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.