Antianginal agents antidysrythmic agents
1 / 50

Antianginal Agents . Antidysrythmic Agents - PowerPoint PPT Presentation

  • Uploaded on

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.

I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
Download Presentation

PowerPoint Slideshow about 'Antianginal Agents . Antidysrythmic Agents' - keanu

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.

- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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

Antianginal agents antidysrythmic agents

Myocardial Oxygen Demand


Wall Stress


Adapted from Runge et al, Netter’s Cardiology

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:

Sublingual Ointments

Buccal Transdermal patches

Chewable tablets Inhalable sprays

Capsules Intravenous 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


  • SA node, AV node, His-Purkinje system

  • Myocardium

  • Juxtaglomerular apparatus

  • Adipocytes


  • Peripheral and coronary vasculature

  • Bronchi

  • Peripheral Muscle

  • Uterine Muscle


  • Peripheral circulation




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

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.



  • Any deviation from the normal rhythm of the heart


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

Resting membrane potential of a cardiac cell
Resting Membrane Potential of a Cardiac Cell

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.

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