Drug Therapy for Coronary Heart Disease

Drug Therapy for Coronary Heart Disease

Overview of Coronary Heart Disease

  • Clinical syndrome characterized by episodes of chest pain

    • Occurs with myocardial oxygen (O2) deficit

    • Produces myocardial ischemia

  • Causes of coronary heart disease:

    • Atherosclerotic plaque in coronary arteries

    • Coronary vasospasm

Development of Coronary Artery Disease (CAD)

  • Atherosclerotic plaque development and progression

    • Represents a continuum that progresses from angina to myocardial infarction (MI)

  • Three main types of angina:

    • Classic angina

    • Typically occurs with exertion or stress

    • Variant angina (also known as Prinzmetal’s or vasospastic angina)

    • Caused by coronary artery spasm

    • Unstable angina

    • Occurs at rest or with minimal exertion and is associated with worsening symptoms

Angina Pectoris

  • Definition: Angina pectoris is a clinical syndrome characterized by episodes of chest pain due to a myocardial oxygen supply deficit relative to demand.

Classic Anginal Pain

  • Characteristics:

    • Substernal chest pain that is:

    • Constricting

    • Squeezing

    • Suffocating

    • Pain may radiate to:

    • Jaw

    • Neck

    • Shoulder

    • Both arms

    • Back

    • Symptoms may be confused with:

    • Arthritis

    • Indigestion

  • Associated symptoms:

    • Nausea and vomiting (N/V)

    • Dizziness

    • Diaphoresis

    • Shortness of breath (SOB)

    • Fear of impending doom

  • Gender differences exist in symptom quality:

    • Women may report different symptoms, such as epigastric or back discomfort.

True or False Questions

  1. Angina pectoris is a clinical syndrome characterized by episodes of chest pain.

    • Answer: True

    • Rationale: Angina pectoris occurs due to an imbalance between myocardial oxygen supply and demand.

  2. Cardiac symptoms are pretty much the same in everyone.

    • Answer: False

    • Rationale: Symptoms differ according to gender; women may have varied symptomatology.

Overlapping Factors in CAD

  • Coronary atherosclerosis

  • Myocardial ischemia

    • Associated with acute coronary syndrome (ACS)

  • Resultant cardiovascular impairments

Nonpharmacologic Management of CAD

  • Risk factor modification:

    • Implement lifestyle changes and medications

    • Address obesity

    • Smoking cessation

    • Manage elevated triglycerides and cholesterol

    • Control elevated blood pressure and fasting glucose

  • Patient education regarding the management of CAD

  • Revascularization and interventional procedures for advanced cases

True or False Question

  1. Optimal management of CAD involves lifestyle changes and medications.

    • Answer: True

    • Rationale: Management of CAD, irrespective of MI symptoms, requires changes in lifestyle and medications when necessary.

Pharmacologic Management of CAD

  • Classes of drugs used:

    • Organic nitrates (e.g., nitroglycerin)

    • Beta-adrenergic blocking agents (e.g., atenolol)

    • Calcium channel blocking agents (e.g., nifedipine):

    • Actions:

      • Reduce myocardial oxygen demand

      • Increase myocardial blood supply

    • Metabolic modulators (e.g., ranolazine):

    • Function to preserve cardiac function without decreasing heart rate or blood pressure (BP)

Adjunctive Antianginal Drugs

  1. Drugs with antithrombotic effects:

    • Aspirin

    • Adenosine diphosphate receptor antagonists

    • Glycoprotein IIb/IIIa receptor antagonists

  2. Antilipidemics:

    • Reduce serum cholesterol

  3. Antihypertensives:

    • Reduce blood pressure

  4. Angiotensin-converting enzyme inhibitors:

    • Cause vasodilation

  5. Morphine:

    • Relieves pain, reduces anxiety, decreases preload

  6. Thrombolytic drugs:

    • Dissolve thrombi and restore blood flow

Goals of Therapy for CAD

  • Relieve acute anginal pain

  • Reduce the number and severity of acute anginal attacks

  • Improve exercise tolerance and quality of life

  • Delay progression of CAD

  • Prevent myocardial infarction and sudden cardiac death

Special Populations in Antianginal Drug Use

  • Considerations for:

    • Children

    • Older adults

    • Individuals with renal impairment

    • Individuals with hepatic impairment

    • Patients in critical illness

    • Home care settings

Nursing Implications

  • Key nursing responsibilities:

    • Preventing drug interactions

    • Administering medications

    • Assessing for therapeutic effects

    • Assessing for adverse effects

    • Patient teaching related to CAD and its management.