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

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Welcome to Indian Dental Academy …

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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  • 1. Antianginal Agents INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. Antianginal Agents Nitrates Beta blockers Calcium channel blockers www.indiandentalacademy.com
  • 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. 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. www.indiandentalacademy.com
  • 6. Antianginal Agents: Therapeutic Objectives Increase blood flow to ischemic heart muscle and/or Decrease myocardial oxygen demand www.indiandentalacademy.com
  • 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. Antianginal Agents: Nitrates Available forms: Sublingual Buccal Chewable tablets Capsules Ointments Transdermal patches Inhalable sprays Intravenous solutions www.indiandentalacademy.com
  • 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. 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. 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. 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. Antianginal Agents: Beta Blockers atenolol (Tenormin) metoprolol (Lopressor) propranolol (Inderal) nadolol (Corgard) www.indiandentalacademy.com
  • 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. Antianginal Agents: Beta Blockers Therapeutic Uses Antianginal Antihypertensive Cardioprotective effects, especially after MI www.indiandentalacademy.com
  • 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. 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. Antianginal Agents: Calcium Channel Blockers verapamil (Calan) diltiazem (Cardizem) nifedipine (Procardia) www.indiandentalacademy.com
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com