Antiplatelet aggregation therapy Obat lini pertama / Kelas 1 dari angina. Jenis obat anti agregasi platelet: Aspirin Clopidogrel (Plavix) 5
Indikasi Mengurangi kejadian aterosklerosis pada pasien pada serangan jantung akut, MI atau penyakit arteri perifer (PAD). Mengurangi kejadian aterosklerosis pada pasien dengan ACS(acute coronary syndrome) seperti pada pasien post PTCA with or without stent placement or CABG 6
Nursing Intervention Hati hati dengan resiko perdarahan Efek platelet berkurang dalam waktu 5 hari setelah di hentikan
ASPIRIN
CLOPIDOGREL
Nitrates Vasodilators Sebagai lini Ke dua Mengurangi kebutuhuan oksigen miokard dan meningkatkan perfusi koroner Contoh obat : Nitroglycerin
10
Indications Profilaksis untuk mencegah atau mengurangi serangan angina atau terhadap serangan angina kronis. Heart failure after an MI
11
Nursing Interventions Hati-hati pada pasien dengan hipotensi dan hipovolum Monitor TTV dengan ketat
12
NTG
13
Beta-adrenergic Blockers Direct decrease in myocardial contractility, HR, BP all of which reduce the myocardial O2 demand Decrease morbidity and mortality rates in pts with CAD (e.g. AMI) Sedian obat : Atenolol, Bisoprolol, Metoprolol tartrate,, Propanolol hydrochloride.
Indications Hypertension Angina secondary to atherosclerosis Cardiac arrhythmias, especially: SVT, VT (induced by digitalis) Prevention of another MI 17
Nursing Intervention
Monitor BP, HR Monitor activity tolerance Monitor liver enzymes, renal function studies Instruct patient to change positions slowly to avoid syncope episodes Monitor for S/S of respiratory distress Monitor for hyper and hypoglycemia Take with foods to decrease GI side effect (nausea, diarrhea). 18
BETA BLOCKER
19
Calcium Channel Blocking
Agents
Systemic vasodilation Decreased myoardial contractility Coronary vasodilation Depressant effect on the SA node rate of discharge, and the condution velocity through the AV node, thus slowing the HR. Norvask, Verapamil, nifedipin 20
Indications Hypertension Prinzmetals angina: Chest pain caused by vasospasm of the coronary arteries usually occurring at rest rather than during exercise.
Chronic stable angina
A-fib or flutter; Paroxysmal supraventricular tachycardia 21
Nursing Interventions Monitor BP, HR, heart rhythm Monitor liver enzymes, renal function Do not chew or divide, sustained-release tabs (SR or XL tabs) Take with food to increase absorption Assure stool softener is ordered to prevent constipation 22
Prinzmetal's angina (variant angina) What can you tell about Prinzmetals angina? How is it different from typical angina?
23
Prinzmetals angina, also called variant
angina, is chest pain (angina) that occurs at rest for no apparent reason unlike typical angina which usually follows physical exertion. Attacks of Prinzmetals angina are brief but painful and occur most often at night 24
The cause of Prinzmetals angina is a coronary
artery spasm, in which the walls of the artery briefly narrow (constrict). This temporarily reduces or obstructs blood flow to the heart muscle, resulting in chest pain. Coronary artery spasms can be associated with atherosclerosis. Treatment of Prinzmetals angina is directed at the underlying cause, such as atherosclerosis. 25
