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Antianginal drug
This document discusses antianginal drugs used to treat angina pectoris. It describes the three main types of angina and the mechanisms of four classes of antianginal drugs: nitrates, beta-blockers, calcium channel blockers, and potassium channel openers. Nitrates like nitroglycerin and isosorbide are first-line treatments that work by dilating blood vessels to reduce cardiac preload and afterload. Proper administration and storage of nitrates is important to avoid side effects like headaches. Nurses monitor patients and educate them about safe use of antianginal medications.
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Antianginal drug
- 1. ANTIANGINAL DRUGS Presented by :-Pankaj rana Nurse Practitioner Critical care
- 2. Introduction : • Anginapectoris is characterized by sudden severe pressing chest pain or heaviness radiating to the neck, jaw, back and arms. • It is often associated with diaphoresis, tachypnea and nausea. • Angina is caused by coronary flow that is insufficient to meet oxygen demands of the myocardium.
- 3. There are threetypes of Angina : 1. Stable Angina 2. Unstable Angina 3. Prinzmetal (variant) angina
- 4. Stable Angina • Attacksare predictably provoked by exercise, emotion etc. It lasts for several seconds and subsides on rest. • “Stable” indicates the reproducible nature of the angina; the same activity at the same intensity faithfully produces symptoms.
- 5. Unstable Angina • Theunstable angina is characterized by recurrent attacks of angina. • It occurs with minimal exertion. • It is precipitated due to combination of athero scleroti-plaque, platelet aggregation at ruptured plaque and vasospasm.
- 6. Prinzmetal (Variant) Angina •This is a relatively uncommon pattern of myocardial ischemia usually occurring at rest or during sleep and often in young individuals. • It is induced by coronary artery vasospasm, it generally responds promptly to vasodilators.
- 7. Antianginal Drugs: 1. Nitrates: •Glyceryl trinitrate (Nitroglycerin) • Isosorbide dinitrate, Isosorbide mononitrate 2. Beta-blocker • Atenolol, propranolol, metoprolol 3. Calcium channel blocker • Nifedipine, amlodipine 4. Potassium channel opener Nicorandil
- 8. Nitrates: • They actdirectly on all the smooth muscle of the body & relax them. • Nitrates release nitric oxide which is a powerful muscle relaxants. • Most predominant in the vascular smooth muscles (i.e walls of arteries & veins).
- 9. Action of nitrates Effectson other smooth muscles Redistribution of coronary flow Afterload reduction Preload reduction
- 10. Preload reduction Nitroglycerin relaxesvascular smooth muscle and dilates both arterial and venous vessels. Dilation of veins is more predominant than dilation of arteries, resulting in peripheral pooling of blood & decreased venous return. decreased preload
- 11. Afterload reduction Nitrates alsoproduce some arteriolar dilatation Decrease peripheral resistance Reduction of afterload
- 12. Redistribution of coronary flow Dilatationof coronary arteries Increase blood supply to the myocardium
- 13. Effects on othersmooth muscles • Relax the bronchi, biliary tracts & esophagus muscles. • Also dilates cutaneous vessels & meningeal vessels .
- 14. Ca++ channel blockers vasodilation Decreasedintracellular ca++ & causes smooth muscles relaxation Block the entry of ca++ ions into the smooth & cardiac muscles
- 15. Beta blockers It reducesthe cardiac work & O2 consumption. Potassium channel opener Prominent action is relaxation of smooth muscles
- 16. Therapeutic uses of antianginaldrugs Nitrates:- • Angina pectoris • MI • Congestive cardiac failure • Biliary colic • Cyanide poisoning • Oesophageal spasm
- 17. Beta & calciumchannel blockers: • Hpertension • Angina • Cardiac arrhythmias
- 18. Adverse effects ofAntianginal drugs: 1.nitrates • Postural hypotension & syncope particularly with sublingual use. • Headache & flushing • Methemaglobinemia • Contact dermatitis
- 19. 2.Calcium channel blockers:- constipation headache dermatitis 3.beta blockers: Hypotension Depression Bradycardia Heart block CHF
- 20. Contraindication of antianginal drugs •Nitrates: hypersensitivity severe hypotension anemia • Beta blockers: heart block pulmonary edema cardiogenic shock
- 21. Common Drugs are:- 1. Glyceryl trinitrate (Nitroglycerin) 2. Isosorbide dinitrate, Isosorbide mononitrate,
- 22.
- 23. Action • Decreased preload •Decreased afterload • Dilates coronary arteries • Dilates arterial or venous bed systematically
- 24. Indication • Stable anginapectoris • CHF
- 25. Available forms 1. Sublingual Tablets. 2.Topical Ointment and Transdermal Patches. 3. Translingual Spray. 4. Transmucosal Tablets. 5. Intravenous (IV).
- 28. Nitroglycerine Preparation Dose RouteOnset/Dura tion of action Trade name Tablets 1,2,3 mg 0.5 mg Sublingual 1 -3 min/30 min Angised spray 0.4 – 0.8 mg Sublingual 2 min/60 min Nitrolingual capsule 5-15 mg oral 20min/4-8 hr Angispan-tr Transdermal patch,5-10 mg one patch for 14 to 16 hr per day skin Max. 24 hrs Nitroderm-tts Injection 5mg/ml 5-20 microgram/min intravenous 2min/5 min Nitroject ointment 2% skin 30 min/12 hr Nitrol
- 29. Side effects • Headache,flushing, hypotension, dizziness Contraindication Hypersensitivity Severe anaemia Increased ICP Cerebral haemorrhage
- 30.
- 31. •Is a nitrate. •Likenitroglycerin, and is used for treating and preventing angina. •It is NOT used to treat HTN. •Is given Sublingual or Per Oral . •SL Isosorbide has a slower onset and a longer duration of action compared to SL nitroglycerin . •Because SL isosorbide does NOT relieve chest pain as rapidly as introglycerin, Isosorbide is limited to treating acute angina in patients intolerant or unresponsive to SL nitroglycerin .
- 32. Dose & Route 1.Isosorbidemononitrate:- 20 to 40 mg orally 2.Isosorbide dinitrate: 5 -1o mg sublingually or orally
- 33.
- 34. Nursing intervention • Historycollection • Assess the duration, time started & character of pain. • Monitor vital signs. • Assist in various diagnostic test like ECG, Echo & other blood investigation. • Nitrates should be kept away from flame. • Store nitrates in original container. • An analgesic can be given to treat headache.
- 35. In Iv NTG: •Do not mix NTG with other drugs • Do not use PVC tubings for IV administration because its absorb the nitrates. • Use glass bottles & tubings provided by manufacturer. • It is Given by infusion pump.
- 36. Ointment/transdermal patch • Removetransdermal patches before defibrillation to prevents burns. • Rotate ointment & transdermal patches sites. • Remove ointment & previous patch before applying new ointment or patch. • Do not trim transdermal patch to alter dose. • Do not rub or massage the area after application of ointment. • Apply to the chest, upper arm, or upper thigh to promote absorption and increase onset of systemic action.
- 37. • Do notget ointment on hands as it can cause headache. • Wash hands after application. • Apply to a non hairy sites, avoid application to skin folds or irritated sites.
- 38. Transmucosal Tablets: The nurseshould place one tablet between lip and gum above incisors or between cheek and gum to promote slow dissolving and extended absorption. Sublingual tablets: Place under the tongue.
- 39. Spray • Do notshake when administering & hold vertically & spray under the tongue. • Advise do not swallow immediately.
- 40. Client teaching • NTGloose potency if exposed to light, moisture or heat. • Avoid alcohol, hot bath as they cause vasodilation & lead to hypotension. • Teach about adverse effects. • Encourage client to discontinue tobacco which causes vasoconstriction. • Encourage to eat high fiber rich diet.
- 41. • Instruct clientdo not chew SL tablets,place under the tongue. • Do not eat food or smoke until tablets dissolve. • Sublingual tablets; In cute anginal attacks, teach client to lie down & take NTG tablets as soon as possible; upto 3 NTG tablets in every 5 min. If no relief go for emergency services.