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PAT20A/B Chapter N/A: (2)PAT20 Fall Week 8-9 Drug Classifications (CAD, ACS, & CMS)

Course Code
Audrey Kenmir

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(2)PAT20 Fall Week 8-9 Drug Classifications (Coronary Artery Disease, Acute Coronary
Syndrome, & Cardiovascular Metabolic Syndrome)
1. Anti-Anginal
a) Beta Blockers “olol” *Cardiovascular Agent* (Anti-catecholamine)
Beta blocker drugs: metoprolol (Betaloc), atenolol (Tenormin), bisoprolol (Zebeta))
Action: competitively block catecholamine (causes fight-or-flight response)
neurotransmitters at the beta receptors in the sympathetic nervous system.
Use: hypertensions, angina, arrhythmia, myocardial infraction, left ventricular
dysfunction, migraine, glaucoma, congestive heart failure.
Pharmacokinetics (Metoprolol):
Onset- PO: 15 mins, PO-XR: unknown, IV: immediate
Peak- PO: 1 hr, PO-XR: 6-12 hrs, IV: 20 mins
Duration- PO: 6-12 hrs, PO-XR: 24 hrs, IV: 5-8 hrs
Side/Adverse Effects:
CNS: dizziness, mental depression, fatigue, hallucinations
CV: bradycardia, heart failure, hypotension, peripheral vascular insufficiency,
exacerbation of AV block
DERM: rash, pruritus, alopecia
EENT: visual disturbances, dry mouth and eyes
GI: nausea, vomiting, diarrhea, cramps, constipation, ischemic colitis
GU: impotence
HEM: anganulocytosis, thrombocytopenic purpura
MS: joint pain
Hypersensitivity, bronchial asthma (nonselective blockers), heart block, cardiac
failure, cardiogenic shock.
- Use with reserpine, other catecholamine- depleting drugs can result in serous
adrenergic blockage.
- Nonselective beta adrenergics antagonize therapeutic effects.
Dosages (Metoprolol):
Injection (IV) = 5 mg/vial, syringe; Tablets (tartrate formulation): 50, 100 mg
Nursing Management Proprieties:
Assess: history of hypersensitivity, blood pressure, apical pulse, respiratory distress
and/or impairment, hepatic impairment, diabetes.

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Dietary management: avoid high- sodium foods, use with alcohol; do not abstain
from food for more than 12 hrs (diabetics).
Lab test evaluation: fasting blood sugar (diabetics).

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b) Nitrates *Cardiovascular Agent* (Anti- pre & afterload)
Nitrates drugs: nitroglycerin (Nitrol)
Action: reduces left ventricular end-diastolic pressure (preload) and systemic vascular
resistance (afterload), which increases blood flow through collateral coronary arteries.
Use: prevents/treats moderate to acute, recurrent angina.
Pharmacokinetics (Nitroglycerin):
Onset- TRANS: 2 mins, SUBLING: 1-3 mins, PO-ER: 40-60 mins, TD: 20-60 mins,
IV: immediate
Peak- TRANS: 4-10 mins, SUBLING, PO-ER, TD & IV: unknown
Duration- TRANS & SUBLING: 30-60 mins, PO-ER: 8-12 hrs, TD: 4-8; 8-24 hrs,
IV: several mins
Side/Adverse Effects:
Headaches, flushing, orthostatic hypotension, reflex tachycardia, syncope, vomiting.
Severe anemia, cerebral hemorrhage, heads trauma, glaucoma, phosphodiesterase
inhibitors, recent myocardial infarction, and hypotension.
Nitrates, calcium channel blockers, and beta-blockers may cause hypotension
when used with antihypertensive drugs.
Dosages (Nitroglycernin):
ER Capsule, Intravenous, Translingual spray, Sublingual tablets, Ointment,
Transdermal, Transmucosal
Nursing Management Proprieties:
Assess: history of hypersensitivity, apical pulse, blood pressure, ECG, lung sounds,
hepatic disease, heart failure.
Dietary management: avoid caffeine, use with alcohol, and high-sodium foods.
Lab test evaluation: cardiac enzymes.
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