2. Introduction
• They are drugs used in the treatment of
angina pectoris. These drugs prevent
terminate attacks of angina pectoris.
• Angina pectoris is a disease results from
anoxia of the cardiac muscles, it is
characterized by pain in chest, sternal pain
radiates down the left shoulder & arm.
4. Nitroglycerine
• It is a volatile liquid absorbed on the inert
matrix of tab & is rendered non explosive & is
used sub lingually when attack is terminating.
• It is readily absorbed from skin & a cutaneous
application has effect for 4 to 6 hrs.
• The tab should be stored in tightly closed glass
containers otherwise drug may be evaporated.
• The tab may be crushed under the teeth &
may spread over buccal mucosa
5. Pharmacological action of nitrates &
nitrites
• Action on eyes- these drugs dilate Intraocular blood
vessels. IOP may be increased.
• Action on Blood vessels- All blood vessels are not
equally effected. Vasodilation is caused in coronary,
cutaneous & cerebral blood vessles. Blood flow is
increased, there is decrease in BP. These drugs produce
direct relaxant actions on arteries, veins & capillaries
without involvement of autonomic nerves.
• Action on smooth muscles- The drugs nitrates &
nitrites produce relaxation of smooth muscles of
intestine, uterus ureter & biliary tract, bronchi ,
esophagus.
6. Conti…
• Action on Hemoglobin- Nitrites convert blood
hemoglobin to methemoglobin.
Methemoglobin formed combines with the
cyanides to form non toxic
cyanmethemoglobin. The nitrites are useful in
cyanide poisoning treatment.
7. Conti…
Indication
• Unstable angina
• Coronary vasospasm
• Hypertension during cardiac
surgery
Contraindication
• Head injury
• Cerebral hemorrhage
• Hypertrophic
cardiomyopathy
8. Conti…
Dose
• Acute Attack(adult)- 0.5mg
every 3 min when pain is
reduced
• Prophylactic dose- 0.5 mg to
be sucked or chewed not to
be swallowed
Pharmacokinetics
• Onset action 1 to 2 min,
peak concentration 3 to 6
min, metabolized by liver
• Drug interaction- Alcohol
may cause severe
hypotension & collapse.
Postural hypertension
occurs with
antihypertensive,
antidepressants
10. Nursing care
• Keep drugs out of reach of children.
• To advice patient to take rest for 15 min after
dose has been taken.
• To advice pt. to rise slowly from lying or sitting
position postural hypotension may occur.
• To advice pt. to avoid driving not to work with
machinery as drowsiness may occur.
• Use non narcotic analgesics if headache is
caused by drug.
11. Beta Blocker(Atenolol)
• It is a cardio selective beta blocker drug having
higher lipid solubility. Its hypertensive effect
persist for at least 24 hour, so once daily dose is
sufficient for beta blocking & antihypertensive
effect.
• It cause no effect on lipid profile, have no or
minor adverse on CNS. It decreases HR, decrease
O2 consumption in myocardium. Higher doses
decrease renin aldosteroneangiotensin system &
inhibit beta 2 receptor in bronchial system.
15. Nursing Care
• To monitor vital sign 4 hrly during therapy.
• To advice pt. to avoid alcohol consumption.
• Keep medicines in cool place, protected from
heat, light, moisture.
• To advice pt to report fever, headache,
depression, dizziness.
• To take dose as recommended, not to
discontinue drug suddenly.
