Patients with history of angina should have _____ and know how to use it. When should they call if they suspect they are having a heart attack?
Nitroglycerin sublingual
If after first dose of no relief call EMS
Patients with symptoms suggestive of CAD should be_______?
referred to a cardiologist.
What are the 3 major classes of anti angina drugs??
Nitrates -long and short acting
BB
CCB
What is the MOA of nitrates??
relax vascular smooth muscle. They cause dilation of the peripheral arteries and veins as well as coronary arteries. Reduction in preload and increased blood flow and oxygen supply to the myocardium.
Nitrates are one of the first medications used for angina. They are used to .....
Stop an acute attack, prevent attacks, and for chronic treatment.
How do you take SL nitro in an acute attack??
0.3-0.4 SL at 3-5 minute intervals for 3 doses.
IF UNIMPROVED OR WORSE AFTER 5 MINUTES, CALL EMS. (IT SHOULD BE EFFECTIVE IN 1-2 MINUTES)
How soon must thrombolytic therapy be started if they are truly having a MI??
1-3 hours of onset
How do Long acting nitrates work??
ex.
Isordil, Nitro-Bid
maintain vasodilation continuously decreasing the workload of the heart and maintaining blood flow to the heart
Isosorbide Dinitrate
Remember these things with administration/dosing...
Start Low and Go Slow
Take on empty stomach
Short half life may have to take multiple doses per day.
Nitrate tolerance is the main limitation with these drugs.
How can you prevent this?
Tolerance can develop in as few as 7-10 days of ongoing treatment.
To prevent this need 10-12 hour nitrate-free intervals every day.
Most common adverse effect of nitrates
headache
Teach patients to avoid use of other vasodilators while taking nitrates because it can cause severe _____?
hypotension
such as tadalifil, sidenfil, vardenafil
While pt taking nitrates, you should have them???
keep diary of prn use
What labs and often obtain should they be obtained with nitrate usage??
cardiac enzymes and electrolytes at least every three months.
Most common interaction with nitrates
ETOH
Can cause severe hypotension and cardiovascular collapse
What is the complications of Geriatrics and Nitrates??
are at greater risk for syncope with nitrates
have patient sit or lie down before administering drug.
usually need lower dose
Nitrate pregnancy category
c
Ranolazine (Ranexa)
MOA unknown
minimal effects on HR and BP
improves exercise duration and angina symptoms when added to patient therapy already on antianginals
Notify healthcare provider if taking nitrates and have what 3 symptoms??