokinetics: Nitrates
A
- MANY Routes; onset varies
- short half life
- rapidly absorbed
- metabolized in liver, excreted in urine
- cross placenta/ detected in breastmilk
11
Q
adverse effects: Nitrates
A
- Adverse effects are related to vasodilation and decrease in blood flow; hypotension, headache, dizziness, tachycardia, rash, flushing, n/v, sweating, chest pain
12
Q
contraindications: Nitrates
A
- Severe anemia; decreased cardiac output> decreased ability to deliver oxygen
- head trauma/ cerebral bleed; relaxation risk intracranial bleeding
- Hypotension and Hypovolemia; exacerbate resulting in serious adverse effects
13
Q
drug-drug interactions: Nitrates
A
- DO NOT combine nitrates w/ drugs used to treat erectile dysfunction; serious hypotension or other CV events could occur
- Risk of decreased therapeutic effects of heparin if given w/ nitrates
14
Q
nursing considerations: Nitrates
A
- Assess HR, BP, ECG, perfusion, electrolytes, renal function tests
- inspect skin for color, intactness, or irritation; roate sites of topical forms to prevent skin breakdown (topical creams)
- assess pts complaint of pain
- instruct pt to sit or lie down prior to administration; risk of hypotension
- Give sublingual under tongue or in buccal pouch; ask if tablet is fizzing or burning
- DO not chew/ crush sustained release forms
15
Q
Therapeutic actions: Beta blockers
A
- Competitively block beta-adrenergic receptors in the heart, decreasing the influence of the SNS on these tissues> decreased excitability of the heart, decreased CO, decreased cardiac oxygen consumption, and decreased BP
16
Q
indications: Beta blockers
A
- Stable angina, HTN, prevention of reinfarction in MI pts, and stable, systemic HF
17
Q
pharmacokinetics: Beta blockers
A
- Oral and IV med
- metabolized in liver, excreted in urine
18
Q
adverse effects: Beta blockers
A
- related to the blockage of the SNS; dizziness, vertigo, HF, arrhythmias, gastric pain, flatulence, v/d, impotence, decreased exercise tolerance
19
Q
contraindications: Beta blockers
A
- Allergy to med
- bradycardia, heart block, and cardiogenic shock
- use caution; diabetes, PVD, asthma, COPD
20
Q
drug-drug interactions: Beta blockers
A
- Decreased antihypertensive effects occur when beta-blockers are given w/ NSAIDs
- change in BG if beta blockers are given w/ insulin or antidiabetic agents
- Avoid clonidine; causes paradoxical hypertension
21
Q
nursing considerations: Beta blockers
A
- Assess HR, BP, ECG, perfusion, electrolytes, renal function tests
- DO NOT stop abruptly after chronic therapy; taper gradually over 2 wks
- establish daily activity program; space activities out
- monitor CO regularly to evaluate drug effectiveness and monitor changes
22
Q
Therapeutic actions: calcium channel blockers
A
- Inhibit the mov’t of calcium ions across the membranes of myocardial and arterial muscle cells, altering the action potential and blocking muscle cells contraction
- decreased BP, cardiac workload and myocardial oxygen consumption
23
Q
Indications: calcium channel blockers
A
- prinzmetal angina, effort- associated angina, chronic stable angina
24
Q
pharmacokinetics: calcium channel blockers
A
- Oral and IV med; generally well absorbed
- metabolized in liver, excreted in urine
- crosses the placenta/ detected in breastmilk
25
Q
adverse effects: calcium channel blockers
A
- related to the effect on cardiac output and on smooth muscle; dizziness, light-headedness, headache, edema, AV block, flushing, nausea
26
Q
contraindications: calcium channel blockers
A
- Allergy to med
- Heart block; exacerbated by conduction slowing effects of the drug
- renal/hepatic dysfunction
pregnancy/ lactation
27
Q
drug-drug interactions: calcium channel blockers
A
- increased in serum levels and toxicity of cyclosporine is possible if taken w/ diltiazem
28
Q
nursing considerations: calcium channel blockers
A
- Assess HR, BP, ECG, perfusion, electrolytes, renal function tests
- avoid grapefruit juice; can increase to toxic levels
- assess pts complaint of pain and if measures relieve it
- monitor pts BP, CO, and cardiac rhythm closely while drug is being administered
- Monitor pts BP closely if the pt is also taking nitrates; increased risk of hypotensive episode
29
Q
Beta-blockers suffix
A
“lols”
30
Q
what class does nitroglycerin belong to
A
nitrates
31
Q
what class does metoprolol belong to
A
beta blockers
32
Q
what class does Diltiazem belong to
A
calcium channel blockers
