1. Drugs Used to Treat Angina Pectoris
Chapter 25
Drugs Used to Treat Angina Pectoris
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2. Chapter 25
Lesson 25.1
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3. Objectives Define angina pectoris Define ischemic heart disease
Identify assessment data needed to evaluate an anginal attack
Implement medication therapy health teaching for an anginal patient in the clinical setting
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4. Objectives (cont’d)
Explain the rationale for the use of HMG-CoA reductase inhibitors (statins) in the treatment of cardiovascular disease
Describe the actions of nitrates, beta-adrenergic blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors on the myocardial tissue of the heart
Slide 4
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5. Angina Pectoris
Chest discomfort arising from the heart due to lack of oxygen to the heart muscle
Variable presentations
Squeezing in the chest, pressure, tightness, choking, burning, heaviness, may radiate to neck, shoulder, jaw
Precipitating factors
Physical activity, exposure to cold, drinking caffeine-containing beverages, smoking, emotional stress, sexual intercourse, eating large meals
Symptom of coronary artery disease (CAD) caused by plaque buildup in blood vessels (atherosclerosis) or a spasm of the artery.
Attacks may last from 30 seconds to 30 minutes and are often described as feeling like someone or something is sitting on the chest.
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6. Types of Angina Pectoris
Chronic stable angina
Precipitated by stress or exertion, short duration
Relieved by rest or nitroglycerin
Probable cause: fixed atherosclerotic obstruction
Unstable angina
Unpredictable; changes in frequency, duration, and onset
Probable cause: atherosclerosis and thrombus formation
Variant angina
Occurs at rest, characteristic ECG changes
Probable cause: vasospasm of the coronary artery
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7. Treatment of Angina Pectoris
Goals
Prevent myocardial infarction and death
Pain relief
Alternatives to drug therapy
Coronary angioplasty
Coronary artery bypass surgery
Patient education
Avoid precipitating factors
Reduce risk factors
Exercise
Symptoms must be caught early so quality of life can be improved and life can be prolonged.
Risk factors include diabetes mellitus, hypertension, and dyslipidemia.
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8. Drug Classes that Treat Angina
Nitrates
Beta-adrenergic blocking agents
ACE inhibitors
Calcium channel blockers
Fatty oxidase enzyme inhibitors
Statins
Platelet-active agents
Nitrates are the oldest of all the drugs and are very effective.
Combination therapy is beneficial for many patients.
Statins have become a standard in drug therapy.
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9. Nursing Process for Anginal Therapy
Obtain history of attacks
Precipitating factors
Characterize attacks
CNS involvement
Cardiovascular signs
Obtain medication history
Prescription and nonprescription
Effect of agents used on attacks
Obtain nutritional history
History of high cholesterol
CNS involvement may be in the form of confusion, restlessness, or irritability, as well as syncope and anxiety.
Cardiovascular signs include palpitations, peripheral pulses, and vital signs.
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10. Patient Education Correct use of prescription medications
Common adverse effects from prescription medication
Avoid fatigue and cold weather
Lifestyle modifications
Smoking cessation referral, if necessary
Always stop activity or exercise when chest pain is present
Patient self-assessment form
It often helps patients to use a pill organizer.
Rapid lifestyle adjustments can lead to feelings of depression. Allow patients and families to verbalize feelings.
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11. Drug Class: Nitrates Nitroglycerin – most common drug Actions Uses
Decreases oxygen demand on heart; dilates arteries and veins; reduces blood volume; decreases preload on heart
Uses
Drug of choice to treat angina pectoris
Common adverse effects
Excessive hypotension, prolonged headache, tolerance
For specific drugs, see Table 25-1.
Patients can develop tolerance, especially when large doses are administered frequently. Nitrate-free periods are necessary.
As patients become adjusted to therapy, headaches usually diminish.
Drugs used for erectile dysfunction, such as sildenafil (Viagra), are contraindicated because a fatal drop in blood pressure may occur.
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12. Drug Class: Nitrates (cont’d)
Administration forms
Sublingual tablets – dissolve rapidly, primarily for acute attacks
Sustained-release capsules, tablets, ointment, transmucosal tablets, and transdermal patches – used prophylactically to prevent anginal attacks
Translingual spray – for acute and prophylaxis of attacks
Amyl nitrite for inhalation (glass vials)
Inform the patient of medication deterioration; every 3 months, nitroglycerin prescriptions should be refilled and a dark-colored glass container should be used for storage.
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13. Drug Class: Beta-Adrenergic Blocking Agents
Actions
Block beta adrenergic receptors in heart
Reduce myocardial oxygen demand
Reduce blood pressure
Uses
Reduce the number of anginal attacks
Reduce nitroglycerin use
See Chapter 23 for further discussion
For specific drugs, see Table 13-3.
Therapy should start at low doses and work upward for patient tolerance.
Combination therapy with nitrates is more effective than using either drug alone.
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14. Drug Class: Calcium Channel Blockers
Actions
Inhibit flow of calcium ions across cell membrane
Reduce peripheral vascular resistance
Improve coronary blood flow
Uses
Reduce incidence of MI, secondary prevention for patients with known coronary artery disease
See Chapter 23 for further discussion
For specific drugs, see Table 25-2.
Potent vasodilators; have an overall effect on myocardial activity.
Should be used with caution in patients who may be developing heart failure.
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15. Drug Class: ACE Inhibitors
Actions
Promote vasodilation, minimize cellular aggregation, prevent thrombus formation
Uses
Reduce incidence of MI; secondary prevention for patients with known coronary artery disease (CAD)
See Chapter 23 for further discussion
For specific drugs, see Table 23-5.
Also recommended for patients with acute MI or heart failure with left systolic dysfunction.
Adverse effects such as dizziness, tachycardia, and fainting may occur within 3 hours after the first several doses.
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16. Drug Class: Fatty Oxidase Enzyme Inhibitor
Drug: ranolazine (Ranexa)
Actions
Enzyme modulator that affects the metabolism within myocardial cells to reduce oxygen demand
Uses
Treat chronic stable angina
Common adverse effects
Dizziness, headache, constipation, nausea
Used in combination with calcium channel blockers, beta-blockers, or nitrates.
Does not affect blood pressure or heart rate. Prolongs Q-T interval; does not reduce symptoms of an acute attack.
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