Question

A student nurse is preparing a paper on coronary artery disease, including the risk factors and the clinical presentation. The paper must include a review of common antianginal agents: nitrates, beta-blockers, and calcium channel blockers.

1. What are the therapeutic actions, indications, and pharmacokinetics for nitroglycerin?
2. What are the indications and pharmacokinetics for metoprolol?
3. What are the therapeutic actions for diltiazem?
4. What are the considerations for the older adult for the use of antianginal agents?
5. What are the important teaching points for patients receiving antianginal nitrates?

Answer 1

A.Nitroglycerin

Therapeutic action	Indication	Pharamacokinetics
Nitroglycerin is denigrated by the action of mALDH in the smooth muscles and the cells.As a result nitrate ion released and changed into nitric oxide .This nitric acid will stimulate the gunaylyl cyclase in the smooth muscle produce high CGMP and it cause vasodilation.	In chest pain assosiated with angina pectoral. Myocardial infraction. Hypertension Pulmonary Edema	Fast absorption of nitroglycerin takes place followed by sublingual administration as tablet.Mean plasma concentration occurs at a mean time of 6-7 minutes after administration.

B..Metoprolol

Indications	pharmacokinetics
It is used with ACE inhibitors and diuretics in the management and prevention of myocardial infraction. In angina pectoral and heart failure	Metoprolol is mostly absorbed from the intestines 95 percentage of oral drug is recover in the urine as unchanged drug and metabolites.Presystemic elimination is 50 percentage.

C . It is a calcium channel blocker,it is used to manage high blood preassure and chest pain.It cause vasodilation and enhance blood flow and oxygen supply to heart.

D.In older people it will leads to arrhythmia and hypotension.Low dose is recommended in older people because poor excretion will leads to toxicity.

E.Advise the patient to avoid smoking because it may affect absorption of the drug.

Teach th epatient to sit for sometime followed by nitrate administration because it cause hypotension.

In emergency situations seek medical help as soon as possible.