(Anti-Anginal & HTN Drugs)

2. B: Anti-hypertensive and Anti- anginal
Drugs

3. Hypertension
Hypertension is characterized by an
elevation of the systolic blood
pressure, diastolic blood pressure or
both. Blood pressure above 140/90 is
considered high blood pressure.

4. Management of hypertension
Non-pharmacologic approaches:
 Weight reduction in obese patients:reduces
about 2.5/1.5 mm Hg per kg wt. lost
 Restriction to salt intake: not more than 6 g NaCl
 Dietary considerations: legumes, fresh fruits and
vegetables, whole grains
 Regular exercise
 Restricted alcohol intake
 Smoking cessation to reduce cardiovascular risk

5. Antihypertensive drugs
Drugs used in the treatment of
hypertension can be subdivided into
several categories of therapeutic agents,
based on site of action.
Clinical studies classify antihypertensive
into preferred, alternative and
adjunctive agents.
Both preferred agents and alternative
agents can be used alone, or in
combination to treat hypertension.

6. Conti….
Adjunctive agents should be used only
in combination with a preferred or an
alternative drugs.

7. Types of antihypertensive
agents
Classes of drugs
Preferred agents Diuretic
Beta- blockers
Alternative agents Angiotensin converting enzyme (ACE)
inhibitor
Calcium Channel Blockers
Angiotensin receptor blocker (ARBs)
Direct vasodilators

8. Preferred Agents
Diuretic
Beta- blockers

9. Diuretics
• Increases the secretion of H2O, wastes and
electrolytes from the body
• Used in heart failure, fluid overload,
hypertension and peripheral edema.
• Types
– Loop – Furosemide (Lasix)
– Potassium-sparing – Aldactone, spironolactone
– Thiazides – Diuril, HydroDiuril, Lozol, Zaroxolyn

10. Cont.
Adverse effects
– Hypotension
– Electrolyte imbalances
– Hyperkalemia from potassium sparing
diuretics
– Orthostatic hypotension

11. Beta Blockers
atenolol (Tenormin) tablets: 25, 50, 100 mg
inj: 0.5mg/mL in 10 mL amp
metoprolol (Lopressor) tablets: 50, 100 mg
inj: 1mg/mL in 5mL amp
propranolol (Inderal) tablet: 10, 20, 40, 60,
80 mg
inj: 1mg/mL in 1mL ampule

12. Alternative Agents
Angiotensin converting enzyme (ACE) inhibitor
Calcium Channel Blockers
Angiotensin Receptor Blocker (ARBs)
Direct Vasoldilators

13. ACEIs

14. Examples
Captopril (capoten) tablets: 25, 50,
100mg
Fosinopril ( monopril) tablets: 10, 20,
40 mg
benazepril (lotensin) tablets: 5, 10, 20,
40 mg
Enalapril (vasotec) tablets: 2.5, 5, 10,
20mg

15. Adverse Effects
• Nausea, vomiting, diarrhea
• Persistent cough
• Trachycardia
• Headache, dizziness, fatigue
• Hypotension
• Hyperkalemia

16. Calcium Channel Blockers
• Calcium channel blockers decrease
cardiac contractibility (negative
inotropic effect by relaxing smooth
muscle) and the workload of the heart,
thus decreasing the need for oxygen.

17. Calcium Channel Blockers
Coronary artery dilation and peripheral
vessels
Decrease resistance
Increase blood flow
Increase oxygen supply

18. Cont….
• Calcium channel blocker are used for
angina, or hypertension.
• It should be used with caution in the
client with CHF, bradycardia, or
atrioventricular block.

19. Examples
Amlodipine (Norvasc) tablets: 5,10 mg
Verapamil ( Calan, Isoptin) tablets:
40,80,120 mg
I/V : 2.5 mg/mL in 2- and 4-mL ampules
Diltiazem (Herbessor) tablets:
30,60,90,120 mg
I/V 5mg/mL in 5- and 10-mL vials
powder for injection: 25 mg

20. Angiotensin Receptor Blockers
• These drugs block angiotensin receptors on
blood vessels and adrenal cortex
• Like the ACEIs, these drugs produce
vasodilation and decrease the activity of
aldosterone
• The angiotensin receptor blockers generally
produce a lower incidence of adverse
effects than the ACEIs

21. Examples
Losartan (Eziday) tablets: 25,50,100 mg
Valsartan (Diovan) tablets:80,160 mg
Telmisartan (Tasmi) tablets:20,40 mg
Olmesartan (Omsana) tablets: 20,40mg
Candesartan (Advant) tablets: 8,16 mg

22. Direct vasodilators
These agents act directly on the smooth
muscles of blood vessels. It produces
both arterial and venous vasodilation,
thus reducing workload.

23. Examples
Hydralazine 25mg
Nitroprusside sodium

24. Hypertensive Crisis
• Severe hypertension is a medical
emergency can lead to stroke and sudden
death
• Immediate drugs and parenteral
administration of antihypertension can
avoid severe complications and
irreversible damage
• Captopril and nitroprusside are potent
drugs used in hypertensive crisis

25. Drug Therapy
Intravenous medication such as sodium
nitroprusside and hydralazine will
administered to decrease blood
pressure.

26. Management
With crisis hypertension client requires
prompt medical attention and nursing
care.
In this situation client should be
connected to cardiac monitor.
Nurse careful monitor vital signs and
neurological status and promptly
reports significant changes to physician

27. Conti....
Nurse carefully monitor the client for
suddenly decrease in pressure may result
in decrease cerebral blood flow causing
cerebral ischemia and possibly stroke.
Hydralazine and nitride is given IV in
hypertensive emergencies, client
receiving these drugs carefully, check
blood pressure & pulse until stable on
parental therapy.

28. Angina Pectoris
• Chest pain due to coronary artery disease
(CAD) and myocardial ischemia
• Exertional angina (pain) usually occurs
during physical exertion or stress
• Vasospastic angina may occur at any time
and is due to coronary artery vasospasm
• Untreated CAD and angina pectoris may
lead to myocardial infarction and death

29. Drugs Used to Treat CAD
• Nitrites and nitrates
• Beta blockers drugs
• Calcium antagonists, also referred
to as calcium channel blockers

30. Nitrites and Nitrates
• Drugs stimulate the formation of nitric oxide, a
potent vasodilator of blood vessels
• Vasodilation of veins and arteries decreases
cardiac work and cardiac oxygen consumption to
relieve the pain of myocardial ischemia
• Nitrites and nitrates may cause a drop in blood
pressure and reflex tachycardia
• These drugs can be used to treat acute attacks of
angina or to prevent anginal attacks

31. Drugs Used to Relieve Acute
Attacks of Angina
• Amyl nitrite is administered by inhalation
from a glass ampule, it has a sudden onset and
duration of action of 5–10 minutes
• Nitroglycerin is administered as sublingual
tablets which require a few minutes for onset
and may last 30–45 minutes
• Nitroglycerin may also be administered
intravenously in more severe cases

32. Drugs Used Prophylactically to
Prevent Angina Pectoris
• Nitroglycerin can be administered as an
ointment, as extended release tablets or
capsules, or by transdermal patch
• Isosorbide and pentaerythritol nitrates are
usually administered orally 3–4 times/day
depending on the frequency of anginal attacks

33. Adverse Effects of Nitrites and
Nitrates
• Vasomotor flushing, dizziness, and
headache are common due to vasodilation
• When administered for acute angina, the
sudden onset of vasodilation may cause
hypotension, fainting, and tachycardia
• Patients should be seated when inhaling or
taking these drugs sublingually

34. Beta Blockers
• Sympathetic beta receptor stimulation of the heart
increases heart rate, force of contraction, and
oxygen consumption
• Blockade of beta receptors decreases cardiac work
and cardiac oxygen demand
• Beta blockers are used prophylactically to prevent
angina and can be combined with other
antianginal drugs

35. Calcium Antagonists
• Drugs block influx of calcium ions into the heart and
blood vessels to vasodilate and lower blood pressure,
cardiac work, and oxygen demand
• Verapamil and diltiazem act on both the heart and
blood vessels
• Nifedipine and other calcium antagonists act mainly
to dilate arterial blood vessels
• Calcium antagonists are used prophylactically to
prevent angina
• Adverse effects include excessive vasodilation,
hypotension, cutaneous flushing, and headache