Antianginal agents antidysrythmic agents
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Antianginal Agents . Antidysrythmic Agents. Coronary Ischemia: Supply and Demand Economics. Coronary Ischemia : Supply and Demand Economics. The Grip of Angina. Supply-Demand Mismatch. Myocardial Oxygen Demand. Heart Rate. Wall Stress. Contractility.

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Antianginal Agents . Antidysrythmic Agents

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Antianginal agents antidysrythmic agents

Antianginal Agents.Antidysrythmic Agents


Coronary ischemia supply and demand economics

Coronary Ischemia:Supply and Demand Economics


Coronary ischemia supply and demand economics1

Coronary Ischemia: Supply and Demand Economics


The grip of angina

The Grip of Angina


Supply demand mismatch

Supply-Demand Mismatch


Antianginal agents antidysrythmic agents

Myocardial Oxygen Demand

HeartRate

Wall Stress

Contractility

Adapted from Runge et al, Netter’s Cardiology


Determinants of myocardial oxygen supply

Determinants of Myocardial Oxygen Supply


Determinants of myocardial oxygen supply1

Determinants of Myocardial Oxygen Supply


Coronary flow reserve

Coronary Flow Reserve

Adapted from Maseri A, Ischemic Heart Disease, Churchill Livingstone, 1995


Angina pectoris chest pain

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 demands a large supply of oxygen to meet the demands placed on it.


Antianginal agents

Antianginal Agents

  • Nitrates

  • Beta blockers

  • Calcium channel blockers


Antianginal agents1

Antianginal Agents:

Therapeutic Objectives

  • Minimize the frequency of attacks and decrease the duration and intensity of anginal pain

  • Improve the patient’s functional capacity with as few side effects as possible

  • Prevent or delay the worst possible outcome, MI


Nitric oxide

Nitric Oxide

Opie LH: Heart Physiology Lippincot Williams & Wilkins, 2004


Antianginal agents nitrates

Antianginal Agents: Nitrates

Available forms:

SublingualOintments

BuccalTransdermal patches

Chewable tabletsInhalable sprays

CapsulesIntravenous solutions


Antianginal agents nitrates1

Antianginal Agents: Nitrates

Side Effects

  • Headache

    • Usually diminish in intensity and frequency with continued use

  • Tachycardia, postural hypotension

  • Tolerance may develop


Nitrate tolerance

Nitrate Tolerance

  • Occurs with chronic administration of long acting nitrates.

  • Efficacy of drug diminishes with chronic exposure (tachyphylaxis).

  • Tolerance readily reverses with nitrate free interval.


Adrenergic receptors

Adrenergic Receptors

Beta1

  • SA node, AV node, His-Purkinje system

  • Myocardium

  • Juxtaglomerular apparatus

  • Adipocytes

    Beta2

  • Peripheral and coronary vasculature

  • Bronchi

  • Peripheral Muscle

  • Uterine Muscle

    Alpha

  • Peripheral circulation

Beta-1

Beta-2

Alpha

Adapted from Runge et al, Netter’s Cardiology


Antianginal agents beta blockers

Antianginal Agents: Beta Blockers

Mechanism of Action

  • Decrease the HR, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart

  • Decrease myocardial contractility, helping to conserve energy or decrease demand


Antianginal agents beta blockers1

Antianginal Agents: Beta Blockers

Therapeutic Uses

  • Antianginal

  • Antihypertensive

  • Cardioprotective effects, especially after MI


Antianginal agents calcium channel blockers

Antianginal Agents: Calcium Channel Blockers

  • verapamil (Calan)

  • diltiazem (Cardizem)

  • nifedipine (Procardia)


Role of calcium channels in myocardial contraction

Role of Calcium Channels in Myocardial Contraction

Opie LH, Heart Physiology, Williams Lippincott and Williams 2004


Role of calcium channel in vascular smooth muscle function

Role of Calcium Channel in Vascular Smooth Muscle Function

Opie LH, Heart Physiology, Williams Lippincott and Williams 2004


Antianginal agents calcium channel blockers1

Antianginal Agents: Calcium Channel Blockers

Mechanism of Action

  • Cause peripheral arterial vasodilation

  • Reduce myocardial contractility (negative inotropic action)

  • Result: decreased myocardial oxygen demand


Antianginal agents calcium channel blockers2

Antianginal Agents: Calcium Channel Blockers

Therapeutic Uses

  • First-line agents for treatment of angina, hypertension, and supraventricular tachycardia

  • Short-term management of atrial fibrillation and flutter

  • Several other uses


Antianginal agents calcium channel blockers3

Antianginal Agents: Calcium Channel Blockers

Side Effects

  • Very acceptable side effect and safety profile

  • May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea


Treatment of ischemic heart disease

Treatment of Ischemic Heart Disease


Antianginal agents nursing implications

Antianginal Agents: Nursing Implications

  • 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.


Antianginal agents nursing implications1

Antianginal Agents: Nursing Implications

  • Alcohol consumption and hot baths or spendingtime in jacuzzis, hot tubs, or saunas will result in vasodilation, hypotension, and the possibility of fainting.

  • Teach patients to change positions slowly to avoid postural BP changes.

  • Encourage patients to keep a record of their anginal attacks, including precipitating factors, number of pills taken, and therapeutic effects.


Antianginal agents nitroglycerin

Antianginal Agents: 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.


Antianginal agents nitroglycerin1

Antianginal Agents: Nitroglycerin

Nursing Implications

  • Patients are taught to take up to three tablets every 5 minutes. If no relief from chest pain is obtained after three tablets, they should seek medical assistance.

  • Absorption nitroglycerin ointments best over a nonfatty and nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves when applying to prevent transdermal absorption by the applier. The ointment is measured as one straight line on the nitroglycerin patch and is gently spread over paper and applied, but not rubbed, into the skin.


Antianginal agents nitroglycerin2

Antianginal Agents: Nitroglycerin

Nursing Implications

  • 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.


Antianginal agents nitroglycerin3

Antianginal Agents: Nitroglycerin

Nursing Implications

  • 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.


Antianginal agents nitroglycerin4

Antianginal Agents: Nitroglycerin

Nursing Implications

  • Instruct patients to take prn nitrates at the first hint 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 acuteexacerbations of angina and during IV administration.


Antianginal agents nitroglycerin5

Antianginal Agents: Nitroglycerin

Nursing Implications

  • 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 blockers4

Antianginal Agents: Calcium Channel Blockers

Nursing Implications

  • Blood levels should be monitored to ensure they are therapeutic.

  • Oral CCBs should be taken before meals and as ordered.

  • Patients should be encouraged to limit caffeine intake.


Antianginal agents beta blockers2

Antianginal Agents: Beta Blockers

Nursing Implications

  • 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 blockers3

Antianginal Agents: Beta Blockers

Nursing Implications

  • These medications should never be abruptly discontinued due to risk of rebound hypertensive crisis.

  • Inform patients that these medications are for long-term prevention of angina, not for immediate relief.


Antidysrhythmics

Antidysrhythmics

Dysrhythmia

  • Any deviation from the normal rhythm of the heart

    Antidysrhythmics

  • Drugs used for the treatment and prevention of disturbances in cardiac rhythm


Heart and conduction system

Heart and Conduction System


Resting membrane potential of a cardiac cell

Resting Membrane Potential of a Cardiac Cell


Abnormal heart rhythms

Abnormal Heart Rhythms


Premature ventricular contraction

Premature Ventricular Contraction


Action potential

Action Potential

  • A change in the distribution of ions causes cardiac cells to become excited.

  • The movement of ions across the cardiac cell’s membrane results in the propagation of an electrical impulse.

  • This electrical impulse leads to contraction of the myocardial muscle.


Action potentials phases sa node

Action Potentials: Phases (SA Node)


Action potentials purkinje fiber

Action Potentials: Purkinje Fiber


Action potentials intervals

Action Potentials: Intervals


Abnormal heart rhythms1

Abnormal Heart Rhythms

  • Caused by:

    • ischemia, infarction, alteration of body chemicals

  • Symptoms:

    • palpitations, syncope, lightheadedness, visual disturbances, pallor, cyanosis, weakness, sweating, chest pain, hypotension


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