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41 Cards in this Set
- Front
- Back
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Antianginal Agents
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Drugs used to prevent myocardial death
Coronary vessels damaged Restore supply/demand ratio of 02 Heart muscle receives O2 from coronary arteries During diastole Pulse pressure |
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Coronary Artery Disease
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Leading cause of death of adults in U.S. and Western nations
Involves changes in coronary vessels Promote atheromas Narrow the arteries Decrease elasticity and responsiveness |
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Coronary Artery Disease (Definitions) Atheromas
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Fatty tumors in the intima of the heart vessels
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Coronary Artery Disease (Definitions) Atherosclerosis
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Narrowing of the heart vessels
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Coronary Artery Disease (Definitions) Angina pectoris
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“Suffocation of the chest”
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Coronary Artery Disease (Definitions) Myocardial infarction
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Cells in the myocardium become necrotic and die
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Types of Angina
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Stable angina
No damage to heart muscle; basic reflexes surrounding the pain restore blood flow Unstable angina Episodes of ischemia occur even when at rest Prinzmetal’s angina Caused by spasm of the blood vessels, not just by vessel narrowing |
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Myocardial Infarction
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Coronary vessel becomes completely occluded
Unable to deliver blood to cardiac muscle Becomes ischemic, then necrotic Pain can be excruciating Danger of arrhythmias developing After healing – muscles may compensate for injury Large injuries may lead to congestive heart failure or cardiogenic shock |
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Actions of Antianginal Drugs
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Improve blood delivery to the heart muscle by dilating blood vessels
Increase the supply of oxygen Improve blood delivery to the heart muscle by decreasing the work of the heart Decrease the demand for oxygen |
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Types of Antianginal Drugs
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Nitrates
Beta-adrenergic blockers Calcium channel blockers |
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Nitrates Action
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Act directly on smooth muscle to relax and depress muscle tone
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Nitrates Indication
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Prevent and treat attacks of angina pectoris
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Nitrates Pharmacokinetics
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Very rapidly absorbed
Metabolized in the liver Excreted in the urine |
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Nitrates Contraindications
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Allergy
Severe anemia Head trauma and cerebral hemorrhage Pregnancy and lactation |
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Nitrates Cautions
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Hepatic or renal disease
Hypotension, hypovolemia, and conditions that limit cardiac output |
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Nitrates Adverse effects
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Related to vasodilation and the decrease in blood flow
CNS: headache, dizziness, and weakness GI: nausea and vomiting CV: hypotension Flushing, pallor, and increased perspiration |
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Nitrates Drug-to-drug interactions
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Ergot derivatives
Heparin |
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Routes for Nitroglycerin
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IV
Sublingual Translingual spray Transmucosal tablet Oral, SR tablet Topical ointment Transdermal |
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Nursing Considerations for Nitrates
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Allergies to nitrates
Impaired liver or kidney functions Any condition that could be exacerbated by hypotension Other medications that cause hypotension or vasodilation Implementation Give medication via appropriate route and dose Sublingual meds should “fizzle” or burn Remove old patch before applying new one Taper doses gradually after long term use Provide patient teaching Evaluation Monitor pt response to drug Monitor for adverse effects Evaluate effectiveness of teaching plan Monitor effectiveness of comfort measures and compliance to the regimen |
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Beta Blockers Actions
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Block beta-adrenergic receptors in the heart and kidneys, decreasing the influence of the SNS on these tissues; decrease cardiac output and the release of renin
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Beta Blockers Indications
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Treats stable angina pectoris and hypertension; prevents reinfarction in MI patients; treats stable CHF
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Beta Blockers Pharmacokinetics
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Absorbed in the GI tract, undergoes hepatic metabolism, and is excreted in the urine
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Beta Blockers Contraindications
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Bradycardia
Heart block Cardiogenic shock Asthma and COPD Pregnancy and lactation |
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Beta Blockers Cautions
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DM
PVD Thyrotoxicosis |
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Beta Blockers Adverse effects
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Related to their blockage of sympathetic nervous system
CNS: dizziness, fatigue, and emotional depression GI: nausea, vomiting, and colitis CV: CHF, decreased cardiac output, and arrhythmias Bronchospasm, dyspnea, and cough |
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Beta Blockers Drug-to-drug interaction
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Clonidine
NSAIDs Epinephrine Ergot alkaloids Insulin, antidiabetic agents |
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Beta Blockers Drugs in focus
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Metoprolol
Nadolol Propranolol |
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Nursing Considerations for Beta Blockers Assessment
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Known allergies
Impaired liver or kidney function Any condition that could be exacerbated by the effects of the drugs Pregnancy and lactation |
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Nursing Considerations for Beta Blockers Implementation
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Monitor cardiac rhythm when initiating or changing dose
Titrate to smallest amount needed Establish safety precautions, if CNS effects occur Comfort measures to help tolerate drug effects Thorough patient teaching |
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Nursing Considerations for Beta Blockers Evaluation
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Monitor pt response to the drug
Monitor for adverse effects (sedation, hypotension, cardiac arrhythmias, respiratory depression, CNS) Evaluation effectiveness of teaching plan Monitor effectiveness of comfort measures and compliance to the regimen |
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Calcium Channel Blockers Actions
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Inhibit the movement of calcium ions across the membranes of myocardial and arterial muscle cells, altering the action potential and blocking muscle cell contraction
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Calcium Channel Blockers Indication
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Prinzmetal's angina
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Calcium Channel Blockers Pharmacokinetics
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Well absorbed
Metabolized in the liver and excreted in the urine |
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Calcium Channel Blockers Contraindications
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Allergy
Heart block and sick sinus syndrome Renal or hepatic dysfunction Pregnancy and lactation |
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Calcium Channel Blockers Adverse effects
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Hypotension
Cardiac arrhythmias GI upset Skin reactions Headache |
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Calcium Channel Blockers Drug-to-drug interactions
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Vary with each drug
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Calcium Channel Blockers Drugs in focus
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Amlodipine
Diltiazem Nicardipine Nifedipine Verapamil |
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Nursing Considerations for Calcium Channel Blockers Assessment
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Known allergies
Impaired liver or kidney function Heart block Pregnancy or lactation |
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Nursing Considerations for Calcium Channel Blockers Implementation
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Monitor pt (blood pressure, cardiac rhythm, cardiac output) while titrating or changing dose
Monitor closely for hypotension if given with nitrates Periodically monitor BP and rhythm because of potential for adverse cardiovascular effects Provide comfort measures to help with drug effects Provide thorough patient teaching |
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Nursing Considerations for Calcium Channel Blockers Evaluation
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Monitor pt response to drug
Monitor for adverse effects Evaluate effectiveness of teaching plan Monitor effectiveness of comfort measures and compliance to the regimen |
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Piperazineacetamide Agent
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2006 – for chronic angina
Also decreases blood glucose levels Decreases incidence V-fib, A-fib and bradycardia in angina patients Decreases cardiac workload Ranolazine (Ranexa) Many drug-drug reactions Avoid grapefruit juice |
