Ppt chapter 46

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Antianginal Agents
Chapter 46

Illustration of an atheromatous
plaque (a) and thrombus of
an atherosclerotic plaque (b)

Coronary Artery Disease (Definitions)
• Atheromas
– Fatty tumors in the intima of the heart vessels
• Atherosclerosis
– Narrowing of the heart vessels
• Angina Pectoris
– “Suffocation of the chest”
• Myocardial Infarction
– Cells in the myocardium become necrotic and die

Types of Angina
• Stable Angina
– No damage to heart muscle; basic reflexes
surrounding the pain restore blood flow
• Unstable Angina
– Episodes of ischemia occur even when at rest
• Prinzmetal’s Angina
– Caused by spasm of the blood vessels, not just by
vessel narrowing

Actions of Antianginal Drugs
• Improve blood delivery to the heart muscle by dilating
blood vessels
– Increasing the supply of oxygen
• Improve blood delivery to the heart muscle by decreasing
the work of the heart
– Decreasing the demand for oxygen

Types of Antianginal Drugs
• Nitrates
• Beta-Adrenergic Blockers
• Calcium Channel Blockers

Factors Affecting Myocardial Oxygen
Demand and the Effect of Antianginals

Nitrates
• Actions
– Act directly on smooth muscle to cause relaxation
and depress muscle tone
• Indications
– Prevention and treatment of attacks of angina
pectoris
• Pharmacokinetics
– Very rapidly absorbed
– Metabolized in the liver
– Excreted in the urine

Nitrates (cont.)
• Contraindications
– Allergy
– Severe anemia
– Head trauma or cerebral hemorrhage
– Pregnancy and lactation
• Caution
– Hepatic or renal disease
– Hypotension, hypovolemia, and conditions that limit
cardiac output

Nitrates (cont.)
• Adverse Effects
– Related to the vasodilatation and decreased in blood
flow
– CNS – Headache, dizziness, and weakness
– GI – Nausea, vomiting
– CV – Hypotension
– Misc. – Flushing, pallor increased perspiration
• Drug-to-Drug Interactions
– Ergot derivatives
– Heparin

Routes for Nitroglycerin
• IV
• Sublingual
• Translingual Spray
• Transmucosal Tablet
• Oral, SR Tablet
• Topical Ointment
• Transdermal

Question
The patient asks the nurse to explain the type of angina he
is experiencing. The nurse explains the pain is due to the
imbalance of myocardial supply and demand. What type
of angina does this describe?
A. Unstable
B. Prinzmetal’s
C. Stable
D. Ischemic

Answer
C. Stable
Rationale: Stable angina: No damage to heart muscle;
basic reflexes surrounding the pain restore blood flow

Beta Blockers
• Actions
– Blocks beta-adrenergic receptors in the heart and
kidneys, decreases the influence of the SNS on these
tissues; decreases cardiac output and the release of
renin
• Indications
– Treats stable angina pectoris and hypertension,
prevents reinfarction in MI patients; treats stable
CHF
– Absorbed in GI tract, undergoes hepatic metabolism,
excreted in the urine

Beta Blockers (cont.)
– Bradycardia
– Heart block
– Cardiogenic shock
– Asthma or COPD
– Pregnancy and lactation
• Caution
– DM
– PVD
– Thyrotoxicosis

Beta Blockers (cont.)
• Adverse Effects
– Related to their blockage of sympathetic nervous
system
– CNS – Dizziness, fatigue, emotional depression
– GI – Nausea, vomiting, colitis
– CV – CHF, decreased cardiac output, and arrhythmias
– Respiratory – Bronchospasm, dyspnea, and cough
– Clonidine

Calcium Channel Blockers
• Actions
– Inhibit the movement of calcium ions across the
membranes of myocardial and arterial muscle cells,
altering the action potential and blocking muscle cell
contraction
• Indications
– Prinzmental’s angina
– Well absorbed
– Metabolized in the liver
– Excreted in the urine

Calcium Channel Blockers (cont.)
– Allergy
– Heart block or sick sinus syndrome
– Renal or hepatic dysfunction
– Pregnancy or lactation

Calcium Channel Blockers (cont.)
• Adverse Effects
– Hypotension
– Cardiac arrhythmias
– GI upset
– Skin reactions
– Headache
– Vary with each drug

Use of Antianginal Agents Across the Lifespan

Prototype Nitrates

Prototype Beta Blockers

Prototype Calcium Channel Blockers

Question
Please answer the following statement as true or false.
Older adults are more likely to develop adverse effects
associated with the use of these drugs—dysrrhythmias,
hypertension, and congestive heart disease.

Answer
False
Rationale: Older adults frequently are prescribed one of
these drugs. They are more likely to develop adverse
effects associated with the use of these drugs—
arrhythmias, hypotension, and congestive heart disease.
Safety measures may be needed if these effects occur
and interfere with the patient’s mobility and balance.

Nursing Considerations for Nitrates
• Assessment: History and Physical Exam
• Nursing Diagnosis
• Implementation
• Evaluation

Nursing Considerations for Beta Blockers
• Implementation
• Evaluation

Nursing Considerations for Calcium
Channel Blockers
• Implementation
• Evaluation

Ppt chapter 46

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Similar to Ppt chapter 46

Similar to Ppt chapter 46 (20)

More from stanbridge

More from stanbridge (20)

Recently uploaded

Recently uploaded (20)

Ppt chapter 46