Antianginals

Antianginals


Action: The antianginals are divided into nitrates, calcium channel blockers, and b-adrenergic blockers. The nitrates dilate coronary arteries, causing decreased preload, and dilate systemic arteries, causing decreased afterload. Calcium channel blockers dilate coronary arteries, decrease SA/AV node conduction. b-adrenergic blockers decrease heart rate so that myocardial O2 use is decreased. Dipyridamole selectively dilates coronary arteries to increase coronary blood flow.

Uses: Antianginals are used in chronic stable angina pectoris, unstable angina, vasospastic angina. Some (i.e. Calcium channel blockers and b-blockers) may be used for dysrhythmias and in hypertension.

Side effects / Adverse reactions: The most common side effects are postural hypotension, headache, flushing, dizziness, nausea, edema, and drowsiness. Also common are rash, dysrhytmias, and fatigue.

Contraindications: Person with known hypersensitivity, increased intracranial pressure, or cerebral hemorrhage should not use some of these products.

Precautions: Antianginals should be used with caution in postural hypotension, pregnancy, lactation, children, renal disease, and hepatic injury.

Interactions: Please check individual monographs since interactions vary widely among products.

Possible nursing diagnoses:
» Altered tissue perfusion: cardiopulmonary [uses]
» Pain [uses]
» Risk for injury [uses]
» Knowledge deficit [teaching]
» Decreased cardiac output [adverse reactions]

Nursing Considerations


Assess:
» Orthostatic B/P, pulse
» Pain: duration, time started, activity being performed, character
» Tolerance if taken over long period
» Headache, light-headedness, decreased B/P; may indicate a need for decreased dosage

Perform/Provide:
» Storage protected from light, moisture; place in cool environment

Evaluate:
» Therapeutic response: decrease, prevention of anginal pain

Teach patient/family:
» To keep tabs in original container
» Not to use OTC products unless directed by the prescriber
» To report bradycardia, dizziness, confusion, depression, fever
» To take pulse at home, advise when to notify prescriber
» To avoid alcohol, smoking, sodium intake
» To comply with weight control, dietary adjustments, modified exercise program
» To carry emergency ID to identify drug that you are taking, allergies
» To make position changes slowly to prevent fainting

Selected generic names


Nitrates
amyl nitrite
isosorbide
nitroglycerin

b-Adrenergic blockers
atenolol
dipyridamole
metoprolol
nadolol
propranolol

Calcium channel blockers
amlodipine
bepridil
diltiazem
nicardipine
nifedipine
verapamil

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