What causes angina? inadequate blood flow to the myocardium due to either plaque occlusions w/in or spasms of the coronary arteries. Decreased blood flow = decreased O2 to myocardium results in pain.
Anti-anginal drugs increase blood flow either by increasing oxygen supply or decreasing demand by the myocardium.
3 Types: Nitrates, Beta blockers, and Calcium Channel Blockers
Nitrates— major systemic effect is a reduction of venous tone, which decreases the workload of the heart and promotes vasodilation. Cause generalized vascular and coronary vasodilation, w/c increases blood flow through the coronary arteries to the myocardial cells. Reduces myocardial ischemia but can cause hypotension.
- Prototype drug: Nitroglcerin (Nitrostat, Nitrobid) - vasodilator; sublingual, the effects of SL last for 10minutes; client can use a maximum of 3 tablets, if pain is not relieve call 911.
- client may experience dizziness, faintness or headache as a result of peripheral vasodilation.
- causes relaxation and dilation, reduces cardiac preload and afterload and reduces myocardial 02 demand.
- ONSET: SL and IV, rapid 1-3mins; Trandermal 30-60minutes, patch should be removed nightly to avoid tolerance, 8-12 hour nitrate free interval. TD should be tapered.
- HA, hypotension, dizziness, weakness, faintness
- decrease the workload of the heart and decrease oxygen demand.
- blocks beta-1 and beta-2
- decrease the effects of SNS by blocking the action of cathecolamines (epinephrine, norepinephrine), thereby reducing heart rate and BP
- used as antianginal, antidysrhythmic, and antihypertensive drugs
- should be tapered of to avoid reflex tachycardia and recurrence of anginal pain
- Contraindicated: pts who have low HR and BP; clients who have 2nd or 3rd degree AV block
- decrease workload of the heart, which decreases oxygen demand.
- Blocks influx of calcium into cardiac cells
- relax coronary artery spasm
- relax peripheral arterioles
- decrease cardiac contractility
- decrease afterload
- decrease peripheral resistance
Nitrates and calcium channel blocker - effective in treating variant angina pectoris.
Beta blockers- for stable angina
Unstable angina, immediate medical care. Nitrates are usually given SQ and IV as needed. If cardiac pain continues, a beta blocker is given intravenously, if bblocker is not tolerated, calcium channel blocker can be used as substitute.
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