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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.
What is Ischemia?
Poor blood supply to an organ
What is Ischemic heart disease?
poor blood supply to the heart muscleAtherosclerosis, CAD
What is a MI or Myocardial Infarction?
Necrosis of cardiac tissue ->disabling or fatal
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
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.
Name the Antianginal drugs.
Nitrates/NitritesBeta-blockersCalcium channel blockers
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.
What are the Nitrates/Nitrites drugs used for?
- Prevention & Tx of Angina
- Nitrates alleviate coronary artery spasms
Nitrates/Nitrites have a VERY HIGH 1st pass effect. What are the available forms of these drugs?
- Ointments (chronic/prevention NOT ACUTE)
- Transdermal patches
- Translingual sprays
- Chewable tabs
- Oral caps/tabs (not used much)
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
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)
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.
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!!
Name the Anti-Anginal Beta-blockers.
- Atenolol (Tenormin)
- Metoprolol (Lopressor)
- Propranolol (Inderal) - nonspecific Beta-blocker
Beta-Blockers like Atenolol can be used as Anti-Anginals & what other indications?
- Cardiac Dysrhythmias
- Cardioprotective effects, after MI
- other uses: migraine HA, essential tremors, stage fright
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
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
What is the Critical nursing assessment with Beta-blockers?
BP & AP
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.
Name the Calcium Channel Blockers used as Anti-Anginal meds.
- Nifedipine (Procardia)
- Diltiazem (Cardizem)
- Amlodipine (Norvasc)
- Verapamil (Calan, Isoptin)
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
What can Calcium Channel Blockers like Nifedipine (Procardia) be used to treat?
Angina, HTN, some dysrhythias, migraines, & Raynaud's disease.
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.
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
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.