NURS 3210 CH 23 PPT
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Questions and Answers

What is the primary indication for metoprolol in patients with angina?

Prophylactic treatment of angina

How does beta blocker therapy benefit a patient who has had an MI?

Slowing of the heart rate

What is the effect of beta blockers on the heart in patients with ischemic heart disease?

Reducing myocardial oxygen demand

What is the benefit of using IV metoprolol in hospitalized patients after an MI?

<p>Reduces mortality rate</p> Signup and view all the answers

What is the role of nitrate therapy in angina management?

<p>Relaxing vascular smooth muscle and reducing preload</p> Signup and view all the answers

How do calcium channel blockers affect the heart in patients with angina?

<p>Reducing myocardial contractility and lowering blood pressure</p> Signup and view all the answers

What is the goal of angina management?

<p>Reducing frequency and severity of angina attacks</p> Signup and view all the answers

How do beta blockers help in preventing myocardial infarction?

<p>Reducing heart rate and blood pressure</p> Signup and view all the answers

What is the primary mechanism by which beta blockers improve survival after a myocardial infarction?

<p>By blocking the harmful effects of catecholamines</p> Signup and view all the answers

What is a common indication for the use of beta blockers?

<p>Angina, antihypertensive, cardiac dysrhythmias</p> Signup and view all the answers

What is a contraindication for the use of beta blockers?

<p>Systolic heart failure</p> Signup and view all the answers

What is a common adverse effect of beta blockers on the cardiovascular system?

<p>Bradycardia, hypotension, atrioventricular block</p> Signup and view all the answers

What is the mechanism of action of atenolol?

<p>Cardioselective beta1-adrenergic receptor blocker</p> Signup and view all the answers

What is a potential benefit of using beta blockers after a myocardial infarction?

<p>Decreased mortality</p> Signup and view all the answers

What is a potential adverse effect of beta blockers on the metabolic system?

<p>Hyperglycemia, hypoglycemia, hyperlipidemia</p> Signup and view all the answers

What is a potential contraindication for the use of beta blockers in patients with diabetes mellitus?

<p>Masking hypoglycemia-induced tachycardia</p> Signup and view all the answers

What is the primary mechanism of action of calcium channel blockers that contributes to decreasing myocardial oxygen demand?

<p>Causing coronary artery vasodilation and peripheral arterial vasodilation, thus decreasing systemic vascular resistance.</p> Signup and view all the answers

Which calcium channel blocker is specifically used to treat cerebral artery spasms associated with aneurysm rupture?

<p>Nimodipine</p> Signup and view all the answers

What is a contraindication for the use of calcium channel blockers?

<p>Second- or third-degree AV block (unless the patient has a pacemaker)</p> Signup and view all the answers

What is the primary indication for the use of diltiazem (Cardizem, Dilacor, Tiazac)?

<p>Treatment of angina pectoris resulting from coronary insufficiency and hypertension</p> Signup and view all the answers

What is the mechanism of action of ranolazine (Ranexa)?

<p>Unknown</p> Signup and view all the answers

What is the primary adverse effect of calcium channel blockers?

<p>Hypotension</p> Signup and view all the answers

What is the indication for the use of amlodipine (Norvasc)?

<p>Both angina and hypertension</p> Signup and view all the answers

What is the effect of calcium channel blockers on the sinoatrial and AV nodes?

<p>Depression of the automaticity of and conduction through the sinoatrial and AV nodes</p> Signup and view all the answers

What is the recommended course of action if the patient's chest pain or discomfort is not relieved in 5 minutes after one dose of sublingual nitroglycerin?

<p>Call 911 immediately, take one more tablet while awaiting emergency care, and a third tablet 5 minutes later.</p> Signup and view all the answers

What is the primary purpose of nitroglycerin in the treatment of ischemic heart conditions?

<p>Symptomatic treatment of angina</p> Signup and view all the answers

What is the advantage of isosorbide dinitrate over other nitrates?

<p>Produces more consistent, steady, therapeutic response</p> Signup and view all the answers

What is the mechanism of action of beta blockers in the treatment of angina?

<p>Block beta1 receptors on the heart, decreasing heart rate, myocardial contractility, and oxygen demand, while increasing oxygen delivery to the heart</p> Signup and view all the answers

Why is it essential to take sublingual nitroglycerin at the first sign of chest pain?

<p>To prevent angina pain from becoming severe and potentially indicating an MI</p> Signup and view all the answers

What is the role of nitrates in the treatment of heart failure?

<p>IV form used for BP control in perioperative hypertension, treatment of heart failure (HF)</p> Signup and view all the answers

What is the primary indication for the use of beta blockers in cardiovascular disease?

<p>Treatment of angina, MI, hypertension, and dysrhythmias</p> Signup and view all the answers

What is the significance of a high level of circulating catecholamines after an MI?

<p>It can cause an imbalance in supply and demand ratio and even lead to life-threatening dysrhythmias</p> Signup and view all the answers

What is a contraindication for the use of certain antianginal drugs?

<p>Pre-existing QT prolongation or hepatic impairment, or taking other QT-prolonging drugs.</p> Signup and view all the answers

What should patients be advised to do before taking any medications?

<p>Check with their physicians.</p> Signup and view all the answers

What should patients be encouraged to limit in their diet?

<p>Caffeine intake.</p> Signup and view all the answers

What should patients report to their healthcare provider?

<p>Symptoms such as blurred vision, persistent headache, dry mouth, edema, fainting episodes, weight gain, or dyspnea.</p> Signup and view all the answers

Why should patients avoid spending time in hot baths or whirlpools?

<p>To avoid vasodilation, hypotension, and the possibility of fainting.</p> Signup and view all the answers

What should patients be taught to do to avoid postural BP changes?

<p>Change positions slowly.</p> Signup and view all the answers

What should patients be encouraged to keep a record of?

<p>Their anginal attacks, including precipitating factors, number of pills taken, and therapeutic effects.</p> Signup and view all the answers

What should patients be instructed in regarding sublingual nitroglycerin for anginal pain?

<p>Proper technique and guidelines for taking the medication.</p> Signup and view all the answers

Study Notes

Calcium Channel Blockers for Chronic Stable Angina

  • Calcium channel blockers are used to treat chronic stable angina, including:
    • Amlodipine
    • Diltiazem
    • Nicardipine
    • Nifedipine
    • Verapamil

Mechanism of Action

  • Calcium channel blockers cause:
    • Coronary artery vasodilation
    • Peripheral arterial vasodilation, decreasing systemic vascular resistance
    • Reduced workload of the heart
    • Decreased myocardial oxygen demand
    • Depression of the automaticity of and conduction through the sinoatrial and AV nodes

Indications

  • Calcium channel blockers are used to treat:
    • Angina
    • Hypertension
    • Supraventricular tachycardia
    • Coronary artery spasms (Prinzmetal angina)
    • Short-term management of atrial fibrillation and flutter
    • Migraine headaches
    • Raynaud’s disease
    • Nimodipine: cerebral artery spasms associated with aneurysm rupture

Contraindications

  • Calcium channel blockers are contraindicated in:
    • Known drug allergy
    • Acute MI
    • Second- or third-degree AV block (unless the patient has a pacemaker)
    • Hypotension

Adverse Effects

  • Calcium channel blockers have:
    • Limited adverse effects
    • Primarily related to overexpression of their therapeutic effects
    • May cause hypotension, palpitations, tachycardia or bradycardia, constipation, nausea, dyspnea, and other adverse effects

Diltiazem (Cardizem, Dilacor, Tiazac)

  • Diltiazem is:
    • Very effective for the treatment of angina pectoris resulting from coronary insufficiency and hypertension
    • Used in the treatment of atrial fibrillation and flutter along with paroxysmal supraventricular tachycardia

Amlodipine (Norvasc)

  • Amlodipine is:
    • Indicated for both angina and hypertension
    • Available only for oral use

Miscellaneous Antianginal Drug

  • Ranolazine (Ranexa) has an unknown mechanism of action.

Nitrates

  • Nitroglycerin is:
    • The prototypical nitrate
    • The most important drug used in the symptomatic treatment of ischemic heart conditions such as angina
    • Available in PO, SL, metered-dose aerosol, IV, and topical forms
  • Isosorbide dinitrate (Isordil) is an organic nitrate available in rapid-acting sublingual tablets, immediate-release tablets, and long-acting oral dosage forms.

Beta Blockers

  • Beta blockers are the mainstay in the treatment of several cardiovascular diseases, including:
    • Angina
    • MI
    • Hypertension
    • Dysrhythmias

Antianginal Beta Blockers

  • Antianginal beta blockers include:
    • Atenolol
    • Metoprolol
    • Propranolol
    • Nadolol

Mechanism of Action

  • Beta blockers:
    • Block beta1 receptors on the heart
    • Decrease heart rate, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart
    • Decrease myocardial contractility, helping to conserve energy or decrease demand
    • Block the harmful effects of catecholamines on the heart, improving survival after MI

Indications

  • Beta blockers are used to treat:
    • Angina
    • Hypertension
    • Cardiac dysrhythmias
    • Cardioprotective effects, especially after MI
    • Some are used for migraine headaches, essential tremors, and stage fright

Contraindications

  • Beta blockers are contraindicated in:
    • Systolic HF
    • Serious conduction disturbances
    • Caution: bronchial asthma, diabetes mellitus, and peripheral vascular disease

Adverse Effects

  • Beta blockers have:
    • Cardiovascular: bradycardia, hypotension, atrioventricular (AV) block
    • Metabolic: hyperglycemia, hypoglycemia, hyperlipidemia
    • Central nervous system: dizziness, fatigue, depression, lethargy
    • Other: impotence, wheezing, dyspnea

Atenolol (Tenormin)

  • Atenolol is:
    • A cardioselective beta1-adrenergic receptor blocker
    • Indicated for prophylactic treatment of angina pectoris
    • Shown to decrease mortality after MI

Metoprolol (Lopressor, Toprol-XL)

  • Metoprolol is:
    • A cardioselective beta1-adrenergic receptor blocker
    • Indicated for prophylactic treatment of angina
    • Reduces mortality rate in patients after MI and in treating angina
    • Available in oral (immediate release and long acting) and parenteral (injectable) forms

Nursing Implications

  • Before administering, perform a complete health history to determine presence of conditions that may be contraindications for use or those that may call for cautious use.
  • Obtain baseline vital signs, including respiratory patterns and rate.
  • Assess for drug interactions.
  • Patients should not take any medications, including over-the-counter medications, without checking with their physicians.
  • Patients should be encouraged to limit caffeine intake.
  • Patients should report specific symptoms, including blurred vision, persistent headache, dry mouth, edema, fainting episodes, and weight gain.
  • 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.

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