Angina, MI, & CVA

Non-pharmacological management of angina pectoris

• Diet

• Limit/abstain alcohol, cessation of smoking

• Exercise

• Mental health

Drug classes used for angina, MI, CVA

• Organic nitrates

• Beta blockers

• Calcium channel blockers

Organic nitrates: indications & action

Preventing & terminating angina episodes

• Vasodilates

  • Relaxes venous muscle —> reduces preload

  • Relaxes arterial muscle —> relaxes spasms

Organic nitrates: adverse effects

• Hypotension

• Flushing

• Dizziness, headache

• Reflex tachycardia

Prototype organic nitrate

Nitroglycerin

Nitroglycerin: therapeutic effect & action

Angina, CHF, pulmonary edema, MI, HTN

• Forms nitric oxide —> vasodilator, increases oxygen supply

Nitroglycerin: adverse effects

• Hypotension

• Flushing

• Headache, dizziness

• Anaphylaxis, met-hemoglobinemia

What do you do if the nitroglycerin does not work the first time?

Wait 5 minutes, then try again— only do it twice.

If angina persists, call 911

Nursing considerations before administering nitroglycerin

• Medical hx, VS, ECG, lab tests

• If on viagra

Prototype beta blocker

Atenolol (Tenormin) & Metoprolol (Lopressor)

Atenolol (Tenormin): therapeutic effect & action

Stable angina, MI, HTN

• Blocks beta1 receptors —> reduce HR, contractility —> reduces CP, BP

Atenolol (Tenormin): adverse effects

• Bradycardia

• Hypotension

• N&V

• Exacerbation of asthma (bronchial constriction)

Metoprolol (Lopressor): therapeutic effect & action

Angina, MI, HTN, dysrhythmias, CHF

• Blocks beta 1 receptors —> decreases HR, contractility —> decreases O2 demand

Metoprolol (Lopressor): adverse effects

• Hypotension

• Bradycardia

• Exacerbation of HF

• N&V

Calcium channel blockers: indications & mechanism

Angina, HTN, dysrhythmias

• Relaxes arterial muscle —> increase O2 supply, decrease afterload

Calcium channel blockers: adverse effects

• Hypotension

• Dysrhythmias

• Exacerbate HF

• Peripheral edema

• Promotes heart block with beta blockers and/or cardiac glycosides

Prototype calcium channel blocker

Diltiazem (Cardizem)

Diltiazem (Cardizem): therapeutic effect & action

Angina, dysrhythmias, HTN

• Blocks muscle channels —> vasodilation —> decrease HR, force of contraction

Diltiazem (Cardizem): adverse effects

• Hypotension

• Bradycardia

• Flushing

• Dizziness, headaches

• Peripheral edema

Thrombolytics: indication & action

MI, CVA

• Stimulates plasmin —> fibrin —> breaks down clots

Thrombolytics: adverse effects

• Bleeding, epistaxis

• Urine in blood, stool

• Bruising

• BP decrease

Prototype thrombolytic

Reteplase (Retavase)

Reteplase (Retavase): therapeutic effect & action

MI

• Stimulates plasmin —> fibrin —> clot dissolving

Reteplase (Retavase): adverse effects

• Bleeding

  • GI, GU, cerebral, intracranial

Other drug classes used for MI

• Thrombolytics

• Anti-platelets (aspirin)

• Anti-coagulants (heparin)

• ACE inhibitors