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Antianginal Agents

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Home | Profile | Project | Our Group | MediDict

Antianginal Agents
‡ Nitrates ‡ Beta blockers ‡ Calcium channel blockers

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Home | Profile | Project | Our Group | MediDict

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. aches. ‡ The heart demands a large supply of oxygen to meet the demands placed on it.

Copyright © 2002, 1998, Elsevier Science (USA). All rights reserved.

Elsevier Science (USA).Home | Profile | Project | Our Group | MediDict 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) Copyright © 2002. All rights reserved. . 1998.

All rights reserved.Home | Profile | Project | Our Group | MediDict Instructors may wish to insert EIC Image # 68: Angina Drug Therapy Copyright © 2002. . 1998. Elsevier Science (USA).

Home | Profile | Project | Our Group | MediDict Antianginal Agents: Therapeutic Objectives ‡ Increase blood flow to ischemic heart muscle and/or ‡ Decrease myocardial oxygen demand Copyright © 2002. 1998. Elsevier Science (USA). All rights reserved. .

1998.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Therapeutic Objectives ‡ Minimize the frequency of attacks and decrease the duration and intensity of anginal pain ‡ Improve the patient¶s functional capacity with as few side effects as possible ‡ Prevent or delay the worst possible outcome. . MI Copyright © 2002. All rights reserved. Elsevier Science (USA).

Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitrates Available forms: Sublingual Buccal Chewable tablets Capsules Ointments Transdermal patches Inhalable sprays Intravenous solutions Copyright © 2002. . Elsevier Science (USA). 1998. All rights reserved.

Elsevier Science (USA). 1998. All rights reserved. .Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitrates ‡ Cause vasodilation due to relaxation of smooth muscles ‡ Potent dilating effect on coronary arteries ‡ Used for prophylaxis and treatment of angina Copyright © 2002.

Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitrates Nitroglycerin ‡ Prototypical nitrate ‡ Large first-pass effect with PO forms first‡ Used for symptomatic treatment of ischemic heart conditions (angina) ‡ IV form used for BP control in perioperative hypertension. 1998. . Elsevier Science (USA). ischemic pain. and pulmonary edema associated with acute MI Copyright © 2002. treatment of CHF. All rights reserved.

1998.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitrates ‡ isosorbide dinitrate (Isordil. Dilatrate SR) ‡ isosorbide mononitrate (Imdur. Elsevier Science (USA). All rights reserved. Monoket. . Sorbitrate. ISMO) Used for: ‡ Acute relief of angina ‡ Prophylaxis in situations that may provoke angina ‡ Long-term prophylaxis of angina LongCopyright © 2002.

postural hypotension ‡ Tolerance may develop Copyright © 2002.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitrates Side Effects ‡ Headache ± Usually diminish in intensity and frequency with continued use ‡ Tachycardia. 1998. Elsevier Science (USA). . All rights reserved.

1998. .Home | Profile | Project | Our Group | MediDict Antianginal Agents: Beta Blockers ‡ atenolol (Tenormin) ‡ metoprolol (Lopressor) ‡ propranolol (Inderal) ‡ nadolol (Corgard) Copyright © 2002. All rights reserved. Elsevier Science (USA).

Home | Profile | Project | Our Group | MediDict Antianginal Agents: Beta Blockers Mechanism of Action ‡ Decrease the HR. . resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart ‡ Decrease myocardial contractility. Elsevier Science (USA). helping to conserve energy or decrease demand Copyright © 2002. All rights reserved. 1998.

Elsevier Science (USA).Home | Profile | Project | Our Group | MediDict Antianginal Agents: Beta Blockers Therapeutic Uses ‡ Antianginal ‡ Antihypertensive ‡ Cardioprotective effects. . 1998. All rights reserved. especially after MI Copyright © 2002.

Home | Profile | Project | Our Group | MediDict Antianginal Agents: Beta Blockers Side Effects Body System Cardiovascular Effects bradycardia. . 1998. hypotension second. Elsevier Science (USA).thirdsecond. All rights reserved.or third-degree heart block heart failure Altered glucose and lipid metabolism Metabolic Copyright © 2002.

Elsevier Science (USA). 1998. lethargy. mental depression. .Home | Profile | Project | Our Group | MediDict Antianginal Agents: Beta Blockers Side Effects Body System CNS Effects dizziness. drowsiness. All rights reserved. fatigue. dyspnea Other Copyright © 2002. unusual dreams impotence wheezing.

Home | Profile | Project | Our Group | MediDict Antianginal Agents: Calcium Channel Blockers ‡ verapamil (Calan) ‡ diltiazem (Cardizem) ‡ nifedipine (Procardia) Copyright © 2002. . Elsevier Science (USA). All rights reserved. 1998.

All rights reserved. .Home | Profile | Project | Our Group | MediDict Antianginal Agents: Calcium Channel Blockers Mechanism of Action ‡ Cause peripheral arterial vasodilation ‡ Reduce myocardial contractility (negative inotropic action) ‡ Result: decreased myocardial oxygen demand Copyright © 2002. 1998. Elsevier Science (USA).

Elsevier Science (USA). All rights reserved. and supraventricular tachycardia ‡ Short-term management of atrial fibrillation and Shortflutter ‡ Several other uses Copyright © 2002. 1998. Firsthypertension. .Home | Profile | Project | Our Group | MediDict Antianginal Agents: Calcium Channel Blockers Therapeutic Uses ‡ First-line agents for treatment of angina.

1998. constipation. palpitations. tachycardia or bradycardia. Elsevier Science (USA). dyspnea Copyright © 2002. nausea. . All rights reserved.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Calcium Channel Blockers Side Effects ‡ Very acceptable side effect and safety profile ‡ May cause hypotension.

. Copyright © 2002. All rights reserved. 1998. ‡ Assess for drug interactions.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nursing Implications ‡ Before administering. Elsevier Science (USA). including respiratory patterns and rate. perform a complete health history to determine presence of conditions that may be contraindications for use or call for cautious use. ‡ Obtain baseline VS.

‡ Patients should report blurred vision. persistent headache. dizziness. dry mouth.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nursing Implications ‡ Patients should not take any medications. Copyright © 2002. edema. and any dyspnea. All rights reserved. . 1998. weight gain of 2 pounds in 1 day or 5 or more pounds in 1 week. fainting episodes. Elsevier Science (USA). without checking with the physician. including OTC medications. pulse rates under 60.

1998. hot tubs.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nursing Implications ‡ Alcohol consumption and hot baths or spending time in jacuzzis. hypotension. and the possibility of fainting. and therapeutic effects. or saunas will result in vasodilation. Copyright © 2002. All rights reserved. . ‡ Encourage patients to keep a record of their anginal attacks. Elsevier Science (USA). number of pills taken. including precipitating factors. ‡ Teach patients to change positions slowly to avoid postural BP changes.

.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitroglycerin Nursing Implications ‡ Instruct patients in proper technique and guidelines for taking sublingual NTG for anginal pain. All rights reserved. ‡ Instruct patients that a burning sensation felt with SL forms indicates that the drug is still potent. 1998. ‡ Instruct patients never to chew or swallow the SL form. Elsevier Science (USA). Copyright © 2002.

Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitroglycerin Nursing Implications ‡ Instruct patients to keep a fresh supply of NTG on hand. potency is lost in about 3 months after the bottle has been opened. Copyright © 2002. 1998. dark glass bottle with a metal cap and no cotton filler to preserve potency. ‡ Medications should be stored in an airtight. . All rights reserved. Elsevier Science (USA).

1998. including site rotation and removal of old medication. All rights reserved. Elsevier Science (USA). Copyright © 2002.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitroglycerin Nursing Implications ‡ Instruct patients in the proper application of nitrate topical ointments and transdermal forms. allowing for a nitrate-free nitrateperiod. ‡ To reduce tolerance. the patient may be instructed to remove topical forms at bedtime. . and apply new doses in the morning.

‡ If experiencing chest pain. ‡ Monitor VS frequently during acute exacerbations of angina and during IV administration. All rights reserved.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitroglycerin Nursing Implications ‡ Instruct patients to take prn nitrates at the first hint of anginal pain. 1998. Copyright © 2002. Elsevier Science (USA). . the patient taking SL NTG should be lying down to prevent or decrease dizziness and fainting that may occur due to hypotension.

Copyright © 2002.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nitroglycerin Nursing Implications ‡ IV forms of NTG must be contained in glass IV bottles and must be given with infusion pumps. All rights reserved. ‡ Discard parenteral solution that is blue. ‡ Follow specific manufacturer¶s instructions for IV administration. green. Use special IV tubing provided or nonnon-PVC tubing. . or dark red. 1998. Elsevier Science (USA).

Copyright © 2002.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Calcium Channel Blockers Nursing Implications ‡ Blood levels should be monitored to ensure they are therapeutic. ‡ Oral CCBs should be taken before meals and as ordered. . All rights reserved. Elsevier Science (USA). ‡ Patients should be encouraged to limit caffeine intake. 1998.

. 1998. ‡ Dizziness or fainting should also be reported.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Beta Blockers Nursing Implications ‡ Patients taking beta blockers should monitor pulse rate daily and report any rate lower than 60 beats per minute. Elsevier Science (USA). All rights reserved. Instruct patients to take in adequate fluids and eat high-fiber foods. high- Copyright © 2002. ‡ Constipation is a common problem.

. not for immediate relief. Copyright © 2002. Elsevier Science (USA). All rights reserved. ‡ Inform patients that these medications are for longlong-term prevention of angina. 1998.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Beta Blockers Nursing Implications ‡ These medications should never be abruptly discontinued due to risk of rebound hypertensive crisis.

All rights reserved. . lighthypotension.Home | Profile | Project | Our Group | MediDict Antianginal Agents: Nursing Implications ‡ Monitor for adverse reactions ± Allergic reactions. or both Copyright © 2002. light-headedness. 1998. dizziness ‡ Monitor for therapeutic effects ± Relief of angina. Elsevier Science (USA). decreased BP. headache.

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