Chapter 24

Chapter Overview

  • Title: Drugs Used to Treat Angina Pectoris

  • Source: Clayton’s Basic Pharmacology for Nurses, 19th edition

  • Author: Michelle Willihnganz, MS, RN, CNE

Lesson Objectives

  • Define Angina Pectoris: Recognize symptoms and assessment data

  • Assessments: Identify key assessment data to evaluate anginal attacks

  • Types of Angina: Differentiate between chronic stable angina and unstable angina

  • Drug Actions and Adverse Effects: Describe drug classifications for angina treatment

  • Risk Factors and Lifestyle Changes: Discuss management strategies to prevent disease progression, myocardial infarction, and death.

Angina Pectoris

  • Definition: Chest discomfort due to inadequate oxygen supply to the heart muscle.

  • Symptoms:

    • Squeezing sensation, pressure, tightness, choking, burning, heaviness.

    • May radiate to neck, shoulder, jaw.

  • Precipitating Factors:

    • Physical activity, cold exposure, caffeine, smoking, emotional stress, sexual activities, large meals.

Types of Angina Pectoris

  • Chronic Stable Angina:

    • Precipitated by stress/exertion; short duration.

    • Relieved by rest or nitroglycerin.

    • Cause: Fixed atherosclerotic obstruction.

  • Unstable Angina:

    • Unpredictable changes in frequency, duration, and onset.

    • Cause: Atherosclerosis and thrombus formation.

  • Variant Angina (Prinzmetal's Angina):

    • Occurs at rest with characteristic ECG changes.

    • Cause: Vasospasm of the coronary artery.

Treatment Goals for Angina Pectoris

  • Prevent myocardial infarction (MI) and death.

  • Provide pain relief.

  • Alternatives to Drug Therapy:

    • Coronary angioplasty, bypass graft surgery.

  • Patient Education:

    • Avoid known precipitating factors, reduce risk factors, engage in exercise.

Drug Classes Used to Treat Angina

  • Nitrates: Primary treatment for angina.

  • Beta-adrenergic Blocking Agents: Reduce oxygen demand on the heart.

  • ACE Inhibitors: Promote vasodilation and prevent thrombus formation.

  • Calcium Channel Blockers: Improve coronary blood flow, reduce peripheral vascular resistance.

  • Fatty Oxidase Enzyme Inhibitors and Statins: Additional treatment options.

  • Platelet-active Agents: Prevent clot formation.

Nursing Process for Anginal Therapy

  • History Taking:

    • Evaluate history of anginal attacks, precipitating factors, CNS and cardiovascular signs.

  • Medication History:

    • Review prescription and OTC medications.

  • Nutritional Assessment:

    • Check for history of high cholesterol.

Drug Class: Nitrates

  • Nitroglycerin:

    • Main drug for angina treatment.

    • Actions: Decreases heart's oxygen demand; dilates arteries/veins; lowers blood volume and preload.

    • Adverse Effects: Hypotension, prolonged headache, tolerance.

    • Caution: Avoid use with erectile dysfunction drugs (e.g., sildenafil).

Administration Forms for Nitrates

  • Sublingual Tablets: For acute attacks, dissolve rapidly.

  • Sustained-Release Tablets/Patches: Used prophylactically.

  • Transmucosal Tablets/Solutions: For immediate effect.

  • IV Forms: Used in acute care settings with continuous monitoring.

Sublingual Use for Emergencies

-Instructions:

  • Patient should sit/lie down, place tablet under tongue without swallowing immediately.

  • If pain persists after 5 minutes, seek medical attention; may repeat dosing if necessary.

Storage and Maintenance for Sublingual Nitrates

  • Storage:

    • Keep in original dark glass container, discard 6 months after opening.

  • Carrying Nitrates: Always have available but not in direct body heat.

Patient Education for Nitrates

  • Transdermal Patch: Apply to clean, dry skin, avoid areas with hair or scars, replace if dislodged, avoid tolerance by removing overnight.

  • Intravenous Administration: Only in acute care settings; requires monitoring, use infusion pumps for accuracy.

Audience Response and Questions

  1. Common Adverse Effects of Sublingual Nitroglycerin: Headache.

  2. Action for Neighbor with Chest Pain: Chew an aspirin tablet after summoning an ambulance.

  3. Reason to Remove Transdermal Patch at Night: To prevent tolerance.

  4. Drug Class to Avoid with Nitrates: Erectile dysfunction drugs.

  5. Core Measure Post-MI: Ensure patients are discharged on Beta-Adrenergic Blockers.

Drug Class: Calcium Channel Blockers

  • Actions: Inhibit calcium flow across membranes; reduce resistance; improve blood flow.

  • Uses: Secondary prevention of MI in coronary artery disease.

Drug Class: ACE Inhibitors

  • Actions: Vasodilation, minimizes platelet aggregation, prevents thrombus.

  • Uses: Secondary prevention for patients with known coronary artery disease.

Drug Class: Ranolazine (Ranexa)

  • Action: Modulates metabolism in myocardial cells to reduce oxygen demand.

  • Common Adverse Effects: Dizziness, headache, constipation, nausea.

Patient Education

  • Importance of proper medication use and awareness of side effects.

  • Lifestyle changes: Smoking cessation, recognize and act on chest pain.

  • Utilize self-assessment forms to monitor condition.

Questions?

  • Open the floor for questions regarding the content presented.