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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
What are the three types of antianginal agents?
- 1. Nitrates
- 2. Beta- blockers
- 3. Calcium channel blockers
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
What is the prototypical nirate?
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
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
What are the interactions with Nitrate?
- with Ca++ blockers
- with beta blockers
- Viagra -- may lead to fatal hypotension
What are the names of nitrates?
- •isosorbide dinitrate -
- (Isordil, Sorbitrate, Dilatrate SR)
- •isosorbide mononitrate –
- (Imdur, Monoket, ISMO)
- Isordil, Sorbitrate, Dilatrate SR
- Imdur, Monoket, ISMO
What are the main uses for Nitrates?
- •Acute relief of angina-- (sublingual, but not
- PO—po takes too long)
- (PREVENT! ) in situations that may provoke angina
- prophylaxis of angina
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
What are the therapeutic uses of Beta blockers?
- Cardioprotective effects, especially after MI
What are the cardiovascular SE of beta blockers?
bradycardia, hypotension, 2nd or third decress heart block, HF
What are the metabolic SE of beta blockers?
altered glucose and lipid metabolism
What are the CNS SE of Beta Blockers?
dizziness, fatigue, mental depression (elderly), lethary, drowsiness, unusual dreams
What are the "other" SE of beta blockers?
impotence (dec. libido) wheezing, dyspnea
What interacts with B. Blockers?
- –Phenothiazines- pheragan, composanine…
- –Insulin & oral hypoglycemics
- •Sx of hypoglycemia
Name some beta blockers!
- atenolol (tenormin)
- metoprolol (lopressor)
- Propanolol (Inderal)
- Nadolol (Corgard)
- post-MI patients. Selective Beta 1
- short AND longacting
- non-selective, most lipid soluble, works well to prevent migranes (gets over BB barrier). Many asians lack the enzyme to metabolize this.
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
What are contraindications of B. blockers?
–COPD, asthma, decompensated HF, arrhythmias
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
What are the 2 types of CCBs?
Dihydropyridines and nondihydropyridines.....
- 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]
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
- Uses- HTN, angina, dysrhymias
- •Diltiazem [Cardizem]
- •Verapamil [Calan, Isoptin]
negative inotrophic (heart muscle) and chronotrophic (Heart beat)
What are the SE and interactions of non-dihydropyramidines?
- –Flushing, HA, dizziness, peripheral edema
- –Constipation- common
- –Confusion, drowsiness, mood changes (elderly)
- –Statins (DO NOT GIVE WITH!)- very severe rxn. Muscle injury. Myopathy. See them degenerate.
- –Grapefruit juice
Do CCBs work for acut angina attacks?
NO! it is just a drug that we take everyday to prevent angina