Chapter 46

Antianginal Agents

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 Illustration of an Atheromatous Plaque
cardiovascular disease
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Thrombosis of an Atherosclerotic Plaque

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 Coronary Artery Disease
(Definitions)
• Atheromas
– Fatty tumors in the intima of the heart vessels
• Atherosclerosis
– Narrowing of the heart vessels
• Angina pectoris
– MIC “Suffocation of the chest”Chestissi
• Myocardial infarction ox got
->

– Cells in the myocardium become necrotic and die

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-65b,Pt
Types of Angina
·Sitesa longsis esssss?
•
↳ Stable angina
– No damage to heart muscle; basic reflexes
⑪yes, surrounding the pain restore blood flow
;
• Unstable angina -
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–
- Episodes of ischemia occur even when at rest
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• Prinzmetal’s angina
– Caused by spasm of the blood vessels, not 2
just by vessel narrowing -81anDia. so".;;s
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↳ Evasoconstrication. .51 gi
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Actions of Antianginal Drugs

• 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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 oxygen isadds, [18, contradion = 451,
demand
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Types of Antianginal Drugs

• Nitrates -> vasobulates-

SUPPMI, demand
• Beta-adrenergic blockers
• Calcium channel blockers (NoM-GY(
-contd-SUPNA-demandd-021

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 Factors Affecting Myocardial Oxygen
Demand and the Effect of Antianginals
46
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 Nitrates -> Vasodatater
• Action jal
– Act directly on smooth muscle to relax and
depress muscle tone
• Indication 11 Iss
– Prevent and treat attacks of angina pectoris
• Pharmacokinetics
– Very rapidly absorbed
– Metabolized in the liver
– Excreted in the urine

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 Nitrates (cont.)
• Contraindications
– Allergy
– Severe anemia
– Head trauma and cerebral hemorrhage
– Pregnancy and lactation
• Cautions :8b48
– Hepatic or renal disease
– Hypotension, hypovolemia, and conditions
that limit cardiac output
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 Nitrates (cont.)
• Adverse effects
– 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
• Drug-to-drug interactions
– Ergot derivatives
– Heparin

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 Routes for Nitroglycerin

• IV
1 5.,5-324•
- Sublingual <1- afeattack
• Translingual spray :100
• Transmucosal tablet
• Oral, SR tablet
• Topical ointment
• Transdermal

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 contraction
BP ->
HRt Beta Blockers demand -

• Actions attack demand-supply

-

– 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
• Indications
– Treats stable angina pectoris and hypertension; prevents
reinfarction in MI patients; treats stable CHF
• Pharmacokinetics
– Absorbed in the GI tract, undergoes hepatic metabolism, and is
excreted in the urine

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 Beta Blockers (cont.)
• Contraindications
– Bradycardia HRA &

– Heart block
– Cardiogenic shock
– Asthma and COPD
– Pregnancy and lactation
• Cautions

·99,55198,ggbetasgymlates
– DM
– PVD
– Thyrotoxicosis

Sesymps,serigsis
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 Beta Blockers (cont.)
• Adverse effects
– 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

• Drug-to-drug interaction
– Clonidine

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 Calcium Channel Blockers BS
• Actions
– Inhibit the movement of calcium ions across the
membranes of myocardial and arterial muscle cells, altering
the action potential and blocking muscle cell contraction
• Indication
– Prinzmetal's angina
• Pharmacokinetics
– Well absorbed
– Metabolized in the liver and excreted in the urine

ithow
is an*
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BloodVesells
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Bloodresells
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Calcium Channel Blockers (cont.)

• Contraindications -> Non-BP only

– Allergy
– Heart block and sick sinus syndrome
– Renal or hepatic dysfunction
– Pregnancy and lactation

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Calcium Channel Blockers (cont.)
• Adverse effects
– Hypotension weflaxtachycardia
– Cardiac arrhythmias
– GI upset
– Skin reactions
– Headache
• Drug-to-drug interactions
– Vary with each drug

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, Use of Antianginal Agents
1.
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 Prototype Nitrates

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cholic E
acted $5.

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Prototype Beta Blockers

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Prototype Calcium Channel Blockers

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Nursing Considerations for Nitrates

• Assessment (history and physical exam)

Blogs
• Nursing diagnosis
• Implementation
attack
• Evaluation ->
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Nursing Considerations for Beta Blockers

• Assessment (history and physical exam)

• Nursing diagnosis
• Implementation
• Evaluation

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 Nursing Considerations for
Calcium Channel Blockers

• Assessment (history and physical exam)

• Nursing diagnosis
• Implementation
• Evaluation

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