Antianginal
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Antianginal

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    Antianginal Antianginal Presentation Transcript

    • ANTIANGINAL Ch 37, 38
    • ANTIANGINALS  Atherosclerosis—narrowing of the lumen of artery d/t fatty plaque deposits on wall of artery  Angina-caused by decreased oxygen to hear muscle d/t atherosclerotic changes. Results in chest pain.  Activities that increase the workload of the heart, (exercise,etc) can cause attack  Drugs to treat—nitrates, calcium channel blockers
    • ANTIANGINALS CON’T  Nitrates & Calcium Channel Blockers Action: dilation of vessles increased blood flow & oxygen supply to tissues  Use:  Angina  Side Effects:  Headache  Dizziness  Weakness Routes: Sublingual Transdermal Oral parenteral 
    • ANTIANGINALS Drug Names Nitrates:  Isordil (isorbide)  Nitroglycerin  Nitrostat  Nitro-Dur   Calcium channel blockers Norvasc (amlodipine)  Cardizem (diltazem )  Procardia (nifedipine)  Calan (verapamil) 
    • ANTIANGINALS  Nursing Process Risk for injury  Pain  Administration  Sublingual (under tongue)  Buccal (between cheek and gum  IV  Transdermal—apply patch to dry, hairless area. Remove previous patch, and initial and date new patch  Nitro ointment—be sure to wear gloves when applying  nitro SL may be repeated Q 5 min X 2. Go to ER if no relief after 3 tablets in 15 min.  Keep tablets in original dark glass container to keep potency. Replace q 6 mo. 
    • ANTICOAGULANTS & THROMBOLYTICS Thrombus=blood clot  Embolus=traveling blood clot  Intermittent Claudication (periodic cramping in legs brought on by walking or exercise, relieved by rest. –Marker for PVD  Anticoagulants:  Prevent formation and extension of thrombus  Do not dissolve clots  AKA blood thinners   ACTION: interfere with clotting mechanism of blood
    • ANTICOAGULANTS & THROMBOLYTICS  USE: Prevent & treat DVT, PE, MI atrial fibrillation  Prevent post-op thrombus formation  Side effects: Bleeding  CI: hemorrhagic disease, active bleeding  Interactions: increased r/o bleeding with ASA 
    • ANTICOAGULANT DRUGS  Oral: Coumadin (warfarin)  Xarelto (rivaroxaban)   Parenteral heparin  Fragmin (dalteparin  Lovenox (enoxaparin) 
    • ANTIPLATELETS  Action:   Decrease clots by decreasing platelets’ ability to stick together (aggregate) in blood Use:  Prevention of acute coronary syndrome, MI, stroke, and intermittent claudication in high risk patients Side effects: Bleeding, dizziness  CI: Bleeding disorders, pregnancy   Drug Name Plavix (clopidogrel)  Aggrastat (tirofiban) 
    • THROMBOLYTICS ―Clot Busters‖—Dissolve clots that have already formed ―lysis‖=breaking down  Action: break down fibrin clots by converting plasminogen to plasmin  Use: Acute MI    blood clots (PE, DVT) Side effects:  bleeding  CI: active bleeding
    • THROMBOLYTICS  Drug Names Activase, tPA (alteplase)  Streptase (streptokinase)  Abbokinase( urokinase) 
    • ANTIDOTES  Vitamin K, Aqua Mephyton (phytonadione)   Antidote for warfarin overdose Protamine Sulfate  Antidote for heparin overdose
    • NURSING PROCESS  Baseline PT/INR test (dosage based on results) for oral anticoagulant  Therapeutic range PT-- 1.2-1.5 times the control  Therapeutic range INR—2-3 times the control   Baseline aPTT (test to monitor heparin)  Therapeutic range aPTT—1.5-2.5 times the control  Nsg Diagnoses:  r/o injury r/t bleeding
    • ANTICOAGULANTS/THROMBOLYTICS  Assess for s/s bleeding       Inspect all drainage (urine, emesis, catheter drainage for pink to red color Check all stools for OB Look for bruising Nosebleeds Bleeding gums Notable drop in BP may indicate internal bleed