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Flashcards in Antianginals Deck (24):
1

CAD- Coronary Artery Disease

1. 1 of the leading causes of death in U.S.
2. Narrowing or occlusion of a coronary artery
3. Narrowing causes myocardial ischemia

2

Atherosclerosis

1. Most common etiology of CAD
2. Caused by presence of plaque

3

Blood Flow to Heart

1. Myocardium receives blood via coronary arteries
2. Diverge into smaller branches around heart
3. Provide continuous supply of 02 & nutrients

4

Angina Pectoris

1. Acute chest pain due to insufficient 02 to myocardium
2. Accompanies physical exertion or emotional excitement
3. Caused by increased myocardial 02 demand

5

S/S of Angina

1. Steady intense pain in anterior chest
2. Pain radiating to L shoulder, L arm, spine, jaw
3. Fear of impending death
4. Pallor, dyspnea, Diaphoresis
5. Tachycardia, Elevated BP
Duration usually short, pain diminishes c physical rest

6

Anginal Classification

1. Stable angina is predictable as to frequency, intensity, duration
a. Usually relieved by rest
2. Vasospastic Angina caused by spasms of coronary arteries
3. Silent angina occurs in absence of angina pain, Rest clears the pain
4. Unstable angina when episodes occur more frequently, more intense, DURING PERIODS OF REST!

7

Angina vs Myocardial Infarction

1. Identify & differentiate the 2 conditions
2. Pharmacological Tx differs considerably between conditions
3. Myocardial infarction carries a high mortality rate

8

Angina Role of RN

1. Monitor client condition
2. Provide education on prescribed Rx Tx
3. Obtain V.S. & medical & Rx Hx.
4. Obtain lifestyle & dietary habits
5. Obtain description of symptoms & pharm Tx initiated by client

9

Pharm management of Angina

1. Reduce intensity & frequency of episodes
2. Improve exercise tolerance
3. 2 Categories of drugs
a. Terminate acute angina episode
b. Decrease frequency of episodes

10

Reduce myocardial demand for 02

1. Slowing HR
2. Reduceing preload
3. Reducing contractility
4. Llowering BP (REDUCED AFTERLOAD)

11

Nitrate

1. Potent vasodilator
2. NITROGLYCERIN (Nitrostat)

12

Nitrostat

1. Mechanism of action: Relax both arterial & venous smooth muscle & dilates coronary arteries
a. Short acting-terminate acute angina episode
b. Long-acting-decrease severity & frequency of episodes
2. Primary Use: Lowering myocardial 02 demand
3. Adverse Effect: Headache, Dizziness, Hypotension, Flushing, Rash

13

Nitrates

1. Obtain BP & Monitor
2. IV nitrate have greatest risk for severe hypotension
3. Educate client that alcohol is contraindicated
4. Hypotension, withhold

14

Beta-Adrenergic Blocker

1. Reduces cardiac workload
2. Prophylaxis for chronic Angina

15

Name 1 Beta-Adrenergic Blocker

1. Inderal- Reduces cardiac workload by slowing HR & Reducing contractility.
2. Primary use: Prophylaxis of stable angina
3. Adverse Effects: Fatigue, Insomnia, Drowsiness, Impotence, Bradycardia, Confusion

16

Beta-Adrenergic Blocker RN Implication/Teaching

1. Assess apical HR
2. Obtain BP & Continue to monitor
3. Monitor Respiratory status
4. Monitor glucose levels
5. Educate client not to stop abruptly

17

Calcium Channel Blockers

1. Reduce cardiac workload & dilate coronary arteries
2. Bring more 02 to myocardium

18

CCB Cardizem

1. Mechanism of action: Reduce cardiac workload by relaxing arteriolar smooth muscle; Dilates coronary arteries
2. Primary Use: Lowering BP; Brings more 02 into myocardium
3. Adverse Effects: Hypotension, Bradycardia, HF, Constipation, Headache, Dizziness, Edema

19

CCB RN Implication/Teaching

1. Assess V.S.
2. Hold medication if HR below 60
3. Obtain Ortho BP
4. Assess for signs of HF
5. Obtain DW
6. Assess bowel function

20

Thrombolytics

1. Dissolve clots
2. Restore circulation to myocardium
3. Reteplase
4. Discussed several classes ago

21

Reteplase

1. Mechanism of action: Dissolve clots obstructing coronary arteries
2. Primary Use: For restoring circulation to myocardium
3. Adverse Effects: Excessive bleeding

22

Reteplase RN Implication/Teaching

1. Assess for conditions that may place client @ increased risk for bleeding
2. Start IV & arterial lines
3. Monitor V.S. & intake & output
4. Monitor changes in neurological status
5. Assess for dysrhythmia

23

Adjunct drugs for myocardial infarctions

1. Nitrates: Dx of MI, arterial & venous dilitation, relieve coronary artery vasospasm
2. Beta-Adrenergic Blockers: Reduce myocardial 02 demand; Slow impulse conduction through the heart.
3. Beta-Adrennergic Blockers: Reduce myocardial 02 demand; Slow impulse conduction through the heart
4. ACEI: Increased survival for those MI pt administration

24

Lisinopril

1. Monitor pt condition & provide education
2. Obtain & monitor V.S.
3. Hx lifestyle, current Drugs, dietary habits
4. Frequency & severity of symptoms