Wednesday, April 4, 2012

ANTIANGINAL DRUG GROUPS


BETA-BLOCKERS

·         Decrease effects of sympathetic nervous system by blocking the action of catecholamies epinephrine and norepinephrine thereby decreasing the heart rate and blood pressure
·         Indication:
o    Angina, dysrhythmia, hypertension
·         Contraindication:
o    Heart block, bradycardia,pulmonary edema, cardiogenic shock, bronchopastic disease, hypersensitivity

Example:
atenolol (Tenormin®)
betaxolol (Betoptic®)
carvedilol (Coreg®)
metropolol (Lopressor®)
nadolol (Corgard®)
propanolol (Inderal®)

Side Effects:

·         Decreased HR and BP
·         Palpitations
·         Bronchospasm
·         Edema
·         Behavioral or psychotic response
·         Impotence (Inderal)
·         Heart Failure

Nursing Considerations:

ü  Monitor HR and BP.
ü  Assess frequency and characteristics of anginal attacks.
ü  Provide patient teachings:
o    Avoid alcohol, hot baths, saunas, and whirlpools, as they can cause vasodilation which can lead to hypotension and fainting.
o    Do not abruptly discontinue as rebound hypertension can occur.
o    Teach patient to check pulse and notify healthcare provider if HR is <60 bpm.
o    Report side effects.
o    Change positions gradually to minimize hypotension.
o    Warn patients with diabetes that beta blockers may mask the increase heart rate associated with decrease blood sugar.


CALCIUM CHANNEL BLOCKERS

·         Decrease cardiac contractility (negative inotropic effect), decrease afterload, peripheral resistance, workload of the heart to decrease need for oxygen
·         Indication:
o    Variant angina, classic angina, hypertension, cardiac dysrhythmia
·         Contraindication:
o    Hepatic and renal disease, cardiogenic shock, hypersensitivity

Example:
        amlodipine (Norvasc®)
       diltiazem (Cardizem®)
       nifedipine (Procadia®, Adalat®)
       verapamil Hydrochloride  (Calan®, Isoptin®)



Side Effects:

·         Headache
·         Hypotension (with nifedipine use only)
·         Dizziness
·         Flushing
·         Reflex tachycardia
·         Peripheral edema
·         Adverse effect: sudden cardiac death (nifedipine)

Nursing Considerations:

ü  Obtain patient history before therapy and reassess regularly.
ü  Obtain baseline BP, HR and rhythm and monitor.
ü  Monitor ECG during therapy and when dose is adjusted.
ü  Monitor for adverse effects.
ü  Obtain apical HR and BP before administering the drug.
ü  Assist with ambulation (dizziness may occur).
ü  Monitor serum drug levels and blood studies such as liver function tests.
ü  Advise patient that sodium and fluid intake may be restricted to minimize edema.

NITRATES

·         Causes generalized vascular and coronary vasodilation to increase blood flow through coronary arteries to the myocardial cells; decreases myocardial demand for oxygen
·         Indication:
o    Variant and classic angina
·         Contraindication:
o    Marked hypotension, acute MI, pericardial tamponade, severe anemia, or concurrent use with sildenafil (Viagra), hypersensitivity

   
Example:
        isosorbide mononitrate (Imdur, Ismo®)
       isosorbide dinitrate (Isordil®)
       nitroglycerin (Nitro-Bid®, Nitrostat®, Nitrol®)

Side Effects:

·         Headache (with Nitroglycerin use only)
·         Hypotension
·         Dizziness
·         Weakness and faintness
·         Rebound effect of severe pain by myocardial ischemia
·         Reflex tachycardia
·         Decreased heart rate
·         Contact dermatitis – ointment or transdermal nitroglycerin tolerance

Nursing Considerations:

ü  Monitor vital signs for hypotension.
ü  Have the patient sit or lie down when taking a nitrate for the first time. Have patient rise slowly to a standing position.
ü  Offer sips of water before giving sublingual nitrates.
ü  Monitor effects of nitroglycerin. Report persistence of angina.
ü  Provide acetaminophen for relief of headache.
ü  Apply ointment (Nitro-Bid) to designated part; use tongue blade or gloves.
ü  Do not touch medication portion for Transderm-nitro patch.
ü  Do not apply on the vicinity of defibrillator-cardioverter paddle placement (Explosion or skin burns may occur). 
ü  Provide patient teaching:



Nursing Considerations:

ü  Monitor vital signs for hypotension.
ü  Have the patient sit or lie down when taking a nitrate for the first time. Have patient rise slowly to a standing position.
ü  Offer sips of water before giving sublingual nitrates.
ü  Monitor effects of nitroglycerin. Report persistence of angina.
ü  Provide acetaminophen for relief of headache.
ü  Apply ointment (Nitro-Bid) to designated part; use tongue blade or gloves.
ü  Do not touch medication portion for Transderm-nitro patch.
ü  Do not apply on the vicinity of defibrillator-cardioverter paddle placement (Explosion or skin burns may occur). 
Provide patient teaching

o    Change position slowly to prevent orthostatic hypotension.
o    Nitroglycerin can lose potency if exposed to light, heat or moisture. Discard cotton packing after opening the bottle.
o    Replace tablets 6 months after opening.
o    Avoid alcohol, hot baths, saunas, and whirlpools, as they can cause vasodilation which can lead to hypotension and fainting.
o    Encourage the patient to discontinue tobacco use (causes vasoconstriction).
o    Inform patient about side effects.
o    Report if dry mouth, severe headaches, or blurred vision occur.

Sublingual Tablets:
o    Teach patient to lie down and take SL tablet as soon as possible if patient has acute anginal attack. Up to 3 tablets every 5 minutes for 15 minutes may be taken. If no relief, emergency services should be notified for transport to emergency room.
o    Do not chew SL tablet; place under tongue to dissolve. Do not swallow.
Buccal:
o    Place tablet between upper lip and gum to dissolve.
Chewable Tablets:
o    Chew thoroughly and hold in mouth for 2 minutes before swallowing.
Oral Sustained-Release Tablets or Capsules:
o    Take with a full glass or water on an empty stomach, swallowing whole medication.
Lingual Aerosol:
o    Do not shake when administering. Hold can vertically and spray under tongue, do not swallow immediately.
Ointment:
o    Use applicator paper and follow directions for application (thin layer).
o    Do not get ointment on hands, it may cause headaches. Wash hands after applying.
o    Apply to nonhairy site and remove old residue before applying and rotate sites.
Transdermal:
o    Avoid application to skin folds or irritated areas.
o    Transdermal patch should be worn for 12-14 hours and then removed for 10-12 hours at night to prevent drug tolerance.
o    Remove old application, remove old residue, and apply at the same time daily, and rotate sites.
o    Advise patient that they can swim or bath with patch on, and to apply a new patch after removing old residue if patch should fall off.





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