Angina Pectoris (Chest Pain)
- When the supply of oxygen and
- nutrients in the blood is insufficient to meet the demands of the heart, the
- heart muscle “aches”
- The heart requires a large supply
- of oxygen to meet the demands placed on it
Types of Angina
- Chronic stable angina
- (also called classic or effort angina)
- Unstable angina
- (also called preinfarction or
- crescendo angina)
- Vasospastic angina
- (also called Prinzmetal’s or
- variant angina)
- Calcium channel blockers
- High blood flow to ischemic heart muscle and/or
- Low myocardial oxygen demand
- -Minimize the frequency of attacks and decrase the duration and intensity of anginal pain.
- -Improve the patients functional capacity with as few side effects as possible.
- -Prevent or delay the worst possible outcome, MI
Nitrates/Nitrites Available forms
Sublingual, Buccal, Chewable tablets, Oral capsules/Tablets, Intravenous solutions, Ointments, Transdermal patches, Translingual sprays
- -cause vasodilation due to relaxtion of smooth muscles
- - Potent dilating effect on coronary arteries
- -Used for prevention and treatment of angina
- -Vasodilation results in reduced myocardial oxygen demand
- - Nitrates cause dilation of both large and small coronary vessels
- -Result: oxygen to ischemis myocardial tissue
- -Nitrates alleviate coronary artery spasms
- -Prototypical nitrite
- -Large first-pass effect with oral forms
- -Used for symptomatic treatment of ischemic heart conditions(angina)
- -IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edems associated with acute MI, and hypertensive emergencies.
Isosorbide dinitrate ( Isordil, Sorbitrate, Dilatrate SR)
Isosorbide mononitrate (Imdur,Monoket, ISMO)
- -Acute relief of angina
- -Prophylaxis in situations that may provoke angina
- -Long-term prophylaxis of angina
Nitroglycerine SL (usually = 0.4mg)
- -Place one under the tongue every 5 mins x 3 for chest pain, if still pain after 5 mins dial 911
- -Keep in original container
- -Once opened replace every 6mo.
- -Side effect of headache should not deter using it.
- -Headache_ usually diminish in intensity and frequency after continued use.
- -Tachycardia, postural hypotension
- -Tolerance may develop
- -Take prn nitrates at the first hint of anginal pain.
- -The patient taking SL NTG should be lying down to prevent or decrease dissiness and fainting that may occur due to hypotension
- -Monitor VS frequently during acute exacerbations of angina and during IV administration.
- -Instructs patients for guidelines for SL NTG, application of ointment and transdermal forms
- -Site rotation and removal of old medication daily- to reduce tolerance
- -Remove topical forms at bedtime and apply new doses in the morning, allowing nitrate-free period.
- -Instruct patients to never chew or swallow SL form, keep fresh supply of NTG on hand, burning sensayion felt with SL forms indicates that the drug is still potent.
- -Potency is lost in about 3mos. after the bottle has been opened.
- -Store in airtight, dark glass bottle with metal cap and no cotton filler to preserve potency.
- -IV forms of NTG must be contained in glass IV bottles and must be given with infusion pumps.
- -Discard parenteral solution that is blue, green, or dark red.
- -Follow specific manufacturer's instructions for IV administration; use special IV tubingprovided or non-PVC tubing.
- -atenolol (Tenormin)
- -metoprolol (Lopressor)
- -propranolol (Inderal)
- -nadolol (Corgard)
Beta-Blockers Mechanisms of action
- - Low HR= low myocardial oxygen demand and highoxygen delivery to the heart
- -Low myocardial contractility helps to conserve energy or decrease demand
- -Cardioprotective effects, especially after MI
- -Some used for migraine headaches
- -Cardio-Bradycardia,hypotension 2nd or 3rd degree block, heart failure
- -Metabolic- Glucose, lipids
- -CNS- Dizziness, fatigue, mental depression, lethargy, drowsiness, unusual dreams
- -Other- Impotence, wheezing, dyspnea
- -Mointor pulse rate daily and report any rate lower than 60 beats per min.
- -Dizziness or fainting should also be reported.
- -Constipation is a comon problem; instruct patients to take in adequate fluids and eat high fiber foods.
- -Never abruptly discontinue due to risk of rebound of hypertensive crisis.
- -Inform patients that these medications are for long-term prevention of angina, not for immediate relief.
Calcium Channel Blockers (CCB's)
- -verapamil (calan) best for chest pain
- -diltiazem (cardizem)
- -nifedipine (procardia)
CCB Mechanisms of action
- -Cause peripheral arterial vasodilation
- -Reduce myocardial contractility (negative inotropic action)
- -Result: decreased myocardial oxygen demand
- -First-line agents for treatments of angina, hypertension, and supraventricular tachycardia
- -Short-term management of atrial fibrillation and flutter
- -Several other uses
CCB side effects
- -Very acceptable side effect and safety profile
- -May cause- Hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea
CCB Nursing Implications
- -Blood levels should be monitored to ensure they are therapeutic
- -Oral CCBs should be taken before meals and as ordered
- -Patients should be encouraged to limit caffeine
CCB Nursing implications
- -Before administering, perform a complete health history to determine presence of conditions that may be contraindications for use or call for cautious use.
- -Obtain baseline VS, including respiratory patterns and rate.
- -Assess for drug interactions
CCB nursing implications
- -Patients should not take any medications, including OTC medications without checking with the physician
- -Patients should report blurred vision, persistent headache, dry mouth, dizziness, edema, fainting episodes, weight gain of 2 lbs in 1 day or greater or less than 5 lbs in 1 week, pulse rate < 60, and any dyspnea
CCB nursing implications
- -Fainting from vasodilation and hypotension with: Alcohol consumption, hot baths, whirpools, hot tubs or saunas
- -Teach patients to change positions slowly to avoid postural BP changes
- -Keep records of anginal attacks including: Precipitating factors, number of pills taken, and therapeutic effects
Antianginal Agents: Nursing Implications
- -Monitor for adverse reactions: Allergic reactions,headache,lightheadedness,hyptension,dizziness
- -Monitor for therapeutic effects: Relief of angina, decreased bp, or both