Antianginal meds

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  1. What causes chest pain (Angina Pectoris)?
    Caused by inadequate blood flow to the myocardium d/t either plaque occlusions w/in or spasms of the coronary arteries.  W/< blood flow, there is a <in O2 to the myocardium, which results in pain.
  2. What is Ischemia?
    Poor blood supply to an organ
  3. What is Ischemic heart disease?
    poor blood supply to the heart muscleAtherosclerosis, CAD
  4. What is a MI or Myocardial Infarction?
    Necrosis of cardiac tissue ->disabling or fatal
  5. What are the therapeutic objectives with Antianginal meds?
    ^blood flow to ischemic heart muscle &/or <myocardial O2 demandminimize the frequency of attacks & <the duration & intensity of anginal painImprove the pts fxnal capacity w/as few A/E as possiblePrevent or delay the worst possible outcome: MI
  6. What are some NON-pharmacological measures to control angina?
    Avoid: heavy meals, smoking, extreme weather changes, strenuous exercise, & emotional upsets.DO: proper nutrition, moderate exercise, adequate rest, & relaxation techniques.
  7. Name the Antianginal drugs.
    Nitrates/NitritesBeta-blockersCalcium channel blockers
  8. What is the action of the Antianginal meds Nitrates/Nitrites?
    • Cause vasodilation of coronary vessels d/t relaxation of smooth muscles = more blood passes thru coronary vessels -> ^O2 to ischemic myocardial tissue.
    • Also: <O2 demand by <the volume of blood returning to the heart.
  9. What are the Nitrates/Nitrites drugs used for?
    • Prevention & Tx of Angina
    • Nitrates alleviate coronary artery spasms
  10. Nitrates/Nitrites have a VERY HIGH 1st pass effect.  What are the available forms of these drugs?
    • Sublingual
    • Buccal
    • IV
    • Ointments (chronic/prevention NOT ACUTE)
    • Transdermal patches
    • Translingual sprays
    • Chewable tabs
    • Oral caps/tabs (not used much)
  11. What are some of the drug names for the Nitrates/Nitrites & what are their uses?
    • Nitroglycerin (Nitro-Bid, Nitrostat)
    • Isosorbide dinitrate: Isordil, Sorbitrate, Dilatrate SR
    • Isosorbide monitrate: Imdur, Monoket, ISMO

    • Uses: Acute relief of angina
    • Prophylaxis in situations that may provoke angina
    • Long-term prophylaxis of angina
  12. What are the A/E of Nitrates?
    • HA: d/t vasodilation but <w/use
    • Reflex Tachycardia: w/vasodilation, orthostatic hypotension occurs & the heart will assume it needs to ^ & causes tachy
    • Postural/orthostatic hypotension
    • Tolerance may develop: avoided by having "nitrate free" time (ie; patch off at NOC.)
    • Alcohol, antihypertensives, sildenafil (ED drug)
  13. What are the nursing implications with Nitroglycerin?
    • Critical assessment: BP
    • Instruct pt: remove topical at HS/apply new a.c.
    • Never chew or swallow the SL form
    • Do NOT stop taking long-acting abruptly
    • Preserve potency: airtight container, dark bottle, w/metal cap & not cotton filler
    • New bottle Q-3months
    • For CP: take lying down to prevent dizziness & fainting that may occur d/t hypotension.
  14. What should a patient be taught if anginal pain occurs?
    • Stop activity/sit or lie down
    • Take prn nitrates right away
    • Take SL tab, wait 5min
    • If NO relief in 5min, call 911
    • Can take up to 2more doses at 5min intervals
    • Do NOT try to drive to the hospital!!
  15. Name the Anti-Anginal Beta-blockers.
    • Atenolol (Tenormin)
    • Metoprolol (Lopressor)
    • Propranolol (Inderal) - nonspecific Beta-blocker
  16. Beta-Blockers like Atenolol can be used as Anti-Anginals & what other indications?
    • Antihyptensive
    • Cardiac Dysrhythmias
    • Cardioprotective effects, after MI
    • other uses: migraine HA, essential tremors, stage fright
  17. What is the mechanism of action for Beta-Blockers when used as Anti-Anginals?
    • Beta 1 receptors on the heart are blocked
    •   *<HR = <myocardial O2 demand & ^O2 delivery to the heart.
    •   *<myocardial contractility helps to conserve energy or <demand
  18. What are the A/E of Beta-Blockers on the Cardiovascular system, Metabolic system, CNS, & Other issues?
    • Cardiovascular: Brady, hypotension, 2nd or 3rd degree heart block; heart failure
    • Metabolic system: Altered glucose & lipid metabolism.
    • CNS: Dizziness, fatigue, mental depression, lethargy, drowsiness.
    • Other issues: Impotence, wheezing, dyspnea
  19. What is the Critical nursing assessment with Beta-blockers?
    BP & AP
  20. What other nursing implications should the patient be taught about concerning Beta-Blockers?
    • Monitor pulse daily & report if <than 60bpm
    • Report dizziness, fainting
    • constipation is common: drink adequate fluids
    • NEVER abruptly d/c med d/t risk of rebound HTN crisis.
    • inform; meds are for long term prevention of angina not immediate relief.
  21. Name the Calcium Channel Blockers used as Anti-Anginal meds.
    • Nifedipine (Procardia)
    • Diltiazem (Cardizem)
    • Amlodipine (Norvasc)
    • Verapamil (Calan, Isoptin)
  22. What is the mechanism of action for the Calcium Channel Blockers when used as Anti-Anginals?
    • Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction.
    • This leads to coronary artery & peripheral arterial vasodilation = <systemic vascular resistance.
    • <workload of the heart = <myocardial O2 demand
  23. What can Calcium Channel Blockers like Nifedipine (Procardia) be used to treat?
    Angina, HTN, some dysrhythias, migraines, & Raynaud's disease.
  24. What are the a/r that can be expericenced with Calcium Channel Blockers like Procardia or Cardizem?
    Hypotension, HA, palpitations, reflex tachycardia (d/t hypotension), bradycardia, constipation, change in liver & kidney fxn.
  25. What are the nursing implications for Anti-anginal meds like Calcium Channel Blockers, Beta Blockers, & Nitrates?
    • BP & PULSE (before admin)
    • Baseline VS, Resp patterns & rate
    • Constipation is common; ^fluid & fiber
    • NO otc w/o checking with Dr.
    • Limit caffeine intake
  26. What are the things a nurse should teach a client taking an Anti-anginal medication?
    • Avoid; alcohol & hot tubs b/c the vasadilate & cause hypotension. sit or lie down until s/s subside.
    • Change positions slowly to avoid postural BP changes
    • Keep record of anginal attacks, including precipitating factors, #of pills taken & therapeutic effects.
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Antianginal meds
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