Antiplatelet

• Antiplatelets are a pharmacological way of managing coronary artery disease and chronic stable angina
• HMG-CoA reductase inhibitors aka statins are used with healthy behavior changes. Treatment must continue lifelong. It is used to reduce cholesterol synthesis
• Indications for statins

  • hypercholesterolemia
  • reduce risk of cardiovascular events (angina and MI)
• Statins inhibits HMG Co-A reductase, an enzyme needed for cholesterol synthesis
• Adverse effects of statins

  • generally well tolerated
  • rashes
  • abdominal cramps, constipation, flatulence, heartburn
  • serious adverse effects: rhabdomyolysis (protein goes into urine) and hepatotoxicity
• Atorvastatin is taking PO and has the therapeutic response of decreasing LDL, triglycerides and coronary artery disease and increasing HDL
• Nursing implications of atorvastatin

  • lipid and lipoprotein screening
  • give statins in the evening because cholesterol synthesis increases at night
  • notify if muscle pain
• Cholesterol is carried through the blood by lipoproteins
• LDL (low density lipoprotein) is the lipoprotein most clearly associated with CAD
• Nitrates are the oldest and most frequently used antianginal drugs. They relieve angina by causing vasodilation
• Nitrates mechanism of action

  • promote vasodilation
  • primarily dilate veins which decreases blood returning to the blood and decreases the oxygen demand from the heart
  • dilation of arterioles and coronary arteries
• Nitroglycerin (nitrate) therapeutic response is decreasing or preventing anginal pain
• Indications for nitrate

  • long acting forms are used to prevent angina episodes, use the transdermal patch
  • rapid acting forms are used to treat acute angina attacks and acute prophylaxis of angina, use sublingual route
• Nitroglycerin adverse effects

  • generally well tolerated
  • headache
  • orthostatic hypotension
  • reflex tachycardia
• Nitroglycerin interactions

  • hypotensive drugs like Viagra and Cialis (wait 24-48h)
  • beta blockers (lower BP)
• There is a risk of tolerance if nitrates are taken continuously. It is why you need to remove the patch at bedtime for at least 8h and apply a new one
• Nursing implications for nitroglycerin patches

  • apply to hairless area
  • rotate sites
  • patch free interval recommended
• Nursing implications for SL nitroglycerin

  • avoid inhaling the drug
  • do not shake the canister
  • under or on the tongue
• Beta blockers decrease heart rate, contractility and SVR which ultimately decreases oxygen demand
• Calcium channel blockers dilate arterioles which decreases SVR (heart pumps against less resistance) which ultimately decreases oxygen demand
• Antiplatelets suppress platelet aggregation (sticking to fibrous plaque) and prevent thrombosis formation in arteries. There are 4 major groups the most important one being aspirin
• Aspiration reduces the risk of MI by inhibiting cyclooxygenase (platelet aggregation). Its inhibition is irreversible and lasts 7-10, the life of the platelet
• Adverse effects of aspirin are increased risk of GI bleeding and hemorrhagic stroke
• Aspirin nursing implications

  • teach to monitor for bleeding
  • advise to inform prior to surgery