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2011-07-19 13:18:41
Antianginal agents

Antianginal Agents 3
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  1. 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
  2. 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)
    • Nitrates/nitrites
    • Beta-blockers
    • Calcium channel blockers
  4. Therapeutic Objectives
    • High blood flow to ischemic heart muscle and/or
    • Low myocardial oxygen demand
  5. Theraupeutic Objectives
    • -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
  6. Nitrates/Nitrites Available forms
    Sublingual, Buccal, Chewable tablets, Oral capsules/Tablets, Intravenous solutions, Ointments, Transdermal patches, Translingual sprays
  7. Nitrates/Nitrites
    • -cause vasodilation due to relaxtion of smooth muscles
    • - Potent dilating effect on coronary arteries
    • -Used for prevention and treatment of angina
  8. Nitrates/Nitrites
    • -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
  9. Nitroglycerin
    • -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.
  10. 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
  11. 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
  13. Nursing Implications
    • -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.
  14. Nursing Implications
    • -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.
  15. Beta-Blockers
    • -atenolol (Tenormin)
    • -metoprolol (Lopressor)
    • -propranolol (Inderal)
    • -nadolol (Corgard)
  16. 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
  17. Indications
    • -Angina
    • -Antihypertensive
    • -Cardioprotective effects, especially after MI
    • -Some used for migraine headaches
  18. Body system

    Side Effects
    • -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
  19. Nursing Implications
    • -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.
  20. Nursing Implications
    • -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.
  21. Calcium Channel Blockers (CCB's)
    • -verapamil (calan) best for chest pain
    • -diltiazem (cardizem)
    • -nifedipine (procardia)
  22. CCB Mechanisms of action
    • -Cause peripheral arterial vasodilation
    • -Reduce myocardial contractility (negative inotropic action)
    • -Result: decreased myocardial oxygen demand
  23. CCB Indications
    • -First-line agents for treatments of angina, hypertension, and supraventricular tachycardia
    • -Short-term management of atrial fibrillation and flutter
    • -Several other uses
  24. CCB side effects
    • -Very acceptable side effect and safety profile
    • -May cause- Hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea
  25. 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
  26. 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
  27. 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
  28. 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
  29. 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