1. nitrates
   1. nitrates
      1. Class:
         1. Organic Nitrates
      2. MOA:
         1. Rapid acting. similar to a vasodilator In chronic stable angina, nitroglycerin dilates veins and decreases venous return (preload). Result: decreases cardiac oxygen demand In variant angina, nitroglycern prevents or reduces coronary artery spasm--> increase oxygen supply (oxygen demand does not decrease)
      3. Indications:
         1. Acute angina attack
         2. Prophylaxis of chronic stable or variant angina
      4. Adverse Effects:
         1. Headache
         2. Flushing
         3. Orthostatic Hypotension
         4. Weakness
         5. Reflex tachycardia
         6. Tolerance
            1. Occurs rapidly and reversed quickly
            2. Develops with high, uninterrupted NTG therapy
            3. Provide a “low/no med” of at least 8 hours everyday
            4. Given mostly at night
      5. Routes of Administration
         1. *Sublingual (SL)
            1. Nitrostat
            2. Given 3x, every 5 min
            3. If no relief after 1st time, call 911. Continue 2 more times. Do not take more than 3 doses.
            4. Vasodilation effects
            5. Headache
            6. Hypotension
            7. Tachycardia
            8. Medication interactions- antihypertensives & PDE5-inhibitors
            9. Tolerance develops rapidly
         2. Tablet
            1. isosorbide mononitrate and dinitrate
         3. Topical
            1. 1-2 inches every 4-6 hours during the day
         4. IV
            1. May be needed if SL is ineffective
         5. Ointment
            1. Avoid touching with bare hands
            2. Can lead to rebound NTG headache
         6. Translingual spray
      6. Nursing Considerations
         1. Monitor drug interactions with Antihypertensives & PDE5- inhibitors
         2. Educate patient on avoiding alcohol, adverse effects, and proper use of medication
         3. Assess before administration
            1. BP
            2. HR
2. BB
   1. metoprolol
3. CCB
   1. verapamil
4. ranolazine
   1. ranolazine
      1. Class:
         1. Antianginal
      2. MOA:
         1. Lowers cardiac oxygen demand; Improves exercise tolerance and decreases pain
      3. Indications:
         1. Angina (not used for variant)
      4. Adverse Effects:
         1. May prolong QT interval
            1. If used for ventricular dysrhythmias, may cause torsades de pointes
         2. Increase BP in those who have renal impairment
         3. Nausea
         4. Headache
      5. Nursing Considerations:
         1. Monitor BP closely
            1. especially those with renal impairment (increases BP by 15 mmHg)
         2. Monitor ECG
         3. Several drug interactions
            1. CYP3A4 Inhibitors
            2. QT prolongation drugs
            3. CCB except amlodipine
5. ACE Inhibitors/ARB
6. Statins
7. ASA