Drugs For Angina

Front 1

Stable Angina

Back 1

disease marked by brief paroxysmal attacks of chest pain precipitated by deficient oxygenation of the heart muscles

Front 2

Unstable Angina

Back 2

pain characterized by sudden changes (as an increase in the severity or length of anginal attacks or a decrease in the exertion required to precipitate an attack) especially when symptoms were previously stable

Front 3

Prinzmetal’s (variant) Angina

Back 3

a variant form that is characterized by chest pain during rest and by an elevated ST segment during pain and that is typically caused by an obstructive lesion in the coronary artery

Front 4

Prototype agent for nitrates?

Back 4

nitroglycerin

Front 5

Action for nitrates?

Back 5

Relaxes vascular smooth muscle
Dilates both arterial and venous vessels:
Venous dilation decreases peripheral resistance, thus decreasing BP.
Arteriolar dilation reduces systemic vascular resistance and arterial pressure, thus reducing afterload.
Decreases myocardial oxygen consumption
Redistributes blood flow in the heart, improving circulation to ischemic areas

Front 6

How do you treat acute angina with nitrates?

Back 6

Sublingual (SL)
Transmucosal
Translingual spray

Front 7

How do you treat chronic recurrent angina with nitrates?

Back 7

Topical - NTG paste
Transdermal – NTG patch
Translingual spray
Transmucosal or oral sustained-release i.e.

Front 8

What other problems can nitrates treat?

Back 8

Use IV for Significant hypertension

Front 9

What adverse effect can occur with nitrates?

Back 9

Tolerance to the vascular and antianginal effects may develop.

Front 10

How do you minimize the tolerance effect?

Back 10

Starting with as small a dose as possible
Removing the NTG (paste or transdermal patches) from the patient for 8-10 hours usually at night

Front 11

What are the nursing responsibilities for patients using nitrates?

Back 11

Assess the patient’s BP and pulse prior to administration.
Acute care: IV access established
Have the patient sit or lie down before taking NTG for acute pain.
Repeat SL NTG every 5 minutes for up to three doses; assume myocardial infarction (MI) if no pain relief.
Monitor for hypotension and reflex tachycardia.
Common adverse effect: Headache.

Front 12

What environmental precautions do we take with nitrates?

Back 12

Loses potency with exposure to:
Light
Humidity
Heat
Plastic IV bags of fluid
Sublingual NTG requires replacement every 3 months

Front 13

What are the actions of Beta receptor antagonists?

Back 13

Prevent stimulation of the beta receptors of the heart
Slow the heart rate, depress atrioventricular (AV) conduction, decrease CO, and reduce BP, resulting in decreased oxygen demand

Front 14

Prototype agent for Beta receptor antagonists was:

Back 14

Propranolol (Inderal)

Front 15

What are the actions of Calcium Channel Antagonists

Back 15

Inhibit calcium from moving across cell membranes
Slow the heart rate, depress impulse formation (automaticity), and slow the velocity of conduction, resulting in decreased oxygen demands of the heart

Front 16

Prototype agent for Calcium Channel Antagonists was?

Back 16

verapamil (calan)

Front 17

When are Calcium Channel Antagonists used in treatment?

Back 17

Used in chronic stable angina when the patient cannot tolerate beta blockers or nitrates, or if the symptoms are not adequately controlled while on these therapies

Front 18

Drug of choice for Variant (Prinzmetal’s) angina

Back 18

Calcium Channel Antagonist - Diltiazem (Cardizem)

Front 19

What adjunct Drug Therapy is used?

Back 19

Oxygen
Aspirin
Morphine
Acronym: MONA

Front 20

What is the purpose of adjunct therapies with drugs that treat angina?

Back 20

These therapies do not decrease oxygen demands on the heart, but slow down the progression of coronary artery disease or prevent/treat complications that may arise with angina.