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Antianginal Agents

Nursing (Our Lady of Fatima University)

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Antianginal Agents May develop at rest

 Nitrates More severe than stable angina

 Beta blockers
Caused by a combination atherosclerotic
 Calcium channel blockers
 Angina Pectoris (Chest Pain) narrowing and thrombus formation of vasospasm
 Vasospastic angina
1) When the supply of oxygen and nutrients in
the blood is insufficient to meet the demands (also called Prinzmetal’s or variant angina)
of the heart, the heart muscle aches.
Occurs while the patient is at rest
2) The heart demands oxygen to meet the on it.
3) a large supply of demands placed Caused by vasospasm of a coronary artery
reducing blood flow.
Types of Angina

Chionic stable angina

Antianginal Agents:
(also called classic or effort angina)
Theiapeutic Objectives

 Increase blood flow to ischemic heart

Unstable angina
muscle and/or
(also called preinfarction or crescendo angina)  Decrease myocardial oxygen demand
 Antianginal Agents:
 Minimize the decrease the anginal pain
Vasospastic angina  frequency of attacks and duration and
intensity of
(also called Prinzmetal’s or variant angina)  Improve the patient’s functional capacity
with as few side effects as possible
 Prevent or delay the worst possible
Chionic stable angina outcome, MI

(also called classic or effort angina)

Precipitated by physical exertion or stress Last

only a few minutes

Relieved by rest or nitroglycerin

Usually caused by a fixed atherosclerotic

obstruction in the coronary arteries.

Antianginal Agents: Nitiates

Unstable angina (also called pieinfaiction )

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 Available forms:  isosorbide mononitrate (Imdur, Monoket,

 Sublingual ISMO)
 Buccal
Used for:
 Ointments
 Transdermal patches 1) Acute relief of angina
 Chewable tablets Inhalable sprays 2) Prophylaxis in situations that may provoke
Capsules Intravenous solutions angina
1) Cause vasodilation due to relaxation of 3) Long-term prophylaxis of angina
smooth muscles
2) Potent dilating effect on coronary arteries
3) Used for prophylaxis and treatment of angina
Side Effects Headache
 Nitroglycerin thought to relax vascular
smooth muscle –Usually diminish in intensity and frequency with
 By conversion to Nitrite ions continued use

Tachycardia, postural hypotension Tolerance may

develop
Nitiic oxide guanylate cyclic cGMP
Antianginal Agents: Beta Blockeis
Dephosphorylation of myosin light chain
 atenolol (Tenormin) metoprolol
Smooth muscle relaxation
(Lopressor) propranolol (Inderal) nadolol
(Corgard)
 Antianginal Agents: Beta Blockers
Nitioglyceiin Piototypical nitiate

 Large first-pass effect with PO forms

 Used for symptomatic treatment of Mechanism of Action
ischemic heart conditions (angina)
 Decrease the HR, resulting in decreased
 IV form used for BP control in
myocardial oxygen demand and
perioperative hypertension, treatment of
increased oxygen delivery to the heart
CHF, ischemic pain, and pulmonary
 Decrease myocardial contractility,
edema associated with acute MI
helping to conserve energy or decrease
demand

 isosorbide dinitrate
 (Isordil, Sorbitrate, Dilatrate SR)

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 Cardioprotective effects, especially after  Several other uses

MI
 Antianginal Agents: Beta Blockers Side Effects

Very acceptable side effect and safety profile

Side Effects May cause hypotension, palpitations, tachycardia

or bradycardia, constipation, nausea, dyspnea

Body System Effects

 Cardiovascular bradycardia, hypotension

heart failure
 Metabolic Altered glucose and lipid
metabolism
 CNS dizziness, fatigue,
 mental depression, lethargy, drowsiness,
unusual dreams
 Other impotence wheezing, dyspnea
Antianginal Agents: Calcium Channel Blockeis
verapamil (Calan) diltiazem (Cardizem) nifedipine
(Procardia)
Antianginal Agents: Calcium Channel Blockers
Mechanism of Action
Cause peripheral arterial vasodilation Reduce
myocardial contractility
Result: decreased myocardial oxygen demand
Antianginal Agents: Nuising Implications
 Before administering, perform a
complete health history to determine
presence of conditions that may be
contraindication for use or call for
cautious use.
 Obtain baseline VS, including respiratory
patterns and rate.
 Assess for drug interactions.
 Patients should not take any
medications, including OTC medications,
without checking with the physician.
 Patients should report blurred vision,
persistent headache, dry mouth,
dizziness, edema, fainting episodes,
weight gain of
 2 pounds in 1 day or 5 or more pounds in
1 week, pulse rates under 60, and any
dyspnea.

 Alcohol consumption and hot baths or

Theiapeutic Uses
spending
 First-line agents for treatment of angina,  time in jacuzzis, hot tubs, or saunas will
hypertension, and supraventricular result in vasodilation, hypotension, and
tachycardia the possibility of fainting.

 Short-term management of atrial  Teach patients to change positions slowly

fibrillation and flutter to avoid postural BP changes.

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 Encourage patients to keep a record of
their anginal attacks, including
precipitating factors, number of pills
taken, and therapeutic effects.
Antianginal Agents: Nitioglyceiin
Nuising 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 felt with
 SL forms indicates that potent.
 burning sensation
 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 in the proper
application of nitrate topical ointments
and transdermal forms, including site
rotation and removal of old medication.
 To reduce tolerance, the patient may be
instructed to remove topical forms at
bedtime, and apply new doses in the
morning, allowing for a nitrate-free
period.
 Instruct patients to take prn nitrates at
the first hint
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 of anginal pain.
 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.
 Monitor VS frequently during acute
exacerbations of angina and during IV
administration.
 IV forms of NTG must be contained in
glass IV bottles and must be given with
infusion pumps.
 Discard parenteral solution that is blue,
green,
 or dark red.
 Follow specific manufacturer’s
instructions for IV administration. Use
special IV tubing provided or non-PVC
tubing.
Antianginal Agents: Calcium Channel Blockeis
 Blood levels should be monitored to
ensure they
 are therapeutic.
 Oral CCBs should be taken before meals
and
 as ordered.
 Patients caffeineshould be encouraged to
limit intake.
Antianginal Agents: Beta Blockeis
Nuising Implications
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 Patients taking beta blockers should

monitor pulse rate daily and report any
rate lower than 60 beats per minute.
 Dizziness or fainting should also be
reported.
 Constipation is a common problem.
Instruct patients to take in adequate
fluids and eat high-fiber foods.

Antianginal Agents: Beta Blockeis

1) These medications should never be abruptly

discontinued due to risk of rebound
hypertensive crisis.
2) Inform patients that these medications are
for
3) long-term prevention of angina, not for
immediate relief.
4) Antianginal Agents: Nursing Implications

Monitoi foi adveise ieactions

–Allergic reactions, headache, light-headedness,

hypotension, dizziness

Monitor for therapeutic effects –Relief of angina,

decreased BP, or both

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