Pharm 118 (Week 3) - Ch 23 Part 1

Cardiovascular I :Cardiovascular I Chapter 23 Antianginal Drugs This lecture is to be utilized for the sole purpose of educational learning only 1


Coronary Artery Disease :Coronary Artery Disease 2 Reference: revolutionhealth.com


Coronary Artery Disease :Coronary Artery Disease Ischemia Poor blood supply to an organ Ischemic heart disease Poor blood supply to the heart muscle Atherosclerosis Coronary artery disease Myocardial infarction (MI) Necrosis, or death, of cardiac tissue Disabling or fatal 3


Coronary Artery Disease :Coronary Artery Disease Angina Pectoris (Chest Pain) When the supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle “aches” The heart requires a large supply of oxygen to meet the demands placed on it 4


Angina :Angina Types of Angina Chronic stable angina (also called classic or effort angina) Unstable angina(also called preinfarction or crescendo angina) Vasospastic angina(also called Prinzmetal’s or variant angina) 5


Drugs for Angina :Drugs for Angina Nitrates/nitrites b(beta)-blockers Calcium channel blockers 6


Nitrates/Nitrites :Nitrates/Nitrites Cause vasodilation due to relaxation of smooth muscles Potent dilating effect on coronary arteries Used for prevention and treatment of angina Vasodilation results in reduced myocardial oxygen demand Nitrates cause dilation of both large and small coronary vessels Result: oxygen to ischemic myocardial tissue Nitrates alleviate coronary artery spasms 7


Nitrates/Nitrites :Nitrates/Nitrites Nitroglycerin Prototypical nitrate Large first-pass effect with oral forms Used for symptomatic treatment of ischemic heart conditions (angina) IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies isosorbide dinitrate (Isordil, Sorbitrate, Dilatrate SR) isosorbide mononitrate (Imdur, Monoket, ISMO) Used for: Acute relief of angina Prophylaxis in situations that may provoke angina Long-term prophylaxis of angina 8


Nitrates/Nitrites :Nitrates/Nitrites Available forms Ointments* Transdermal patches* Translingual sprays* Sublingual* Buccal* Chewable tablets Oral capsules/tablets Intravenous solutions* * Bypass the liver and the first-pass effect Rapid-acting forms Used to treat acute anginal attacks Sublingual tablets; intravenous infusion Long-acting forms Used to PREVENT anginal episodes 9


Nitrates/Nitrites :Nitrates/Nitrites Adverse effects Headaches Usually diminish in intensity and frequency with continued use Tachycardia, postural hypotension or hypotension Tolerance may develop Dizziness Nausea, vomiting, incontinence Reflex tachycardia 10


Nitrates/Nitrites :Nitrates/Nitrites Reference: revolutionhealth.com Medication administration Sublingual preparations Under the tongue Check expiration date on bottle Protect the medication from heat and light Sustained-release (SR) Do not crush or chew Topical forms Rotate sites Remove old patch 11


Nitroglycerin Nursing Implications :Nitroglycerin Nursing Implications Instruct patients in proper technique and guidelines for taking sublingual NTG for anginal pain Instruct patients never to chew or swallow the SL form Instruct patients that a burning sensation felt with SL forms indicates that the drug is still potent or working Instruct patients to keep a fresh supply of NTG on hand; potency is lost in about 3 months after the bottle has been opened Medications should be stored in an airtight, dark glass bottle with a metal cap and no cotton filler to preserve potency Instruct patients to take prn nitrates at the first hint of anginal pain Monitor VS frequently during acute exacerbations of angina and during IV administration If experiencing chest pain, the patient taking SL NTG should be lying down to prevent or decrease dizziness and fainting that may occur due to hypotension 12


Nitroglycerin Nursing Implications :Nitroglycerin Nursing Implications If anginal pain occurs: Stop activity and sit or lie down Take a SL tablet, and wait 5 minutes If no relief in 5 minutes, take a second SL tablet If no relief in 5 minutes, take a third SL tablet After three tablets/15 minutes, if no relief of chest pain, call Emergency Services/911 immediately IV forms of NTG must be given with special non-PVC tubing and bags Discard parenteral solution that is blue, green, or dark red Follow specific manufacturer’s instructions for IV administration Do not try to drive to the hospital 13