Question

pharmacology

Assignments, Chapter 46, Antianginal Agents Learning Objective(s) Written Assignments 1. Define coronary artery disease and identify the signs and symptoms of coronary artery disease. 2. Describe the differences between stable and unstable angina. What is Prinzmetal's angina? 3. Many older adults are prescribed antianginal drugs. What factors make these patients more at risk for adverse effects? What nursing measures should be implemented when using antianginal drugs in older adults? Learning Objective(s) Group Assignments 1. As a group, prepare a poster presentation for a community health screening. Identify the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and the important drug-drug interactions for nitrates, beta-blockers, and calcium channel blockers. 2. As a panel group, compare and contrast the prototype drugs nitroglycerin, metoprolol, and diltiazem to other drugs used to treat angina. Discuss the best indications for the use of each prototype medication.

Answer 1

1. Coronary artery disease -

A disease of the arteries that supply blood and oxygen to the heart , that causes decreased blood flow to the heart muscle.

Sign and symptoms of coronary artery disease are :-

Shortness of breath, Palpitation's, a faster heartbeat, weakness or dizziness, nausea, sweating, heart failure, arrhythmia. But the most common symptom of this disease would be angina, or a feeling that most likely feels like heartburn.

2. Difference between stable and unstable angina :-

Stable angina :-

Chest pain/ discomfort reliably brought on by exertion or emotional stress

Lasts up to 15 minutes

Relieved with rest or GTN

Aetiology: mismatch of myocardial demand coronary vasospasm

non-urgent - can see GP for management and investigation

#. Unstable angina :-

Angina at rest

Prolonged >15 min

getting worse or no relief after 15 mins or with GTN

Aetiology: non-occlusive plaque rupture and blood clotting

Requires urgent assessment (ACS)

Prinzmetal angina - angina which occurs due to coronary artery spasm .

3. The factors that make these patients more at risk for adverse effects are :-

- age

- ethnicity

- family history

- smoking

- abnormal cholesterol level

- high blood pressure

- physical inactivity

- obesity

#. General Nursing Considerations of Nitrates/Antianginals

take sublingual tablets under tongue or in buccal pouch; tablet should "fizzle" or burn, check expiration date on bottle, discard unused med after 6 months, take sustained-released tablets with water, do not chew, administer topically over 6x6 inch area using applicator, cover with plastic wrap, rotate sides; administer transmucosal tablets between lip and gum above the incisor or between the cheek and gum; Do NOT swallow or chew

withdraw med gradually, provide rest periods, teach to take med when chest pain anticipated, may take q 5 min x 3

keep in the dark, go to ED if not effective after 3 doses, remove patch/paste before defib