can
Coronary Artery Disease (Definitions)
v Atheromas
o Fatty tumors in the intima of the heart vessels
v Atherosclerosis
o Narrowing of the heart vesselsautomaquermateetbunau
Chapter 46:
v Angina Pectoris
Antianginal Agents
o “Suffocation of the chest”
complainant
often
weigntonanestitianiga
tightness
pain
v Myocardial Infarctioneneartattacia
o Cells in the myocardium become necrotic and die
arteries
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provideougenomeosannecroseraie
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• Drugs that a ect the cardiovascular system
• supportive measures that we take for pts who are having chest pain
• chest pain is common in males
• females present in jaw pain
• The reason that ppl have heart attacks is b/c there are
arteries that supply blood to the heart muscle itself
◦those arteries become lled up with plaque and
become occluded. This part of the heart does not
receive blood and begins to die
• Intervention for a possible heart attack:
◦group e ort of HCPs: take labs, check troponins,
CK-MBs, vitals, ekgs., recheck in 5 min
◦morphine (helps with breathing and helps pt calm
down a lil bit),
◦oxygen for support (bcuz the heart is not getting
that much oxygen so it lessens the burden.
◦administer Nitroglycerin (1 tab)
Illustration of an atheromatous
plaque (a) and thrombus of
an atherosclerotic plaque (b)
• stable:
◦when ur walking around, all of a sudden you have
chest pain, then it goes away
• unstable:
◦happens when ur resting and comfortable then all of
a sudden u have chest pain (not a good sign bcuz
when ur resting u dont need that much oxygen vs
when ur moving around and doing things)
• prinzmetals: vasospasm + chest pain
◦Major vessels of the heart, due to the plaque buildup
are having spasms
◦Tx: calcium channel blockers- slows down the spasm
◦if we block the calcium from going thru the ion
channels it decreases the amount of intervation in the
heart and it slows down that spasm
Types of Angina
v Stable Angina
tuneannasies
o No damage to heart muscle; basic reflexes
surrounding the pain restore blood flow wpreuntomosomnaringrain
v Unstable Anginaemergencymaaswepta.es
wastetime.aqesaireatiyiounenospita qacnestpain
o Episodes of ischemia occur even when at rest
v Prinzmetal’s Angina
narrowingvasospa.ms
o Caused by spasm of the blood vessels, not just by
vessel narrowing
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thrombus
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man
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Acute Myocardial Infarction
Actions of Antianginal Drugs
v If a coronary vessel becomes completely occluded and is
unable to deliver blood to the cardiac muscle the area of
muscle that depends on that vessel for oxygen becomes
ischemic and then necrotic dies
v Improve blood delivery to the heart muscle by dilating
blood vessels vasodilation
o Resulting in excruciating pain, nausea and severe
sympathetic stress reaction
o ccluded
becomes
vessel
coronary
unassewaniverbooatoo
o Increasing the supply of oxygen
v Improve blood delivery to the heart muscle by
decreasing the work of the heart
o Decreasing the demand for oxygen
ischemia
necrosis dies
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aprovide
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supportive
nausea
semesympaineticstressreaction
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Gomofmeds
toimprovedeliveryto bycausing
vasodilation
increasing
ofoxygen
supply
the
b loodaeliverytotherbyttnework
improving
oxygen
bysiowingdowntneo atmedemandfor
• When a pt is having a heart attack:
◦the heart is working harder (contracting harder) so
it gets larger ➡ BP, HR, blood volume all
increases which leads to an increase of oxygen
consumption.
Factors Affecting Myocardial Oxygen
Demand and the Effect of Antianginalsmeds
Use of Antianginal Agents Across the
Lifespan
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warm
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main
man
armour
amusaecontractiategimorestby
cassowaries
vasodinationancwormessnaras
nitroglycerin
causes
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Types of Antianginal Drugs
v Nitrates
v Beta-Adrenergic Blockers
v Calcium Channel Blockers
DrugsforAngina
Nitrates #1
neprestonemeoggentomenean
muscrewnenmanenaosowirest
v Help restore the appropriate supply-and-demand ratio in
oxygen delivery to the myocardium when rest is not enough
o Nitroglycerin
v Actions
o Act directly on smooth muscle to cause relaxation and
depress muscle tonewasodination
v Indications
unstrain
o Prevention and treatment of attacks of angina pectoris
v Pharmacokinetics
o Very rapidly absorbed
o Metabolized in the liver
o Excreted in the urine bythenianeys
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Nitrates #2
Nitrates #3
v Contraindications dogivetnistoptswi
v Adverse Effects
to
o Allergy nitrates
o Related to the vasodilatation and decreased in blood
flow
o Severe anemia
o Head trauma or cerebral hemorrhage brain
b leeding
o Pregnancy and lactation
v Caution
o GI – Nausea, vomiting
o CV – Hypotension
untimnasanpped
o Misc. – Flushing, pallor increased perspiration
o Hepatic or renal disease
wer
o CNS – Headache, dizziness, weakness
inane
o Hypotension, hypovolemia, and conditions that limit
cardiac output monitrateswomanrinenoweromir
another
arguassasarmament
and
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v Drug-Drug Interactions
o Ergot derivatives
o Heparin
used
totreat
afungus
headaches
i nterneuronsanticoagulation
nitrates
erreasonerann
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Bioavailability
eneamountoraraginationaname
wineratient
any
Routes for Nitroglycerin
Nursing Considerations for Nitrates
v IV
v Assess:
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v Sublingual
unortonguiswreinaaryeaancareanrownv.ae
o Early MI, head trauma, cerebral hemorrhage,
hypotension, hypovolemia, anemia, or low-cardiacoutput states; and current status of pregnancy or
lactation
v Translingual Spray
v Transmucosal Tablet
sustainarenas
v Oral, SR Tablet
v Topical Ointment
o History and Physical Exam and known allergy
pasteawaeronortapewneneyonmeasure
outeneouse
v Transdermal
o Skin, complaint of pain, including onset, duration, whatsworked
intensity, location, and measures used to relieve it.wnatnasnewor.ca
o Respirations, LS, cardiac status, BP, baseline ECG
and appropriate lab valuescroponin
electrolytes
tomanesureevenpningswn
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• nitroglycerin is very quick acting
◦Onset: 1-2 min
◦Halftime: very short (1-4 min) means u can keep giving it
• for a pt getting nitro monitor their BP if it drops too much
◦slow down on the Nitro
Prototype Nitrates
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Beta blockers brings down the HR, BP, heart work less while
were tryna gure out whats going on with the heart
Beta Blockers #1
v Block the stimulatory effects of the sympathetic nervous
system
o Metoprolol
mama
ano
o Propranolol
important
nai
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my.ca
men
noncaraiospecificcaonigvetoptswnonaeastnmaacomsl.si
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Beta Blockers #2
v Actions
Beta Blockers #3
v Contraindications
o Blocks beta-adrenergic receptors in the heart and
kidneys, decreases the influence of the SNS on these
tissues; decreases cardiac output and the release of
renin
o Bradycardia
o Heart block
their
artrunner
bring
brian
selective
selective
cardio
themacardio
non
BBnot
give
o Asthma or COPD
v Caution
v Indications
o Treats stable angina pectoris and hypertension,
prevents reinfarction in MI patients; treats stable
CHF
v Pharmacokinetics
o DM
o PVD
o Thyrotoxicosis
norm
m uon
engroia
too
oneinbody
o Absorbed in GI tract, undergoes hepatic metabolism,
excreted in the urine
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renin
bythekidneys
produced
renin
thenwe
a ngiotensin
tothe
goes
get
a potentvasoconstrictors
c ascade lower
whole
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Be
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ogan
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Beta Blockers #4
Nursing Considerations for Beta Blockers
v Adverse Effects
v Assess:
o Related to their blockage of sympathetic nervous system
o History and Physical Exam and known allergy
o CNS – Dizziness, fatigue, emotional depression
o See chapter 31 for nursing considerations associated
with Beta Blockers
o GI – Nausea, vomiting, colitis
o CV – CHF, decreased cardiac output, and arrhythmias
o Respiratory – Bronchospasm, dyspnea, and cough
v Drug-Drug Interactionscarasooingenesameeningincreased
erect
o Clonidine
o NSAIDs
much
too
are
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Prototype Beta Blockers
Calcium Channel Blockers #1
v Inhibit the movement of calcium ions across the membranes of
myocardial and arterial muscle cells
o Diltiazem
v Actions
o Inhibit the movement of calcium ions across the
membranes of myocardial and arterial muscle cells,
altering the action potential and blocking muscle cell
contraction
v Indications
o Prinzmental’s angina cnarrowingevasospasms
nature
v Pharmacokinetics
o Well absorbed
o Metabolized in the liver
o Excreted in the urine
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Calcium Channel Blockers #2
Calcium Channel Blockers #3
v Contraindications
v Adverse Effects
o Allergy
tocarciumaramablockers
o Hypotension
B
o Heart block or sick sinus syndrome
o Cardiac arrhythmias messes
w irmpomortner
o Renal or hepatic dysfunction
o GI upset
o Pregnancy or lactation
o Skin reactions
o Headache
v Drug-Drug Interactions
o Cyclosporine
o Digoxin
o Vary with each drug
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Nursing Considerations for Calcium
Channel Blockers
Prototype Calcium Channel Blockers
v Assess:
o History and Physical Exam, known allergy
o Impaired liver or kidney function
prevents movementcalcium
ions
one
or
cardiac
move
membrane
across
one
that
muscemaxion
come
remains
moon
rest
o Baseline status, skin, complaint of pain, including
onset, duration, intensity, and location, and
measures used to relieve the pain
o Cardiopulmonary status, baseline ECG, respirations,
LS and appropriate lab values
importantnow timing
the
its
we
remain
now
one
drug
and
win
long
artisan
in
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me
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Heart Attack intervention from doctor:
◦catheter with stents
◦balloon and suction out the clot
• Once a tissue is dead, its dead
• To get blood supply back to that area a procedure that
can be done is:
◦Stent: metal mesh that goes in and opens up
◦Balloon: goes in and sucks out the clot
◦Coronary Artery Bypass Graft (CABG): they take
a vein out to bypass the narrowed areas and
restore the blood ow to the heart
Micellaneous Agent #1
Ranolazine #2
v Ranolazine
v Adverse Effects: Dizziness, headache, nausea, constipation
v Effective in treating angina and has added benefits of
decreasing blood glucose levels in diabetic patients and
decreasing incidence of ventricular fibrillation, atrial
fibrillation, and bradycardia in chronic angina patients
v Drug-drug interactions
o Diltiazem
o Verapamil
v Oral ER tablet
o Macrolide antibiotics
v Mechanism of action not understood
o HIV protease inhibitors
v Contraindications: known sensitivity, hepatic impairment,
lactation
o TCAs and antipsychotics
o Digoxin
v Caution: pregnancy, renal impairment
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