Angina

Angina

chest pain caused by the heart muscle not getting enough oxygen-rich blood.

Three types to remember:

• Stable: Happens with exercise or stress.

• Unstable: More severe; can happen at rest and may cause heart muscle damage.

• Variant (Prinzmetal’s): Caused by spasms of the coronary blood vessels; can happen at rest.

The main drugs that treat angina (chest pain caused by not enough oxygen reaching the heart muscle)

Drug/class	How it helps
Nitroglycerin (Nitrostat)	Dilates blood vessels and decreases the heart’s workload.
Isosorbide dinitrate (Isordil)	Dilates blood vessels; used to help prevent angina attacks.
Beta blockers — Atenolol (Tenormin), Propranolol (Inderal)	Decrease the heart’s workload and oxygen demand.
Calcium channel blockers (CCBs) — Verapamil (Isoptin), Nifedipine (Procardia), Amlodipine (Norvasc)	Dilate coronary arteries and help treat all three types of angina.

Nitroglycerine preps

What it is

A vasodilator that relaxes blood vessels.

What it treats

All three types of angina: stable, unstable, and variant.

Mechanism of action

Decreases preload, dilates coronary arteries, and relaxes peripheral veins.

Preparations and onset

Under-the-tongue spray: 2–3 min; under-the-tongue tablet: 1–3 min; intravenous: immediate; oral: 20–30 min; patch: 45 min; ointment: 30–45 min; buccal tablet: 1–3 min.

Prevention

Can be used before exertion to prevent an angina attack.

Tolerance

A nitrate-free interval is required to prevent tolerance.

Long-acting nitrates

Used to prevent (prophylaxis for) unstable and variant angina.

Nurse-to-patient teaching: Remember the nitrate-free interval to prevent tolerance.

Isosorbide dinitrate

What the drug is: A nitrate vasodilator.

Use of the drug: Prevents angina (chest pain). Your slide specifies prophylaxis for angina except stable angina.

What to be aware of (mechanism of action):

• Decreases preload.

• Dilates coronary arteries.

• Relaxes peripheral veins.

Isosorbide dinitrate = prevention of angina, according to your slide.

Amlodipine

What the drug is: Calcium channel blocker (CCB).

Use of the drug:

• Treats angina and hypertension (high blood pressure).

• Helps treat all three types of angina.

• Good for patients with low ejection fraction, according to your slide.

Signs and symptoms (S/S) / side effects:

• Edema (swelling)

• Hypotension (low blood pressure)

• Headache

• Dizziness

• Increased heart rate (HR)

What to be aware of (mechanism of action):

• Blocks calcium movement into smooth muscle cells.

• Causes vasodilation (widens blood vessels).

• Decreases total peripheral resistance (TPR).

• Dilates coronary arteries to help treat angina.

Combination drug: Exforge = valsartan + amlodipine.

Exam tip: Amlodipine = calcium channel blocker that dilates coronary arteries and can treat all three types of angina.

Propranolol

What the drug is: Beta-1 and Beta-2 blocker (β₁ + β₂ blocker).

Use of the drug:

• Treats stable and unstable angina.

• Decreases the heart’s workload.

Nurse-to-patient teaching: Do not discontinue abruptly! Do not suddenly stop taking this medication.

What to be aware of:

• Good oral absorption (PO = by mouth).

• Also a Class II antiarrhythmic drug.

• Decreases conduction through the atrioventricular (AV) node and increases its refractory period.

• Can be used for digoxin-induced arrhythmias and atrial arrhythmias, including atrial fibrillation (A-fib).

• Not used for variant angina.

Continue or discontinue: Do not stop abruptly.

Exam tip: Propranolol decreases the heart’s workload, but do not use it for variant angina, according to your slides.

Metoprolol

What it is: Beta-1 blocker (β₁ blocker).

Use: Treats hypertension (high blood pressure) and may be used for CHF (congestive heart failure).

What to be aware of:

• Blocks beta-1 receptors.

• Good PO (by mouth) absorption.

• The slide says do NOT use in COPD (chronic obstructive pulmonary disease) and diabetes.

Metoprolol = beta-1 blocker

Atenolol

What it is: Beta-1 blocker (β₁ blocker).

Use: Treats angina by decreasing the heart’s workload.

• Nurse-to-patient teaching: Do not discontinue abruptly (do not stop suddenly).

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• What to be aware of:

  • Has a long half-life (stays in the body longer).

  • NOT used for variant angina.

• Continue or discontinue: Do not stop abruptly.