ANTI-ANGINAL AGENTS

Drugs MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
Nitrates – Indications: acute angina, HTN, CHF, pulmonary – HA – Acute tx; sublingual, max of 3 tabs in 15 mins
nitroglycerin edema – Development of tolerance – Prophylactic: patch
– Huge vasodilator – ↓ development of tolerance: 12 hrs on & 12 hrs off
– Large PO 1st pass effect – X: Viagra or Cialis are vasodilators & will cause severe
hypotensive episodes if used w/ nitrates
B-Blockers – Indications: LT management of angina (not acute – CNS effects: depression, sexual – X: if bradycardia is present OR with CCBs
atenolol (Tenormin) attack); HTN, post MI, dysrhythmias dysfx, lethargy – Don’t STOP abruptly → rebound HTN
– Cardioprotective → exercise tolerance – Caution with DM → may mask hypoglycemia
– Best to use selective B-blockers with low lipid
solubility → ↓ CNS effects
CCBs – Indications: LT management & prevention of – Hypotension → palpitations, – Causes heart block if used w/ β-1 blocker
verapamil (Calan) angina/ prevention; HTN, dysrhythmias reflex tachycardia – Can contribute to CHF
nifedipine (Procardia) – vasodilators – GI: constipation, nausea, – Interaction w/ grapefruit (↑ GI absorption)
– Bradycardia
– Other: peripheral edema, rash...

Metabolic modifiers – Indications: chronic/irretractable angina as add on if – – Caution with other agents that ↓ QT interval
ranolazine (Ranexa) other drugs aren't working (erythromycin, amiodarone) & CYP3A4 inhibitors
– Helps heart cells generate energy more efficiently (verapamil, grapefruit juice) → arrhythmias

ANTI-LIPEMICS
Drugs MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
Bile Acid Sequestrants – Prevent bile acid absorption from small intestines – GI effects: bloating, – ↓ absorption of other vitamins / medications →
Questran, Colestid, – Bile acid necessary for cholesterol absorption constipation, nausea, belching, take them 1 hr before or 2 hrs after
Welchol – NOT systematically absorbed/metabolized heartburn
– these subsides over time
HMG-CoA Reductase – ↓ rate of cholesterol production – GI effects, rash, HA – Monitor LFTs w/in or after 4 mos. of tx
Inhibitors – ↓ LDL & TG, ↑ HDL – Myopathy early in tx (leg pain)
"statins” – HMG-CoA reductase = enzyme necessary for liver production – rhabdomyolysis
of cholesterol – ↑ liver enzymes
– New indications: Prevents CHD, ↓ type II DM, less bone
fractures in older adults, prevent MI & strokes, ↓ dementia

Nicotinic Acid – ↑ lipoprotein lipase activity → break downs lipids – Flushing, pruritis – Take ASA 30 mins prior to relieve flushing or try
Niacin = vit B3 – ↑ HDL metabolism – GI distress taking with ice H2O
– Inhibits liver synthesis of VLDL & LDL – Hepatotoxicity with released → Monitor LFTs
– inhibits release of free fatty acids from adipose tissue form
Fibric Acid Derivatives – ↓ TGS by enhancing VLDL & LDL catabolism – GI effects, myopathy, – Combined with “statins” only in high risk pts
gemfibrozil (Lipid) – Indication: hypertriglycerdemia rhadbomyolysis, cholelithiasis, – Monitor LFTS, CBC
blood dyscracias – d/c if ↑ CPK
Cholesterol Absorption – Inhibits intestinal absorption of cholesterol → ↓ cholesterol – – Ok to use with “statins” for ↑ efficacy
Inhibitor goes to liver → ↓ cholesterol stored in liver → ↓clearance of
ezetimibe (Zetia) cholesterol from the blood
 CHF AGENTS
Therapy Drugs MOA and other information Nursing Implications & Client Teachings
Pre-hospital Tx – ACEis – Vasodilation, ↓ PVR/SVR, less cardiac workload – Should be used early in CHF
“pril” – Prevents collagen deposition in heart, improve coronary artery
– ARBs blood flow, improve kidney fx
“sartan” – 1st line drugs in CHF → reduces mortality & improves QOL
– B-blockers – Start slow & never d/c abruptly
carvedilol (Coreg) → non-selective – s/s of CHF may seem to get worse at 1st use, will get better
metoprolol (Toprol XL) → selective in the long
– Cardiac glycoside – Inhibits Na+/K+ pump (refer to anti-dysrhythmic agent notes) –
– Vasodilators – ↓ afterload, reverses persistent vasoconstriction
Hydralazine (Apresoline)
– Loop diuretics – Controls pulmonary edema – Watch for K+ & Na+ imbalance
furosemide (Lasix) – Added if ACEis alone don't control volume overload – Avoid NSAIDs
– Pts on fluid restriction; tolerance to Lasix develops
– X: lithium
– Monitor K levels before giving this
Acute Tx – Nitroglycerin SL, Loop diuretics, O2 –
– hBNP – vasodilation → reduces preload
Nesiritide (Natrecor) – diuresis & renal excretion of Na+
Outpatient Tx – ACEis or ARBs –
– non-selective B-Blockers – Take w/ food
– K+ sparing diuretics – For severe CHF not controlled by ACEis alone
– Appear to be tolerated with ARBs → Watch K+ intake
– Loop diuretics – Monitor electrolytes
– Supplemented w/ KCl
– Cardiac glycoside –