McKenna's Pharmacology for Nursing, 2e

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Antianginal agents

Learning objectives Upon completion of this chapter, you should be able to: 1. Describe coronary artery disease, including identified risk factors and clinical presentation. 2. Describe the therapeutic actions, indications, pharmacokinetics, contraindications and cautions, most common adverse reactions and important drug–drug interactions associated with the nitrates, beta-blockers and calcium channel blockers used to treat angina. 3. Discuss the use of antianginal agents across the lifespan. 4. Compare and contrast the prototype drugs glyceryl trinitrate, metoprolol and diltiazem with other agents used to treat angina. 5. Outline the care considerations, including important teaching points, for people receiving drugs used to treat angina.

Test your current knowledge of antianginal agents with a PrepU Practice Quiz!

Simulation-based learning On completion of the chapter, consider the scenario of Carl Shapiro (Part 2) who arrives in the emergency department. Consider the medication management of Carl’s condition, as it relates to your learning in this chapter.

Glossary of key terms angina pectoris: “suffocation of the chest”; pain caused by the imbalance between oxygen being supplied to the heart muscle and demand for oxygen by the heart muscle atheroma: plaque in the endothelial lining of arteries; contains fats, blood cells, lipids, inflammatory agents and platelets; leads to narrowing of the lumen of the artery, stiffening of the artery and loss of distensibility and responsiveness atherosclerosis: narrowing of the arteries caused by build-up of atheromas, swelling and accumulation of platelets; leads to a loss of elasticity and responsiveness to normal stimuli coronary artery disease (CAD): characterised by progressive narrowing of coronary arteries, leading to a decreased delivery of oxygen to cardiac muscle cells; leading killer of adults in the Western world myocardial infarction: end result of vessel blockage in the heart; leads to ischaemia and then necrosis of the area cut off from the blood supply; it can heal, with the dead cells replaced by scar tissue nitrates: drugs used to cause direct relaxation of smooth muscle, leading to vasodilation and decreased venous return to the heart with decreased resistance to blood flow; this rapidly decreases oxygen demand in the heart and can restore the balance between blood delivered and blood needed in the heart muscle of people with angina pulse pressure: the systolic blood pressure minus the diastolic blood pressure; reflects the filling pressure of the coronary arteries stable angina: predictable pain due to the imbalance of myocardial oxygen supply and demand that is relieved by rest or stoppage of activity unstable angina: unpredictable episode of myocardial ischaemia with pain due to the imbalance of myocardial oxygen supply and demand when the person is at rest variant (Prinzmetal or vasospastic) angina: drop in blood flow through the coronary arteries caused by a vasospasm in the artery, not by atherosclerosis