Pharmacological Management of Angina bsn.pdf

how can manage angina symptoms and its management

1. Pharmacological Management of Angina,
Hypertension, and Drug Administration

1. 1. Main Classes of Drugs Used for Treating Angina
Pectoris (AP)
Angina pectoris (chest pain due to myocardial ischemia) is managed pharmacologically by drugs
that reduce myocardial oxygen demand or increase oxygen supply.
A. Nitrates
 Examples: Nitroglycerin, isosorbide dinitrate
 Action: Vasodilation reduces preload and afterload → decreases myocardial oxygen
demand.
 Use: Acute angina relief (sublingual), long-term prevention (oral/transdermal)
B. Beta-Blockers
 Examples: Atenolol, metoprolol
 Action: Decrease heart rate and contractility → reduce oxygen demand.
 Use: Chronic stable angina, post-MI management
C. Calcium Channel Blockers
 Examples: Amlodipine, verapamil, diltiazem
 Action: Vasodilation and decreased myocardial contractility.
 Use: Prinzmetal’s angina, when beta-blockers are contraindicated
D. Antiplatelet Agents
 Examples: Aspirin, clopidogrel
 Action: Inhibit platelet aggregation, reducing risk of thrombosis.
 Use: Prevention of myocardial infarction
E. Ranolazine
 Action: Inhibits late sodium current → improves myocardial relaxation and reduces
oxygen consumption.
 Use: Chronic angina not responding to other drugs

2. 2. Nursing Responsibilities for Each Class of Anti-
Anginal Drugs
Nitrates:
 Monitor BP and HR before and after administration.
 Educate on proper use (e.g., sit down when taking sublingual nitro to avoid falls).
 Ensure nitrate-free interval (for patches) to prevent tolerance.
Beta-Blockers:
 Monitor for bradycardia, hypotension, and fatigue.
 Assess for contraindications (e.g., asthma, heart block).
 Educate patients to not stop abruptly.
Calcium Channel Blockers:
 Watch for edema, hypotension, and bradycardia (especially verapamil).
 Monitor liver and kidney function for long-term therapy.
Antiplatelets:
 Monitor for signs of bleeding (gums, stool, bruising).
 Educate about risk of bleeding and importance of adherence.
Ranolazine:
 Monitor QT interval on ECG.
 Check renal and hepatic function.
3. Pharmacological Management of Hypertension and
Hypertensive Crisis
A. First-Line Antihypertensive Classes (Chronic Management):
 ACE Inhibitors (e.g., enalapril, lisinopril)
 ARBs (e.g., losartan, valsartan)
 Thiazide diuretics (e.g., hydrochlorothiazide)
 Calcium channel blockers (e.g., amlodipine)
B. Other Agents:
 Beta-blockers (e.g., atenolol) – used in select patients

3.  Alpha-blockers (e.g., prazosin) – resistant hypertension
 Aldosterone antagonists (e.g., spironolactone) – heart failure or resistant HTN
C. Hypertensive Crisis Management:
Hypertensive Emergency:
 Definition: BP >180/120 mmHg with target organ damage (e.g., stroke, MI, renal
failure)
 Drugs (IV): Nitroprusside, labetalol, nicardipine
 Goal: Gradual BP reduction to prevent ischemia
Hypertensive Urgency:
 Definition: Severe BP elevation without organ damage
 Drugs (oral): Captopril, clonidine, labetalol
 Goal: Lower BP over 24–48 hours

4. 4. Nursing Responsibilities Related to Antihypertensive
Drugs
 Monitor BP and HR before and after drug administration.
 Assess for orthostatic hypotension – especially in elderly.
 Monitor for electrolyte imbalances (e.g., with diuretics: ↓K⁺, ↓Na⁺).
 Educate on lifestyle modifications (diet, exercise, smoking cessation).
 Teach patient medication adherence and dangers of abrupt withdrawal.
 In hypertensive crisis: Monitor neurological status, ECG, urine output.

5. 5. Drug Dosage Calculation for Oral and Parenteral
Medications
Key Formula:
Dose to Give = (Desired Dose / Available Dose) × Volume of Solution
Examples:
Oral Medication:
 Order: 250 mg paracetamol

4.  Available: 500 mg/5 mL
 Calculation:
(250 / 500) × 5 = 2.5 mL
Parenteral Medication:
 Order: 1 mg morphine IV
 Available: 10 mg/mL
 Calculation:
(1 / 10) × 1 = 0.1 mL
Nursing Considerations:
 Double-check all high-alert medications (e.g., insulin, opioids).
 Use a calculator or a second nurse for verification in critical settings.
 Check expiration dates, dilution instructions, and administration routes.
 Always use sterile technique for injections and IV medications.
 Document time, dose, route, and patient response.

6. Conclusion
Effective pharmacological management of angina and hypertension requires knowledge of drug
classes, patient-specific factors, and vigilant nursing care. Accurate drug administration,
including calculation and monitoring for side effects, ensures safe treatment outcomes. Nurses
are key in bridging pharmacological therapy and patient safety.
MCQs on Angina, Hypertension, and Drug Administration
1. Which class of drugs is primarily used to relieve acute angina attacks?
A. Beta-blockers
B. Calcium channel blockers
C. Nitrates
D. Antiplatelet agents
Answer: C
Explanation: Nitrates, especially sublingual nitroglycerin, are used for acute relief of angina.
2. Beta-blockers primarily reduce myocardial oxygen demand by:
A. Decreasing heart rate and contractility
B. Increasing heart rate and contractility
C. Vasodilation
D. Enhancing platelet aggregation

5. Answer: A
Explanation: Beta-blockers decrease heart rate and myocardial contractility, reducing oxygen
demand.
3. Which of the following is a common side effect of calcium channel blockers in angina
management?
A. Hyperglycemia
B. Edema
C. Bradycardia
D. Tinnitus
Answer: B
Explanation: Calcium channel blockers like amlodipine can cause peripheral edema as a side
effect.
4. Which drug is commonly used to prevent myocardial infarction in angina patients?
A. Aspirin
B. Nitroglycerin
C. Ranolazine
D. Metoprolol
Answer: A
Explanation: Aspirin prevents platelet aggregation, reducing the risk of myocardial infarction.
5. A patient is taking nitrates for chronic stable angina. What is the most important
nursing instruction for this patient?
A. Avoid grapefruit juice
B. Do not stop taking the medication abruptly
C. Take the drug only at bedtime
D. Ensure a nitrate-free interval to prevent tolerance
Answer: D
Explanation: A nitrate-free interval is necessary to avoid tolerance to nitrates.
6. Which of the following antihypertensive drugs works by blocking angiotensin II
receptors?
A. Lisinopril
B. Losartan
C. Hydrochlorothiazide
D. Amlodipine
Answer: B
Explanation: Losartan is an angiotensin II receptor blocker (ARB).
7. The goal of treating hypertensive emergencies is to:
A. Rapidly decrease BP to normal levels

6. B. Gradually lower BP over 24–48 hours
C. Reduce the risk of MI only
D. Increase the blood flow to kidneys
Answer: B
Explanation: Hypertensive emergencies should be treated gradually to prevent ischemic
damage.
8. Which of the following medications is commonly used in the management of
hypertensive crisis?
A. Atenolol
B. Labetalol
C. Clonidine
D. Hydrochlorothiazide
Answer: B
Explanation: Labetalol is often used in hypertensive crises because of its dual action on alpha
and beta receptors.
9. What is the most common side effect of ACE inhibitors like lisinopril?
A. Hypokalemia
B. Cough
C. Hyperglycemia
D. Bradycardia
Answer: B
Explanation: A persistent dry cough is a well-known side effect of ACE inhibitors.
10. What should be monitored when a patient is prescribed a diuretic for hypertension?
A. Liver function
B. Blood glucose levels
C. Electrolyte levels
D. Urinary output
Answer: C
Explanation: Diuretics can cause electrolyte imbalances, such as hypokalemia or hyponatremia.