Anti-Anginal Pharm

Question 1

Anti-Anginals

Answer 1

Relieve Chest pain

Question 2

Pharm: Stable Angina

Answer 2

Goal: Relieve chest pain

• Nitrates
• Beta blockers
• Calcium channel blockers
• Ranolazine

Goal: reduce Hyperlipidemia

• Statins
• Aspirin or clopidogrel (Plavix)

Goal: Improve morbidity & mortality
-ACE inhibitor or ARB

Question 3

Anti-Anginal: Nitrates MOA

Answer 3

Dilates veins which decreases preload

Question 4

Anti-Anginal: CCB

Answer 4

Dilate arterioles which decreases afterload

-decrease HR + contractility

Question 5

Anti-Anginal: Ranolazine

Answer 5

Helps the myocardium generate energy more efficiently

Question 6

Anti-Anginal: Beta blockers

Answer 6

Decrease HR and Contractility

Question 7

Organic Nitrates:

Answer 7

Nitroglycerin

First antianginal agent

Question 8

Nitroglycerin MOA

Answer 8

• Dilates veins

- Decreases preload

Question 9

Nitroglycerin: AE

Answer 9

Related to vasodilation:

• H/A, hypotension, reflex tachycardia
• Tolerance

Question 10

Nitroglycerin: Rapid Acting

Answer 10

Nitrostat (sublingual)

• experiencing active angina
• repeat every 5 min up to 3X as needed

Question 11

Nitroglycerin: Short Acting

Answer 11

Transderm-Nitro
(Skin Patch)
-Apply to chest or thigh area daily
-Put on in morning, off at night

Nitro-Bid (2%)
(Ointment)
-Apply 1 to 2 inches to chest or thigh

Question 12

Nitroglycerin: Long Acting

Answer 12

Isosorbide
(Sublingual or Oral)

For prevention of anginal attacks, tolerance builds up over time

Question 13

Nitrates (Nitroglycerin) Nursing Implications 1

Answer 13

1. Monitor for headache
   - mild analgesic
   - most H/A subside in 20 minutes
2. Apply nitro patches in morning and remove at night
   - apply to hairless areas and rotate sites
3. Pt. Ed: Treatment of acute chest pain
   -Take only as many SL tablets as needed (TOLERANCE)
   -Use SL form, do NOT swallow
   -Fall precautions: dizziness/hypotension
   -No relief in 5 minutes: call 911
   Ok to take second SL tab in 5 minutes and a 3rd in 5 more minutes. DO NOT exceed 3 doses

Question 14

Nitrates (Nitroglycerin) Nursing Implications 2

Answer 14

4. IV form
   - glass bottle with special tubing
   - Monitor for severe h/a and tachycardia
5. Long acting forms (isosorbide)
   - taper when d/c to prevent increased chest pain from vasospasm

Question 15

Nitrates (Nitroglycerin) Nursing Implications: Interactions

Answer 15

Severe hypotension when taken with:

• sildenafil/Viagra
• Antihypertensive
• Alcohol

Question 16

Nitro: Most recent Guidelines

Answer 16

If chest pain had not improved or it has worsened 5 minutes after taking the 1st nitro, the patient needs to call 911

Question 17

Ranolazine (Ranexa): Class

Answer 17

Anti-anginal

Question 18

Ranolazine (Ranexa): MOA

Answer 18

UNKNOWN

-possibly helps myocardium use energy more efficiently

Question 19

Ranolazine (Ranexa): Warnings

Answer 19

• Prolonged QT intervals
• Acute renal failure (w/existing renal disease)
• Liver cirrhosis

Question 20

Ranolazine (Ranexa): AE

Answer 20

• Headache
• Dizziness
• Nausea
• Constipation
• CYP340 Inhibitor: avoid grapefruit and other CYP inhibitors