Antiplatelet Agents 

¨        First line of pharmacologic intervention

¨        NI: monitor for S & S of bleeding, assess CBC

¨        Patient Education: Take daily dose with food, report any bleeding or bruising

¨        SE: ASA – Tinnitus; All – gastric irritation, ­ risk bleeding

 Antiplatelet Agents medications

acetylsalicylic acid (ASA) drug of choice (81 mg – 325 mg/day)

ticlopidine (Ticlid)

clopidogrel (Plavix)

Nitrates

¨        Most common initial treatment nitrate therapy

¨        Dilate coronary arteries & collateral circulation

¨        Do not administer if had phosphodiesterase inhibitor e.g. sildenafil (Viagra); tadalafil (Cialis); and vardenafil (Levitra) in last 24 hours

¨        SE: H/A, orthostatic hypotension, & tachycardia.  May take Tylenol pre dose to ease H/A

¨        Tolerance can develop it is best to have nitrate free periods each day of 12 hrs

 Nitrates Rx forms

Nitroglycerin Tablets

Nitroglycerine Spray

Nitroglycerin Ointment

Transdermal Controlled Release Nitrates

 Long Acting Nitrates

Intravenous NTG

Nitroglycerin Tablets: Dosages

1 tab SL (0.4 mg / gr 1/150) q 5 min

 3 tabs MAX over 15 min

    Relieves pain in 3 min for 20 – 45 min

  If no relief in 15 min (3 tab) go to ER

©        SE: dizziness, faintness or H/A.  If adm and BP ¯ < 100 or ¯ 25 mm from previous reading – lower HOB and notify MD

©        Patient Teaching:  may use prophylactically, keep pills in original light resistant container; do not carry in pocket, lose potency – purchase new supply q 6 – 9 months; lie down when taking; can hold tablet under tongue & drink 5 mL H2O prn to allow the tablet to dissolve; treat H/A /c mild pain reliever

Nitroglycerine Spray

1 spray under the tongue

may be repeated in 10 – 15 min

no more than 3 sprays in a 15 min period

spray should not be inhaled

Sprayed under tongue on mucous membrane

Do Not Shake

 Nitroglycerin Ointment

©        2 % topical ointment, prescribed by the inch

©        Produces anginal prophylaxis for 3 – 6 hrs

©        Messy; avoid getting on fingers

©        Use paper provided; rotate sites

Transdermal Controlled Release Nitrates

:examples and information

©        Transderm – Nitro, Nitro – Dur, Nitro – Disc

©        Plasma levels reached within 2 hours

©        Change q 24 hours; rotate sites

©        Reservoir seal should not be punctured or broken it can result in dose dumping

 Long Acting Nitrates: examples 

 isosorbide dinatrate (Isordil, Iso–Bid)

isosorbide monnitrate (Imdur)

  Intravenous NTG

©        Hospitalized pt. /c unstable angina to stop pain

ICU SON!

▪       Beta-Adrenergic Blockers / Beta Blockers: FxN, NI, SE, Pt teaching. 

¨        Block of beta₁ receptors in cardiac muscle (cardio-selective beta blocker)

¨        ¯ Sympathetic effect = ¯ HR and contractility = ¯ O₂ demand; ¯ BP

¨        Associated /c¯ mortality &morbidity rates in CAD, esp. after MI

¨        NI: Hold &question if pulse falls < 50 or arrhythmia occurs, or if BP < 90 or 100 

¨        SE: orthostatic hypotension, bradycardia, fatigue, depression, erectile dysfunction, difficulty breathing (if nonspecific beta blocker – propranolol)

¨        Patient Teaching: Δ position slowly, notify is tightness in chest (wheeze), do not D/C suddenly.  Pts. with asthma or bronchospasm generally not prescribed

▪       Beta-Adrenergic Blockers / Beta Blockers: examples

 atenolol (Tenormin)

metoprolol (Lopressor)

propranolol (Inderal)

nadolol (Cogard)

"-olol" is a beta blocker