antianginal/ anticlotting
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| Angina pectoris | Acute chest pain caused by insufficient oxygen to a portion of the myocardium
accompanies physical exertion/emotional excitement
duration usually short
pain this ministry is with rest or stress reduction
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| Signs and symptoms of angina pectoris | Study intense pain
pain radiating to left shoulder, arm, spine, jaw
fear of impending death
dyspnea, diaphoresis, pallor (pale color)
tacky, elevated BP
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| Types of angina | Stable – fairly predictable as to frequency, intensity, duration relieved w rest
vasospastic/ prinzmetals-spasms of coronary arteries due to decrease myocardial blood flow
silent- absence of chest pain
unstable- more frequently intense & during rest
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| atherosclerosis | The buildup of fats and cholesterol and other substance in and on the artery walls
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| CABG(Coronary artery bypass graft) | A portion of a pain from the leg or chest is used to create a bypass artery for severe cases of coronary obstruction
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| Management of angina | Anti-anginal drugs:
slows the hrt rate
dilate veins so the hrt receives less blood (- preload)
causes the hrt to contract with less force (- contractility)
lowering BP, the hrt less resistant when ejecting blood from its chambers (-afterload)
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| Angina versus myocardial infarction | Angina is more likely to be completely relieved by nitroglycerin up legal tablets is to decrease blood supply and pain with moving
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| Diagnostic Tests: angina/ MI | Electrocardiogram (ECG)
Cardiac enzymes
Creatine Kinase (CK)
CK-MB
Troponin I
Troponin T
Cardiac Echo
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| PCI procedure (percutaneous coronary intervention) | Coronary arteries significantly obstructed may include atherectomy (removing the plaque) or angioplasty (compressing the plaque against the vessel wall) stents are inserted following angioplasty.
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| Drug therapy for angina pectoris | Nitrates – Drug of choice for term acute episodes of stable
Beta blockers – often the drug of choice for prophylaxis of stable
CCBs – drug of choice for treating vasospactic
labs:Urinary catecholamines, vanillylmandelic acid concentration (VMA)
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| Nitroglycerin/ Nitrostat | Class: Nitrates Relax arterial and venous move muscles dilate coronary arteries by reducing the amount of bld returning to the heart, so the chambers contain a smaller volume and reduces cardiac output.
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| nitrates | Admin: use class IV bottle special IV tubing for IV admin, cover the IV bottle to reduce the integration due to light exposure, use gloves when administering nitroglycerin, Preg Cat C.
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| Nitrate- adverse/contradictions/interactions pt 1 | Side: hypotension dizziness headache was enough face rash tachycardia.
Con: do not give with pre-existing hypotension, high intracranial pressure or head trauma, pericardial tamponade and constructive pericarditis cannot increase cardiac output
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| Nitrate- adverse/contradictions/interactions pt 2 | Sustained-release not given to pts w glaucoma ^ intraocular pressure.
Inter: Viagra, Levitra, Cialis may cause hypotension and cardiovascular collapse. Use w alcohol and anti-HTN cause hypotension.
herbal: Hawthorne result in hypotension
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| assessments for nitrates | Complete health history, vitals, labs
subsided or decreased chest pain hrt rt, ECG & bp wnl
1 nitro rep 2 times q 5 min prn
remove patch 6-12 hr HS
observe neurologic cardiac and respiratory
report h/a change in hrt or lung sounds consciousness
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| Lifespan of angina/MI | Use subjective and objective data in evaluating pain really and ethnically diverse in older patients
older adults at risk for hypotension
history of cardiac or CVA disease recent head injury worsened by vasodilation
report abnormal angina BP pulse
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| Patient teaching for angina/MI | Monitor BP and pulse
proper use of nitroglycerin and patches
cleanse skin and rotate sites use hair-free area no arms or legs
do not take ED meds
may cause dizziness so change positions slowly
report mental status consciousness palps dyspnea cough
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| Atenolol/ Tenormin | Class: beta blocker Reduce the cardiac workload by slowing heart rate and reducing contractility which lower myocardial oxygen demand
Action: antianginal
admin: BP and pulse before dose, recheck after oral dose, given once daily, Preg Cat D
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| Atenolol side/warning/con | Side: fatigue weakness bradycardia and hypotension
warning: abrupt d/c avoided in pts w is she Mick heart disease
con: do not give with severe brady aterioventricular heart block cardiogenic shock decompensated HF and severe hypotension
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| atenolol Interactions | Inter: drugs-CCB's may result in cardiac suppression digoxin may lead to heart block other anti-HTN increase hypertension anti-cholinergic's decreased absorption from the G.I.
Labs: increase your tacit lipids potassium creatinine anti-nuclear antibody
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| Diltiazem/ Cardizem | Class: CCB reduced cardiac workload bring more oxygen to myocardium.
action: antianginal
admin: IV admin continuously monitor cardioversion equipment near extended release should not be crushed or split Preg Cat C
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| Diltiazem/ Cardizem Side/contradiction | Side: Headache dizziness edema of the ankles and feet abrupt withdrawal acute anginal episode
con: patient with AV heart block sinus syndrome severe hypotension leading aneurysm undergoing intracranial surgery. Use caution w renal/hepatic impairment
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| Diltiazem/ Cardizem interaction drugs | Inter: other cardiovascular drugs may cause partial or complete heart block heart failure or dysrhythmias ^ digoxin or Quinidine levels additive hypotension w ethanol anti-HTN never use dantrolene cytochrome P – 450 3A4 inhibit metabolism
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| Diltiazem/ Cardizem interaction food/herbal | St. John's wort in ginseng decrease the effectiveness of diltiazem. Garlic Hawthorne in goldenseal may increase the antihypertensive effect
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| Myocardial infarction (MI) | Coronary artery becomes legally occluded deprived of oxygen supply affected area of myocardial become ishemic and myocyte begin to die. Necrosis of myocardial tissue release enzyme markers to diagnose MI
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| myocardial ischemia | Disorder that is usually caused by a critical coronary artery obstruction known as CAD (atherosclerotic coronary artery disease)
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| Necrosis | The death of most or all of the sales in an organ or tissue do to disease, injury, or failure of the blood supply
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| Pharmacologic treatment of MI | Restore bld supply (reperfusion) damage tissue use of thrombolytics or PCI
reduce myocardial oxygen to prevent more infarction
control or prevent MI dysrhythmias
manage severe MI pain
prevent enlargement of the thrombus with anti-coagulant/platelet
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| Thrombolytics | (clot buster) Dissolve clots obstructing the coronary arteries and restore perfusion to affected regions of the myocardium
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| reteplase/ Retavase | Class: dissolving blood clots by cleaving plasminogen to form plasma that degrades the fibrin matrix to form thrombi.
Admin: reconstitute drug stat prior to use do not shake give through IV do not mix with any other drugs in same IV line Preg Cat C
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| reteplase/ Retavase side/contraindiction | Side: abnormal bleeding prolonged bleeding and injection sites in catheter insertion site dysrhythmias may occur during myocardial reperfusion.
Con: patients w active bleeding or history of stroke or recent surgical procedures never combine heparin
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| reteplase/ Retavase interaction | Inter: Drug- aspirin anticoagulants and platelet aggregation inhibitors increase anticoagulant effect and risk of bleeding
Herbal/food: ginkgo biloba should be avoided increased risk of bleeding
labs: increase serum plasminogen & fibrinogen levels
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