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