ANTIANGINALS (NITRATES, BETA-BLOCKERS, CALCIUM CHANNEL BLOCKERS)

Nitrates (Nitroglycerin) – Mechanism

Vasodilates veins and arteries → ↓ preload/afterload → ↓ myocardial O₂ demand.

Nitroglycerin (SL) – Onset/Duration

Onset 1–3 min; duration 30–60 min; used for acute angina relief.

Nitroglycerin – Administration Rule

Take 1 tablet q5min × 3 max; call 911 if pain persists after first dose.

Nitroglycerin – Side Effects

Headache, flushing, hypotension, reflex tachycardia.

Nitroglycerin – Nursing Caution

Do not use with PDE-5 inhibitors (sildenafil); may cause severe hypotension.

Nitroglycerin – Storage

Keep in dark, tightly closed glass container; replace every 6 months after opening.

Nitroglycerin Patch – Teaching

Apply to hairless area; rotate sites; remove at night for nitrate-free interval.

Nitroglycerin Ointment – Application Steps

Gloves → measure dose → apply thin layer → cover → label site/time.

Nitroglycerin Toxicity

Persistent hypotension, blurred vision, or confusion—remove patch, notify provider.

Beta-Blockers (e.g., Metoprolol, Atenolol) – Mechanism

Decrease HR, contractility, and BP → reduce myocardial oxygen demand.

Beta-Blockers – Nursing Caution

Do not stop abruptly; can cause rebound angina or MI.

Beta-Blockers – Contraindications

Severe bradycardia, heart block, asthma (non-selective agents).

Calcium Channel Blockers (e.g., Verapamil, Diltiazem) – Mechanism

Block calcium influx → coronary vasodilation, ↓ HR, ↓ contractility.

Calcium Channel Blockers – Use

Variant (Prinzmetal) angina, HTN, atrial dysrhythmias.

Calcium Channel Blockers – Adverse Effects

Bradycardia, hypotension, peripheral edema, constipation.

Antianginal Nonpharmacologic 

Avoid heavy meals, stress, smoking; exercise and rest balance; healthy diet.