Week 9 - Anti Anginals Flashcards
What is angina pectoris?
Chest pain
When the supply of O2 and nutrients is not enough to meet demands of heart, the muscle aches
Ischemia
Poor blood supply to an organ
Ischemic heart disease
Poor blood supply to the heart
- atherosclerosis
- CAD
MI
Myocardial infarction
- necrosis of cardiac tissue
Types of angina (3)
Chronic stable angina
Unstable angina
Vasospastic angina
For sure on exam
Chronic stable angina (from google)
Type where angina is present during physical or emotional stress
Relieved by rest or medication
Unstable angina (from google)
Chest pain that is unpredictable
Not relieved by Nitroglycerin or rest
MI potential
Vasospastic angina (from google)
Severe chest pain due to coronary artery spasms
Typically not resolved by rest
Drug categories for angina (3)
Nitrates/nitrites
beta blockers
Calcium channel blockers
Therapeutic objectives in angina
Minimize frequency of attacked and decrease duration/intensity of pain
Improve patients functional capacity
Preventt or delay MI
Nitrates and nitrites are available in many forms like:
Sublingual
Chewable
Oral capsules
IV
Transdermal
Ointments
Translingual sprays
Forms of nitrates/nitrites that bypass the liver / first pass effect
SL, IV, transferral, translingual sprays
Nitrates/nitrites: mechanism of action
Causes vasodilation due to relaxation of smooth muscles
Nitrates and nitrites: drug effect
Potent dilating effect of coronary arteries
Result: o2 to ischemic tissue
Used to prevent/treat angina
Rapid acting forms of nitrates / nitrites
(Form/use)
Sublingual tabs/spray
IV
Used to treat acute anginal attacks
Long acting forms of nitrites/nitrates use
To prevent anginal episodes
Nitrates and nitrites examples and if they are long/rapid acting
Nitroglycerin (both)
Isosorbide dinitrate (both)
Isosorbide mono nitrate (primarily long acting)
Nitroglycerin overview (what is it, use)
Prototype nitrate
Large first pass effect if taken orally
Used for symptomatic treatment of angina
IV form used to treat hypertension, pulmonary edema (with MI)
nitrates adverse effects
Headaches
- usually less with continued use
Reflex tachycardia
Postural hypotension
May develop tolerance
Tolerance of nitrates
Occurs if you take it all the time or long acting forms
Prevented by allowing a nitrate free period to allow enzyme pathways to replenish
Nitrates: contraindications
Allergy
Severe anemia
Glaucoma
Hypotension
Head injury
Use of erectile dysfunction drugs
What is the most importance drug used in teh treatment of angina
Nitroglycerin
Beta blockers treat:
Angina
MI
Hypertension
Dysrhythmias
Examples of anti anginal beta blockers
Atenolol
Metoprolol
Porranolol hydrochloride
Nadolol
Anything ending in “olol”
Beta blockers mechanism of action
Block beta 1 receptors on teh heart
This decreases heart rate, resulting in decreased o2 demand
Decreases myocardial contractility, conserves energy
After an MI, there are lots of catecholamines in the heart which irritate it. These block teh effects of catecholamines
Catecholamines
Present in the heart after an MI
Cause imbalance of supply/demand ratio and cause dsyrhythmias
Beta blockers counter these
Beta blockers indication
Angina, hypertension, dysrhythmias, MI
Headaches
Beta blockers contraindications
Systolic HF
Conduction disturbances
Asthma
Diabetes mellitus (can mask hypoglycemia)
PAD
Beta blockers adverse effects
CV: bradycardia, hypotension
Metabolic: hyper/hyporglycemia, hyperlipidemia
CNS: dizziness, fatigue, depression
MISC: ED, dyspnea
Atenolol
Brand name - tenormin
Beta1 adrenergic receptor blocker
Indication: angina
Metoprolol
Trade name - lopresor/betaloc
Beta1 adrenergic receptor blocker
Basically the same as atenolol
Reduces mortality in MI patients
Calcium channel blockers for chronic stable angina (examples)
Amlodipine
Diltiazem
Nifedipine
Verapamil hydrochloride
Calcium channel blockers mechanism of action
Cause coronary artery vasodilation and peripheral artery vasodilation
- decrease systemic vascular resistance
Reduce heart workload
- decrease o2 demand Decreases myocardial
Calcium channel blockers: indication
Angina
Hypertension
Tachycardia
Coronary artery spasm
AFIB
Migraines
Calcium channel blockers contraindications
Allergy
Acute MI
AV block (unless pacemaker is in place)
Hypotension
Calcium channel blockers adverse effects
Not many, basically if they express too much
Hypotension, palpitations, constipation, nausea
Diltiazem hydrochloride
Trade - cardizem, Tiazac
Very effect angina treator
Used in treatment for AFIB and tachycardia
Amlodipine besylate
Trade - norvasc
Most popular Ca channel blocker
Used for angina and hypertension
Oral use only
Nursing implications (general with antianginals)
- Complete health history to determine contraindications
- obtain vitals
- assess for interactions
- encourage limited caffeine
- tell them to report symptoms
- dont drink
- dont go in hot tubs too long that would be dumb
Nursing implications for nitroglycerin
- teach proper technique
- dont chew/swallow SL form
- stock up
- store in good places
- take as needed
- lie down if pain
Nursing implications for beta blockers
- monitor pulse rates daily and report if <60
- do not abruptly DC
- long term, not immediate effect
Nursing implications for Ca channel blockers
- constipation is common (drink water)
