Angina Pectoris: Drugs and Review (Nursing)

00:01 Now let's look at drugs for angina pectoris. Now, I have heard people say this multiple different ways. So, I'm not sure on your part of the country, I've heard everything from angina, to angina.

00:13 So however you want to say it, I just usually say chest pain, but the official diagnosis is angina pectoris, or however you want to pronounce it.

00:23 Now, there are 4 families of antianginal agents.

00:26 These are drugs that we use to treat chest pain.

00:29 So as we're starting to look at the drugs, I just want you to tell yourself, "Hey, listen, there are only 4 families or groups of drugs that we're going to talk about in this video." So let's look at the first one.

00:41 It's the one that everyone sees on TV, right? We're going to look at organic nitrates.

00:47 An example of that, first of the 4 families is nitroglycerin.

00:51 The second of the 4 families are beta blockers, like propranolol, metoprolol.

00:58 Those -- both end in "olol." Remember, that's a clue when you're studying medications.

01:03 The generic name of beta blockers have that "olol" response.

01:08 Next, is calcium channel blockers. 1 example is verapamil.

01:12 So, that will help us also in treating chest pain.

01:16 So we've talked about the first 3 families: nitrates, beta blockers, and calcium channel blockers.

01:24 Now, you probably heard of nitrates before you watch this video.

01:28 Beta blockers, if you've looked at our videos on hypertension, we've already talked about those, as we have calcium channel blockers.

01:35 But we're going to talk a little bit differently about the application of these medications when we're talking about treating chest pain.

01:42 The fourth group may actually be the newest to you, because it's the newest to us, ranolazine.

01:48 This is a new drug and it's got some limited indications, but when it's used appropriately, it can be quite helpful.

01:54 It's now approved as a first line therapy for chest pain.

01:59 So it's moving up in the ranks. We usually combine it with other drugs.

02:03 So there you have it.

02:04 Before we start rolling into this, you've got the framework to look at.

02:08 You can tell yourself, "There's 4 families of drugs that we use for chest pain: nitrates, beta blockers, calcium channel blockers, and ranolazine.

02:19 That's all there is. Now let's break each one of these families down.

02:24 Now, angina pectoris, there are 3 types.

02:27 So we talked about 4 different types of drugs that we use to treat chest pain, but I want you to focus on the concept of 3 different types of chest pain.

02:36 They have different causes -- they all 3 hurt, but they have different causes, and so, that's what we want to focus on so you understand why we treat them just a little bit differently.

02:47 Now, you've got prinzmetal angina, which is also known as variant angina.

02:51 So write the word "variant" above that first red box.

02:55 Those are caused by vasospasms, where the vessels just -- they just, literally, spasm. They clamp down, which is why it's in a supply ischemia.

03:04 Supply means we're having a supply issue.

03:07 There's not an appropriate amount of blood getting to the heart tissue.

03:11 Ischemia means there's still hope.

03:14 If we can educate our patients and we can intervene quick enough, hopefully, we can restore blood supply to that tissue, and keep healthy heart tissue.

03:23 Now, the next 2 are similar, but I'm going to walk you through how it's different.

03:28 Chronic stable angina is usually caused because they've got some coronary artery disease, those arteries are kind of filled up with some plaque, and that means they did something, chronic stable angina.

03:40 In my part of the country, this always happens in the winter.

03:43 We see a lot of cases in the ER where we get a random snow and somebody gets the bright idea to go out and shovel their driveway for the first time in years.

03:52 So they really exert themselves.

03:54 Well, because of that extra activity, that extra demand that they've placed on their heart, they end up having chest pain.

04:03 That's because they don't have fantastic blood supply to their heart, but for normal daily life, it's okay.

04:09 But then when they go and do the manly thing, and try and shovel their driveway, they end up putting a greater demand on their heart, and that's why chronic stable angina is considered demand ischemia.

04:23 Now the last one, they've cleverly putting – "they've cleverly putting" -- they've cleverly placed a triangle for you there with a big exclamation point in it.

04:32 You can further circle and star that, whatever format works for you, because this isn't a medical emergency.

04:40 This is a life-threatening emergency.

04:43 When we say unstable angina, now this is someone who maybe had chronic stable angina or maybe did not, but at this point, it's caused by a thrombus, that means a clot.

04:54 So if they had some coronary artery disease, something broke off, traveled through the blood supply.

05:00 Now just become a plug or a stopper.

05:03 And so, this is something that needs huge attention, right? This is the -- someone who goes straight to the front of the line.

05:10 They come in in an ambulance, or if they walk into our ER, and they show us these signs and symptoms, they get taken right back to a bed immediately.

05:18 Because it's a supply ischemia that's going to quickly turn into infarction if we don't intervene because we don't just have a spasm, like we do in variant angina.

05:27 We don't just have a demand ischemia, where if I can get you to lay down and relax and just take some simple medications, you're probably going to feel better.

05:36 This is, "Oh my goodness, the blood supply has been cut off to the heart muscle.

05:41 This is an emergency," because we've got to do something significant because it's a supply issue that cannot be fixed unless we deal with that clot.