Antianginal Agents

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indianden...
Antianginal Agents
Nitrates
Beta blockers
Calcium channel blockers

www.indiandentalacademy.com
Angina Pectoris (Chest Pain)
When the supply of oxygen and nutrients in the

blood is insufficient to meet the demands of...
Types of Angina
Chronic stable angina
(also called classic or effort angina)
Unstable angina
(also called preinfarction ...
www.indiandentalacademy.com
Antianginal Agents:
Therapeutic Objectives
Increase blood flow to ischemic heart muscle

and/or
Decrease myocardial oxyg...
Antianginal Agents:
Therapeutic Objectives
Minimize the frequency of attacks and decrease the

duration and intensity of ...
Antianginal Agents: Nitrates
Available forms:
Sublingual
Buccal
Chewable tablets
Capsules

Ointments
Transdermal patches
I...
Antianginal Agents: Nitrates
Cause vasodilation due to relaxation of smooth

muscles

Potent dilating effect on coronary...
Antianginal Agents: Nitrates
Nitroglycerin
Prototypical nitrate
Large first-pass effect with PO forms
Used for symptoma...
Antianginal Agents: Nitrates
isosorbide dinitrate

(Isordil, Sorbitrate, Dilatrate SR)
isosorbide mononitrate
(Imdur, Mo...
Antianginal Agents: Nitrates
Side Effects
Headache
Usually diminish in intensity and frequency

with continued use
Tach...
Antianginal Agents: Beta
Blockers
atenolol (Tenormin)
metoprolol (Lopressor)
propranolol (Inderal)
nadolol (Corgard)

...
Antianginal Agents: Beta
Blockers
Mechanism of Action
Decrease the HR, resulting in decreased myocardial

oxygen demand a...
Antianginal Agents: Beta
Blockers
Therapeutic Uses
Antianginal
Antihypertensive
Cardioprotective effects, especially af...
Antianginal Agents: Beta
Blockers
Side Effects
Body System
Cardiovascular

Metabolic

Effects
bradycardia, hypotension
sec...
Antianginal Agents: Beta
Blockers
Side Effects
Body System

Effects

CNS
dizziness, fatigue,
mental depression, lethargy,
...
Antianginal Agents:
Calcium Channel Blockers
verapamil (Calan)
diltiazem (Cardizem)
nifedipine (Procardia)

www.indiand...
Antianginal Agents:
Calcium Channel Blockers
Mechanism of Action
Cause peripheral arterial vasodilation
Reduce myocardia...
Antianginal Agents:
Calcium Channel Blockers
Therapeutic Uses
First-line agents for treatment of angina, hypertension,

a...
Antianginal Agents:
Calcium Channel Blockers
Side Effects
Very acceptable side effect and safety profile
May cause hypot...
Antianginal Agents:
Nursing Implications
Before administering, perform a complete health

history to determine presence o...
Antianginal Agents:
Nursing Implications
Patients should not take any medications, including

OTC medications, without ch...
Antianginal Agents:
Nursing Implications
Alcohol consumption and hot baths or spending

time in jacuzzis, hot tubs, or sa...
Antianginal Agents: Nitroglycerin
Nursing Implications
Instruct patients in proper technique and guidelines for

taking s...
Antianginal Agents: Nitroglycerin
Nursing Implications
Instruct patients to keep a fresh supply of NTG on hand;

potency ...
Antianginal Agents: Nitroglycerin
Nursing Implications
Instruct patients in the proper application of nitrate

topical oi...
Antianginal Agents: Nitroglycerin
Nursing Implications
Instruct patients to take prn nitrates at the first hint

of angin...
Antianginal Agents: Nitroglycerin
Nursing Implications
IV forms of NTG must be contained in glass IV bottles and

must be...
Antianginal Agents:
Calcium Channel Blockers
Nursing Implications
Blood levels should be monitored to ensure they

are th...
Antianginal Agents: Beta Blockers
Nursing Implications
Patients taking beta blockers should monitor pulse rate

daily and...
Antianginal Agents: Beta Blockers
Nursing Implications
These medications should never be abruptly discontinued

due to ri...
Antianginal Agents:
Nursing Implications
Monitor for adverse reactions
Allergic reactions, headache, light-headedness,

...
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
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Anti anginal Agents /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable.

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  • Anti anginal Agents /certified fixed orthodontic courses by Indian dental academy

    1. 1. Antianginal Agents INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
    2. 2. Antianginal Agents Nitrates Beta blockers Calcium channel blockers www.indiandentalacademy.com
    3. 3. 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. The heart demands a large supply of oxygen to meet the demands placed on it. www.indiandentalacademy.com
    4. 4. 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) www.indiandentalacademy.com
    5. 5. www.indiandentalacademy.com
    6. 6. Antianginal Agents: Therapeutic Objectives Increase blood flow to ischemic heart muscle and/or Decrease myocardial oxygen demand www.indiandentalacademy.com
    7. 7. 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 www.indiandentalacademy.com
    8. 8. Antianginal Agents: Nitrates Available forms: Sublingual Buccal Chewable tablets Capsules Ointments Transdermal patches Inhalable sprays Intravenous solutions www.indiandentalacademy.com
    9. 9. Antianginal Agents: Nitrates Cause vasodilation due to relaxation of smooth muscles Potent dilating effect on coronary arteries Used for prophylaxis and treatment of angina www.indiandentalacademy.com
    10. 10. Antianginal Agents: Nitrates Nitroglycerin Prototypical nitrate Large first-pass effect with PO forms Used for symptomatic treatment of ischemic heart conditions (angina) IV form used for BP control in perioperative hypertension, treatment of CHF, ischemic pain, and pulmonary edema associated with acute MI www.indiandentalacademy.com
    11. 11. Antianginal Agents: Nitrates isosorbide dinitrate (Isordil, Sorbitrate, Dilatrate SR) isosorbide mononitrate (Imdur, Monoket, ISMO) Used for: Acute relief of angina Prophylaxis in situations that may provoke angina Long-term prophylaxis of angina www.indiandentalacademy.com
    12. 12. Antianginal Agents: Nitrates Side Effects Headache Usually diminish in intensity and frequency with continued use Tachycardia, postural hypotension Tolerance may develop www.indiandentalacademy.com
    13. 13. Antianginal Agents: Beta Blockers atenolol (Tenormin) metoprolol (Lopressor) propranolol (Inderal) nadolol (Corgard) www.indiandentalacademy.com
    14. 14. 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, helping to conserve energy or decrease demand www.indiandentalacademy.com
    15. 15. Antianginal Agents: Beta Blockers Therapeutic Uses Antianginal Antihypertensive Cardioprotective effects, especially after MI www.indiandentalacademy.com
    16. 16. Antianginal Agents: Beta Blockers Side Effects Body System Cardiovascular Metabolic Effects bradycardia, hypotension second- or third-degree heart block heart failure Altered glucose and lipid metabolism www.indiandentalacademy.com
    17. 17. Antianginal Agents: Beta Blockers Side Effects Body System Effects CNS dizziness, fatigue, mental depression, lethargy, drowsiness, unusual dreams Other impotence wheezing, dyspnea www.indiandentalacademy.com
    18. 18. Antianginal Agents: Calcium Channel Blockers verapamil (Calan) diltiazem (Cardizem) nifedipine (Procardia) www.indiandentalacademy.com
    19. 19. Antianginal Agents: Calcium Channel Blockers Mechanism of Action Cause peripheral arterial vasodilation Reduce myocardial contractility (negative inotropic action) Result: decreased myocardial oxygen demand www.indiandentalacademy.com
    20. 20. Antianginal Agents: Calcium Channel Blockers Therapeutic Uses First-line agents for treatment of angina, hypertension, and supraventricular tachycardia Short-term management of atrial fibrillation and flutter Several other uses www.indiandentalacademy.com
    21. 21. Antianginal Agents: Calcium Channel Blockers Side Effects Very acceptable side effect and safety profile May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea www.indiandentalacademy.com
    22. 22. Antianginal Agents: Nursing Implications Before administering, perform a complete health history to determine presence of conditions that may be contraindications for use or call for cautious use. Obtain baseline VS, including respiratory patterns and rate. Assess for drug interactions. www.indiandentalacademy.com
    23. 23. Antianginal Agents: Nursing Implications Patients should not take any medications, including OTC medications, without checking with the physician. Patients should report blurred vision, persistent headache, dry mouth, dizziness, edema, fainting episodes, weight gain of 2 pounds in 1 day or 5 or more pounds in 1 week, pulse rates under 60, and any dyspnea. www.indiandentalacademy.com
    24. 24. Antianginal Agents: Nursing Implications Alcohol consumption and hot baths or spending time in jacuzzis, hot tubs, or saunas will result in vasodilation, hypotension, and the possibility of fainting. Teach patients to change positions slowly to avoid postural BP changes. Encourage patients to keep a record of their anginal attacks, including precipitating factors, number of pills taken, and therapeutic effects. www.indiandentalacademy.com
    25. 25. Antianginal Agents: Nitroglycerin Nursing Implications Instruct patients in proper technique and guidelines for taking sublingual NTG for anginal pain. Instruct patients never to chew or swallow the SL form. Instruct patients that a burning sensation felt with SL forms indicates that the drug is still potent. www.indiandentalacademy.com
    26. 26. 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. Medications should be stored in an airtight, dark glass bottle with a metal cap and no cotton filler to preserve potency. www.indiandentalacademy.com
    27. 27. Antianginal Agents: Nitroglycerin Nursing Implications Instruct patients in the proper application of nitrate topical ointments and transdermal forms, including site rotation and removal of old medication. To reduce tolerance, the patient may be instructed to remove topical forms at bedtime, and apply new doses in the morning, allowing for a nitrate-free period. www.indiandentalacademy.com
    28. 28. Antianginal Agents: Nitroglycerin Nursing Implications Instruct patients to take prn nitrates at the first hint of anginal pain. If experiencing chest pain, the patient taking SL NTG should be lying down to prevent or decrease dizziness and fainting that may occur due to hypotension. Monitor VS frequently during acute exacerbations of angina and during IV administration. www.indiandentalacademy.com
    29. 29. Antianginal Agents: Nitroglycerin Nursing Implications IV forms of NTG must be contained in glass IV bottles and must be given with infusion pumps. Discard parenteral solution that is blue, green, or dark red. Follow specific manufacturer’s instructions for IV administration. Use special IV tubing provided or nonPVC tubing. www.indiandentalacademy.com
    30. 30. 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. Patients should be encouraged to limit caffeine intake. www.indiandentalacademy.com
    31. 31. 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. Dizziness or fainting should also be reported. Constipation is a common problem. Instruct patients to take in adequate fluids and eat high-fiber foods. www.indiandentalacademy.com
    32. 32. Antianginal Agents: Beta Blockers Nursing Implications These medications should never be abruptly discontinued due to risk of rebound hypertensive crisis. Inform patients that these medications are for long-term prevention of angina, not for immediate relief. www.indiandentalacademy.com
    33. 33. Antianginal Agents: Nursing Implications Monitor for adverse reactions Allergic reactions, headache, light-headedness, hypotension, dizziness Monitor for therapeutic effects Relief of angina, decreased BP, or both www.indiandentalacademy.com
    34. 34. Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com

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