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  1. What is Angina?
    • Sudden pain beneath the sternum often radiating to left shoulder and arm
    • Oxygen demand greater than oxygen supply (eschemia)
    • Prodromal sign (warning)
  2. Goals of Drug therapy for angina pectoris
    Prevention of myocardial ischemia and 
anginal painPrevention of myocardial infarction and death
  3. Types of Angina
    • Chronic stable angina (exertional)
    • Treatment: Increase O2 or decrease demand
    • Variant angina (Prinzmetal’s)
    • Treatment: Increase O2 with vasodilators
    • Unstable angina (no known cause or trigger)
    • Treatment: Decrease O2 demands, Reduce pain and progression with medications
  4. Unstable Angina
    • Severe Coronary Artery Disease
    • Vasospasm
    • Platelet aggregation
    • Transient coronary thrombi/emboli
    • Management
    • Anticoagulants
    • Nitrates
    • Beta Blockers
    • Calcium channel blockers
    • Morphine
  5. Find the flow chart for antianginal drug selection and know it.
    Image Upload
  6. Nitrates
    • Vasodilator
    • Relaxes vascular smooth muscle beds
    • Decreases O2 consumption
    • Allows heart to work with a lower O2 demand
    • Reduces preload and afterload –results in decreased cardiac workload
  7. Adverse Effects of Nitrates
    • Headache
    • Othostatic hypotension
    • Reflex tachycardia
    • Flush
    • Teaching is importatnt because you don't want pts with orthstatic hypotension driving around or trying to do ADLs that require them to be standing/alert.

    Tolerence develops rapidly…should have at least 8 hours of drug free time a day. Should have at least 8hrs drug free time/day.
  8. Nitrate routs of admin
    • Sublingual
    • Oral sustained-release, so don't crush it!
    • Transdermal delivery systems. Need to wear gloves to avoid self-administering nitroglycerin and discard in appropriate way.
    • Translingual spray
    • Buccal
    • Topical
    • Intravenous
  9. At first sign of angina, what should your pt do?
    • Lie down***
    • Take appropriate dose of nitrate
    • In 5 minutes if pain is not relieved…take another dose
    • In acute setting the nurse should take VS. 
    • If SBP is < 100 or 25 mg lower than previous BP should notify MD prior to dose
    • A total of 3 doses may be administered in 15 minutes

    If pain does not subside after 2nd dose, pt should call the am-buh-lance. Don't have sigother drive.
  10. Proper storage of Nitrates
    • Nitrates should be replaced q 6 months
    • Drug is heat, air  and light sensitive = Need to be in amber colored container
    • Administer and dispose of patches carefully. 1 patch = 1 dose. Should be tossed in a very inconspicuous way.
    • Emphasize importance of safety in drug administration
  11. Beta Blockers for Angina
    • Used to prevent Angina from occuring. Not usually seen PRN.
    • Fixed schedule
    • Initial low dose
    • Heart rate monitoring
    • Gradual withdrawal
  12. Calcium Channel Blockers for Angina.
    • Examples are verapamil, diltiazem, nifedipine.
    • Can be given PRN in same way as nitroglycerin
    • Stable and variant angina
    • Adverse effects
    • Hypotension
    • Reflex tachycardia
  13. Revascularizeation therapy
    • Coronary Artery Bypass Graft Surgery (CABG)
    • Percutaneous Transluminal Coronary Angioplasty (PTCA)
Card Set:
2012-06-25 19:59:56
PT3 Angina

Drugs for Angina
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