NUR 426 Lecture Notes - Lecture 3: Antianginal, Catecholamine, Aspirin

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3 Oct 2017
Department
Course
Professor
Antianginal, Antiarrhythmic and Antilipemic
Right coronary artery feeds the right side and inferior wall
Left anterior descending feeds the whole front of the heart
Right coronary artery, left coronary artery, circumflex
Right coronary artery feeds the inferior and posterior wall (RIP)
LAD (left anterior descending) feeds the left anterior wall and septum
Circumflex feeds the lateral wall and posterior wall
Cardiac conduction system
SA node -> Bachman -> AV node -> bundle of HIS -> bundle branches -> purkinje fibers
(contraction)
Heart rate x Stroke Volume = Cardiac output (volume of blood the heart pumps out)
Preload = ventricular filling (working phase)
Afterload = the resistance being met
Contractility = did the heart muscle contract and relax
Drug effects: terms
Inotropic contractility (force of contraction)
Chronotropic either positive or negative (effects rate)
Dromotropi conduction (electrical)
Angina
Can be a condition, can be temporary and can be a warning sign
Coronary arteries build up with plaque
Can also be caused by coronary spasm (prevalent in cocaine users), have clean vessels and the
artery clams down
Needs to be taken seriously
Usually caused by coronary artery disease
Risk factors for CAD
Cannot be changed
- Genetics
- Age
- Gender
Can change
- Gout
- Smoking
- Sedentary lifestyle
- Stress
- Hypertension
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- Obesity
- Diabetes
Angina types
Classic (stable) predictable stress or exertion
Unstable (preinfaraction) progressive severity unrelated to activity, unpredictable regarding
stress/exertion and intensity. Watch for impending MI
Variant (prinzmetal) drop in blood flow caused by vasospasm
Take nitroglycerine or aspirin at onset of symptoms
Non pharm treatment for angina
Avoid heavy meals
Avoid smoking
Avoid extreme weather changes
Avoid strenuous exercise
Avoid emotional upsets
Proper nutrition
Mod exercise MD referral
Adequate rest
Relaxation techniques
Preventative measures
Anti-Angina Drugs - work by increasing O2 to heart muscle or decreasing O2 demand of the heart
Nitrates
Beta blockers
Calcium channel blockers
Nitrates
Vasodilator
Relax arteries
Decrease vasospasm
Increase blood flow
Increase O2 supply
Decrease preload
PO, SL, IV, Transdermal
Nitroglycerin
- Action of NTG
- Reacts directly on smooth muscles
- Dilation
- Decrease preload and after load
- Reduces myocardial O2 demands
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- PO, SL, IV, transdermal
- Sublingual is most common
- Nitro paste is absorbed through skin avoid touching (will end up with headache)
- Side effects
o Headaches
o Bradycardia
o Hypotension
o Dizziness
o Weakness
o Faintness
o Reflex tachycardia
o Need to take BP before giving and after giving
o If the systolic BP is under 90 hold medication
- Nitro SL
o Sit or lay down
o Stop all activity
o 3x5 rule take up to 3 nitro 5 min apart
o Do not excel more than 3
o Do not crush or chew
o Call 911 if first pill does not work
o Dose: 0.3-0.6mg every 5 minutes for maximum of 3 tablets in 15 minutes
o Most common dose is 0.4mg
o It is sensitive to light and heat (will breakdown)
o Take cotton out of bottle
o Inexpensive
o Do not take other peoples nitro
o Mouth will get dry, it is okay to sip water
- Drug interactions
o Beta blockers
o Calcium channel blockers
o Vasodilators
o Alcohol
o Drugs will enhance the effects of nitro
o Enhance hypotensive effect
o IV NTG may antagonize the effects of heparin
o IV needs to be in glass bottle
o IV is titrated to reach level needed (till pain subsides or BP drops)
- Side effects
o N/V
o Blurred vision
o Dizziness
o Syncope
o Weakness
o Dry mouth
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