Pharm

• 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

• 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)

• Nitrates/nitrites
• Beta-blockers
• 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

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.

• -Acute relief of angina
• -Prophylaxis in situations that may provoke angina
• -Long-term prophylaxis of angina

• -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)

• - Low HR= low myocardial oxygen demand and highoxygen delivery to the heart
• -Low myocardial contractility helps to conserve energy or decrease demand

• -Angina
• -Antihypertensive
• -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.

• -verapamil (calan) best for chest pain
• -diltiazem (cardizem)
• -nifedipine (procardia)

• -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

• -Very acceptable side effect and safety profile
• -May cause- Hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea

• -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

• -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

• -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

• -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

• -Monitor for adverse reactions: Allergic reactions,headache,lightheadedness,hyptension,dizziness
• -Monitor for therapeutic effects: Relief of angina, decreased bp, or both