2. Introduction :
• Angina pectoris 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 three types of Angina :
1. Stable Angina ( Most common)
2. Unstable Angina
3. Prinzmetal (variant) angina
4.
5. Stable Angina
• Attacks are 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.
6. Unstable Angina
• The unstable 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.
7. 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.
11. NITRATES
• They act directly 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).
12. Action of nitrates
Effects on
other smooth
muscles
Redistribution
of coronary
flow
Afterload
reduction
Preload
reduction
13. Preload reduction
Nitroglycerin relaxes vascular 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
24. •Is a nitrate.
•Like nitroglycerin, 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 .
25. Dose & Route
1.Isosorbide mononitrate:-
20 to 40 mg orally
2.Isosorbide dinitrate:
5 -1o mg sublingually or orally
27. CCB have negative chronotropic effect
and dromotropic action on heart
• COMMON CALCIUM CHANNEL BLOCKER USED ARE
• VERAPEMIL ( most potent)
• NIFIDEPINE
• DILTIZEM ( least potent)
31. BETA BLOCKERS
DECREASE CORONARY SUPPLY
DECREASE THE HEART RATE BY BLOCKING BETA RECEPTOR
DECREASE THE WORK OF HEART
DECREASE O2 CONSUMPTION
INCREASE REDISTRIBUTION OF BLOOD
39. Nursing intervention
• History collection
• 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.
40. IN IV NTG:
•Do not mix NTG with other drugs
•Do not use PVC tubing's for IV
administration because its absorb the
nitrates.
•Use glass bottles & tubing's provided by
manufacturer.
• It is Given by infusion pump.
41. Ointment/transdermal patch
• Remove transdermal 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.
42. • Do not get ointment on hands as it can cause
headache.
• Wash hands after application.
• Apply to a nonhairy sites, avoid application to
skin folds or irritated sites.
43. Transmucosal Tablets:
The nurse should 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.
44. Spray
•Do not shake when administering &
hold
•vertically & spray under the tongue.
•Advise do not swallow immediately.
45. CLIENT TEACHING
• NTG loose 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.
46. • Instruct client do 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.