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Drugs for Angina


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Stable Angina
disease marked by brief paroxysmal attacks of chest pain precipitated by deficient oxygenation of the heart muscles
Unstable Angina
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
Prinzmetal’s (variant) Angina
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
Prototype agent for nitrates?
Action for nitrates?
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
How do you treat acute angina with nitrates?
Sublingual (SL)
Translingual spray
How do you treat chronic recurrent angina with nitrates?
Topical - NTG paste
Transdermal – NTG patch
Translingual spray
Transmucosal or oral sustained-release i.e.
What other problems can nitrates treat?
Use IV for Significant hypertension
What adverse effect can occur with nitrates?
Tolerance to the vascular and antianginal effects may develop.
How do you minimize the tolerance effect?
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
What are the nursing responsibilities for patients using nitrates?
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.
What environmental precautions do we take with nitrates?
Loses potency with exposure to:
Plastic IV bags of fluid
Sublingual NTG requires replacement every 3 months
What are the actions of Beta receptor antagonists?
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
Prototype agent for Beta receptor antagonists was:
Propranolol (Inderal)
What are the actions of Calcium Channel Antagonists
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
Prototype agent for Calcium Channel Antagonists was?
verapamil (calan)
When are Calcium Channel Antagonists used in treatment?
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
Drug of choice for Variant (Prinzmetal’s) angina
Calcium Channel Antagonist - Diltiazem (Cardizem)
What adjunct Drug Therapy is used?
Acronym: MONA
What is the purpose of adjunct therapies with drugs that treat angina?
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.

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