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What are the therapeutic objecctives of antianginal agents?
increase blood flow to ischemic heart muscle and/or decrease myocardial oxygen demand
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What are the three types of antianginal agents?
- 1. Nitrates
- 2. Beta- blockers
- 3. Calcium channel blockers
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What do nitrates do?
- - cause vasodilation due to relaxation of smooth muscles
- - potent dilating effect on coronary arteries
- - used for prophylaxis and treatement of angina
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What is the prototypical nirate?
nitroglycerin
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What are the effects of nitroglycerin?
- large first-pass effect with PO forms
- used for symptomatic treatment fo ischemic heart conditions (angina)
- •IV form used for BP control in perioperative hypertension, treatment of CHF, ischemic pain, and pulmonary edema associated with acute MI
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What are the side effects of nitrates?
- HA (b/c the blood vessels were dilalated)
- flushing of face
- tachycardia, postural hypotension
- tolerance may develop-- mostly with transdermal
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What are the interactions with Nitrate?
- with Ca++ blockers
- with beta blockers
- ETOH
- Viagra -- may lead to fatal hypotension
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What are the names of nitrates?
- •isosorbide dinitrate -
- (Isordil, Sorbitrate, Dilatrate SR)
- •isosorbide mononitrate –
- (Imdur, Monoket, ISMO)
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isosorbide dinitrate
- Nitrate
- Names:
- Isordil, Sorbitrate, Dilatrate SR
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isosorbide mononitrate
- Nitrate
- Names:
- Imdur, Monoket, ISMO
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What are the main uses for Nitrates?
- •Acute relief of angina-- (sublingual, but not
- PO—po takes too long)
- •Prophylaxis
- (PREVENT! ) in situations that may provoke angina
- •Long-term
- prophylaxis of angina
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what is the mechanism of actions of Beta Blockers
blocks the myocardium itself. Slows rate adn contractility. Decreases demand adn increases delivery to the heart.
- •Decrease the HR, resulting in decreased myocardial oxygen demand and increased oxygen
- delivery to the heart
•Decrease myocardial contractility, helping to conserve energy or decrease demand
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What are the therapeutic uses of Beta blockers?
- Antianginal
- Antihypertensive
- Cardioprotective effects, especially after MI
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What are the cardiovascular SE of beta blockers?
bradycardia, hypotension, 2nd or third decress heart block, HF
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What are the metabolic SE of beta blockers?
altered glucose and lipid metabolism
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What are the CNS SE of Beta Blockers?
dizziness, fatigue, mental depression (elderly), lethary, drowsiness, unusual dreams
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What are the "other" SE of beta blockers?
impotence (dec. libido) wheezing, dyspnea
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What interacts with B. Blockers?
- –Diuretics--additative
- –Antihypertensives
- –Phenothiazines- pheragan, composanine…
- –Anticholinergics
- –Insulin & oral hypoglycemics
- •Sx of hypoglycemia
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Name some beta blockers!
-olol
- atenolol (tenormin)
- metoprolol (lopressor)
- Propanolol (Inderal)
- Nadolol (Corgard)
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Atenolol (Tenormin)
- b.blocker
- post-MI patients. Selective Beta 1
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Metoprololol (Lopressor)
- b.blocker
- short AND longacting
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Propanolol (Inderal)
- b.blocker
- non-selective, most lipid soluble, works well to prevent migranes (gets over BB barrier). Many asians lack the enzyme to metabolize this.
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What are some nursing actions to take while administering b.blockers?
- –Monitor HR & BP- soon before giving the drug.
- –Safety- can have dizziness (CNS rxn)
- –Blood sugar
- –Lung sounds
- –Taper to stop
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What are contraindications of B. blockers?
–COPD, asthma, decompensated HF, arrhythmias
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What are the mechanisms of actions for Ca Channel blockers?
- •Cause peripheral arterial vasodilation
- •Reduce myocardial contractility
- (negative inotropic action)
- •Depress SA & AV nodes
- •Result: decreased myocardial oxygen demand
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What are the 2 types of CCBs?
Dihydropyridines and nondihydropyridines.....
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Dihyropyridines
- CCB
- work in arterial smooth muscle
- Tx HTN adn angina, prevent angina
- Drugs-- end in "pine"
- •nifedipine [adalat, Procardia] – po- oldest one
- •amlodipine [Norvasc] -
- •isradipine [DynaCirc] – most potent
- •nicardipine [Cardene]
- •nisoldipine [Nisocor]
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What are the SE and interactions of the dihydropyramidines CCB?
- SE: flushing, HA, hypotension, peripheral edema (all bc of vasodilation....expected)
- Interactions: B. BLOCKERS, digoxin, grapefruit juice
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Nondihydropyridines
- CCBs
- Uses- HTN, angina, dysrhymias
- Drugs:
- •Diltiazem [Cardizem]
- •Verapamil [Calan, Isoptin]
negative inotrophic (heart muscle) and chronotrophic (Heart beat)
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What are the SE and interactions of non-dihydropyramidines?
- •SE
- –Flushing, HA, dizziness, peripheral edema
- –Constipation- common
- –Dysrhythmias
- –Confusion, drowsiness, mood changes (elderly)
- •Interactions
- –Digoxin
- –Antihypertensives
- –Statins (DO NOT GIVE WITH!)- very severe rxn. Muscle injury. Myopathy. See them degenerate.
- –Grapefruit juice
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Do CCBs work for acut angina attacks?
NO! it is just a drug that we take everyday to prevent angina
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