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What is Angina?
- Sudden pain beneath the sternum often radiating to left shoulder and arm
- Oxygen demand greater than oxygen supply (eschemia)
- Prodromal sign (warning)
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Goals of Drug therapy for angina pectoris
Prevention of myocardial ischemia and
anginal painPrevention of myocardial infarction and death
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Types of Angina
- Chronic stable angina (exertional)
- Treatment: Increase O2 or decrease demand
- Variant angina (Prinzmetal’s)
- Treatment: Increase O2 with vasodilators
- Unstable angina (no known cause or trigger)
- Treatment: Decrease O2 demands, Reduce pain and progression with medications
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Unstable Angina
- Severe Coronary Artery Disease
- Vasospasm
- Platelet aggregation
- Transient coronary thrombi/emboli
- Management
- Anticoagulants
- Nitrates
- Beta Blockers
- Calcium channel blockers
- Morphine
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Find the flow chart for antianginal drug selection and know it.
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Nitrates
(NItroglycerin)
- Vasodilator
- Relaxes vascular smooth muscle beds
- Decreases O2 consumption
- Allows heart to work with a lower O2 demand
- Reduces preload and afterload –results in decreased cardiac workload
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Adverse Effects of Nitrates
- Headache
- Othostatic hypotension
- Reflex tachycardia
- Flush
- Teaching is importatnt because you don't want pts with orthstatic hypotension driving around or trying to do ADLs that require them to be standing/alert.
Tolerence develops rapidly…should have at least 8 hours of drug free time a day. Should have at least 8hrs drug free time/day.
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Nitrate routs of admin
- Sublingual
- Oral sustained-release, so don't crush it!
- Transdermal delivery systems. Need to wear gloves to avoid self-administering nitroglycerin and discard in appropriate way.
- Translingual spray
- Buccal
- Topical
- Intravenous
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At first sign of angina, what should your pt do?
- Lie down***
- Take appropriate dose of nitrate
- In 5 minutes if pain is not relieved…take another dose
- In acute setting the nurse should take VS.
- If SBP is < 100 or 25 mg lower than previous BP should notify MD prior to dose
- A total of 3 doses may be administered in 15 minutes
If pain does not subside after 2nd dose, pt should call the am-buh-lance. Don't have sigother drive.
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Proper storage of Nitrates
- Nitrates should be replaced q 6 months
- Drug is heat, air and light sensitive = Need to be in amber colored container
- Administer and dispose of patches carefully. 1 patch = 1 dose. Should be tossed in a very inconspicuous way.
- Emphasize importance of safety in drug administration
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Beta Blockers for Angina
- Used to prevent Angina from occuring. Not usually seen PRN.
- Fixed schedule
- Initial low dose
- Heart rate monitoring
- Gradual withdrawal
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Calcium Channel Blockers for Angina.
- Examples are verapamil, diltiazem, nifedipine.
- Can be given PRN in same way as nitroglycerin
- Stable and variant angina
- Adverse effects
- Hypotension
- Reflex tachycardia
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Revascularizeation therapy
- Coronary Artery Bypass Graft Surgery (CABG)
- Percutaneous Transluminal Coronary Angioplasty (PTCA)
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