Pharm Cardio - Angina (ch 23)

nitrate MOA

vasodilation -dilation of coronary arteries = ↑ oxygen supply to the heart -venous dilation = ↓ preload and afterload

calcium channel blockers treat which type of angina?

vasospastic/variant/Prinzmetal angina

Purpose of antianginal drug therapy

↑ blood flow to ischemic cardiac muscle and ↓ myocardial oxygen demand

when to withhold nitrates (3)

-systolic BP <90 mm Hg -pulse rate <60 beats/min -pulse rate >100 beats/min

The nurse is reviewing drug interactions with a male patient who as a prescription for isosorbide dinitrate (Isordil) as treatment for angina symptoms. Which substances listed could potentially result in a drug interaction? Select all that apply: 1. A glass of wine 2. Thyroid replacement hormone 3. tadalafil (Cialis), an erectile dysfunction drug 4. metformin (Glucophage), an antidiabetic drug 5. carvedilol (Coreg), a beta blocker

1. A glass of wine 3. tadalafil (Cialis), an erectile dysfunction drug 5. carvedilol (Coreg), a beta blocker Pharm

For a patient receiving IV nitroglycerin (Tridil), what are the priority nursing interventions? (Select all that apply.) 1. Check the heart rate. 2. Monitor blood pressure. 3. Auscultate lung sounds. 4. Measure intake and output. 5. Assess for worsening chest pain.

1. Check the heart rate. 2. Monitor blood pressure. 5. Assess for worsening chest pain. Pharm

The nurse understands that a patient receiving nitroglycerin should be monitored for which common adverse effects associated with this medication? (Select all that apply.) 1. Flushing 2. Headache 3. Dizziness 4. Hypotension 5. Blurred vision

1. Flushing 2. Headache 3. Dizziness 4. Hypotension Pharm

3 main classes of drugs to treat angina

1. nitrates/nitrites 2. beta blockers 3. calcium channel blockers

A client in the hospital emergency department who received nitroglycerin for chest pain has obtained relief but now complains of a headache. The nurse should interpret that this client is most likely experiencing which condition? 1. An allergic reaction to nitroglycerin 2. An expected medication side effect 3. An early sign of tolerance to the medication 4. A warning that the medication should not be used again

2. An expected medication side effect NCLEX

The nurse is teaching treatment of acute chest pain for a patient prescribed nitroglycerin (Nitrostat) sublingual tablets. Which instructions should the nurse include? 1. Take five tablets every 3 minutes for chest pain. 2. Sit or lie down before taking medication. 3. Chew or swallow the tablet for the quickest effect. 4. Keep the tablets locked in a safe place until you need them.

2. Sit or lie down before taking medication. Pharm

Which dosage form of nitroglycerin has the longest duration of action? 1. Sublingual tablet 2. Transdermal patch 3. Intravenous (IV) infusion 4. Immediate-release tablet

2. Transdermal patch Pharm

A hospitalized client with coronary artery disease complains of substernal chest pain. After assessing the client's heart rate and blood pressure, the nurse administers nitroglycerin, 0.4 mg sublingually. After 5 minutes the client states, "My chest still hurts." Which actions should the nurse take? (Select all that apply.) 1. Call a Code Blue. 2. Contact the client's family. 3. Assess the client's pain level. 4. Check the client's blood pressure. 5. Contact the health care provider (HCP). 6. Administer a second nitroglycerin, 0.4 mg sublingually.

3. Assess the client's pain level. 4. Check the client's blood pressure. 6. Administer a second nitroglycerin, 0.4 mg sublingually. NCLEX

When caring for a patient with angina pectoris, the nurse would question a prescription for a noncardioselective beta blocker in a patient with which preexisting condition? 1. Hypertension 2. Atrial fibrillation 3. Bronchial asthma 4. Myocardial infarction

3. Bronchial asthma Pharm

It is MOST important for the nurse to instruct a patient prescribed nitroglycerin to avoid which substance? 1. Antacids 2. Grapefruit juice 3. Erectile dysfunction drugs 4. Potassium-sparing diuretics

3. Erectile dysfunction drugs Pharm

Transdermal nitroglycerin patches are most appropriately used for which reason? 1. To relieve exertional angina 2. To prevent palpations 3. To prevent the occurrence of angina 4. To stop an episode of angina

3. To prevent the occurrence of angina Pharm

A client with angina pectoris has been given a new prescription for nitroglycerin transdermal patches. The client indicates an understanding of how to use this medication administration system by making which statement? 1. "I need to wait until the next day to apply a new patch if it falls off." 2. "I need to alternate daily dosage times to prevent tolerance to the medication." 3. "I need to place the patch in the area of a skin fold to promote better adherence." 4. "I need to apply the patch in the morning and leave it in place for 12 to 14 hours as directed."

4. "I need to apply the patch in the morning and leave it in place for 12 to 14 hours as directed." NCLEX

Nitroglycerin relieves cardiac-related chest pain by: A. dilating the coronary arteries and improving cardiac blood flow. B. increasing the amount of work that is placed on the myocardium. C. contracting the smooth muscle of the coronary and cerebral arteries. D. constricting the coronary arteries and improving cardiac blood flow.

A. dilating the coronary arteries and improving cardiac blood flow. EMT book

Common side effects of nitroglycerin include all of the following, EXCEPT: A. bradycardia. B. hypertension. C. hypotension. D. severe headache

B. hypertension. EMT book

Nitroglycerin is contraindicated in patients: A. who have taken up to two doses. B. who have experienced a head injury. C. with a history of an ischemic stroke. D. with a systolic blood pressure less than 120 mm Hg.

B. who have experienced a head injury. EMT book

A client is to be discharged home with a transdermal nitroglycerin patch. Which instruction will the nurse include in the client's teaching plan? a. "Apply the patch to a nonhairy area of the upper torso or arm." b. "Apply the patch to the same site each day." c. "If you have a headache, remove the patch for 4 hours and then reapply." d. "If you have chest pain, apply a second patch next to the first patch."

a. "Apply the patch to a nonhairy area of the upper torso or arm." Pharm

Which effects contribute to making nitrates the first-line therapy for the treatment of angina? Select all that apply: a. Decrease preload b. Decrease afterload c. Dilate coronary arteries d. Decrease heart rate e. Prevent thrombosis of plaques f. Decrease myocardial contractility

a. Decrease preload b. Decrease afterload c. Dilate coronary arteries MS workbook ch 33

Before administering isosorbide mononitrate (Imdur) sustained-release tablet to a patient, what is the priority nursing intervention? a. Obtain a blood pressure reading. b. Remind the patient to take the tablet before meals. c. Emphasize that the patient should swallow the tablet whole. d. Advise the patient that Tylenol is used to treat headache

a. Obtain a blood pressure reading. Pharm

Which statement by the pt reflects the need for additional pt education about the calcium channel blocker diltiazem (Cardizem)? a. "I can take this drug to stop an attack of angina." b. "I understand that food and antacids alter the absorption of this oral drug." c. "When the long-acting forms are taken, the drug cannot be crushed." d. "This drug may cause my blood pressure to drop, so I need to be careful when getting up."

a. "I can take this drug to stop an attack of angina." Pharm

During his morning walk, a man begins to experience chest pain. He sits down and takes one nitroglycerin sublingual tablet. After 5 minutes, the chest pain is worsening. What action would be priority in this situation? a. call 911 (emergency medical services) b. take another nitroglycerin tablet c. take 2 more nitroglycerin tablets at the same time d. sit quietly to wait for the pain to subside

a. call 911 workbook

Nitroglycerin can be given by which routes? (Select all that apply) a. continuous intravenous drip b. intravenous bolus c. sublingual spray d. oral dosage forms e. topical ointment f. rectal suppository

a. continuous intravenous drip c. sublingual spray d. oral dosage forms e. topical ointment workbook

Which of the following is a side effect of nitrates? a. reflex tachycardia b. hypertension c. nausea d. cough

a. reflex tachycardia workbook

sublingual nitroglycerin: pt teaching (4)

-store in original glass container (away from heat, light, moisture) -sit or lie down before taking medication -do not swallow until medication is completely dissolved -if the drug does not burn, the medication has lost its potency

The nurse acknowledges that beta blockers are as effective as antianginals because they do what? a. Increase oxygen to the systemic circulation. b. Maintain heart rate and blood pressure. c. Decrease heart rate and decrease myocardial contractility. d. Decrease heart rate and increase myocardial contractility.

c. Decrease heart rate and decrease myocardial contractility.

A pt with coronary artery spasms will be effectively treated with which type of anginal medication? a. beta blockers b. calcium channel blockers c. nitrates d. nitrites

b. calcium channel blockers workbook

A nurse with adequate knowledge about the administration of IV nitroglycerin will recognize that which statement is correct? a. the IV form is given by IV push injection b. because the IV forms are short-lived, the dosing must be every 2 hrs c. IV nitroglycerin must be protected from exposure to light through use of special tubing d. IV nitroglycerin can be given via gravity drip infusions

c. IV nitroglycerin must be protected from exposure to light through use of special tubing Pharm

The nurse will teach a pt who will be taking nitroglycerin about which common adverse effect of this drug? a. blurred vision b. dizziness c. headache d. weakness

c. headache workbook

Which of the following describes the rationale for the administration of nitroglycerin by the sublingual route? a. the side effects are lessened b. pts can self-administer c. the first pass effect is avoided d. it can be used in pts with swallowing problems

c. the first pass effect is avoided workbook

The nurse is caring for a pt with angina. Nitroglycerin is prescribed for what purpose? a. to assist smooth muscles to contract b. to increase venous return to the heart c. to reduce preload and afterload d. to slow and strengthen the heart rate

c. to reduce preload and afterload Leadership and Management

What do you tell a patient who asks, "What is my next step if I take one nitroglycerin tablet, wait 5 minutes, but still have anginal pain?"

call the emergency response team (if pain is not relieved 5 min after taking first tablet, call 911, then take a second tablet) ATI Pharm ch 22

beta blockers treat which type of angina?

chronic stable angina/exertional angina

When assessing a pt with angina who is to start beta blocker therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used? a. hypertension b. essential tremors c. exertional angina d. asthma

d. asthma Pharm

effect of beta blockers on: preload afterload contractility heart rate

preload: ↑ afterload: no effect/may ↓ contractility: ↓ heart rate: ↓

effect of nitrates on: preload afterload contractility heart rate

preload: ↓ afterload: ↓ contractility: no effect heart rate: no effect/may ↑ Pharm text Table 23-1

effect of calcium channel blockers on: preload afterload contractility heart rate

preload: ↓ afterload: ↓ contractility: ↓ heart rate: ↓ Pharm text Table 23-1

how to prevent tolerance when using transdermal nitrate patches

remove the patch at night and then apply a new patch in the morning

Sublingual nitroglycerin tablets during an anginal attack: take up to ____ doses, ____ minutes apart

take up to 3 doses, 5 minutes apart

afterload

the force against which the heart must pump (systemic vascular resistance)

preload

the pressure in the heart caused by blood volume, the blood return to the heart

nitroglycerin ointment: pt teaching (6)

-remove all residual ointment from previous dose -rotate application sites (to prevent irritation) -apply to clean, dry, hairless skin -apply to upper torso or arms -do not apply ointment with fingers, use dosage paper -cover area with occlusive dressing

transdermal nitroglycerin patches: pt teaching (6)

-remove old patch before applying new one, clean residue off skin -rotate application sites (to prevent irritation) -apply to clean, dry, hairless skin -apply to upper torso or arms -apply patch at same time every day -remove patch at night (to prevent tolerance)

What instruction should the nurse provide to the client who needs to apply nitroglycerin ointment? a. Use the fingers to spread the ointment evenly over a 3-inch area. b. Apply the ointment to a nonhairy part of the upper torso. c. Massage the ointment into the skin. d. Cover the application paper with ointment before use.

b. Apply the ointment to a nonhairy part of the upper torso. Pharm

Which characteristics describe unstable angina? Select all that apply: a. Usually precipitated by exertion b. New-onset angina with minimal exertion c. Occurs only when the person is recumbent d. Characterized by increased duration or severity e. Usually occurs in response to coronary artery spasm

b. New-onset angina with minimal exertion d. Characterized by increased duration or severity MS workbook ch 33

Pts who are taking beta blockers for angina need to be taught which information? a. these drugs must be taken as soon as angina pain occurs b. these drugs are for long-term prevention of angina episodes c. these drugs will be discontinued if dizziness is experienced d. these drugs need to be carried with the pt at all times

b. these drugs are for long-term prevention of angina episodes workbook

side effects of nitrates (6)

-headache (most common) -hypotension -orthostatic hypotension -flushing -reflex tachycardia -drug tolerance

contraindications for nitrates (4)

-increased intracranial pressure/head injury -hypotension -severe anemia -closed-angle glaucoma

what to assess before giving a pt nitrates (2)

-BP -heart rate/pulse

chronic stable angina

-aka exertional angina -chest pain caused by atherosclerosis -long-term, stable level of obstruction in one or more coronary arteries -can be triggered by exertion, usually subsides with rest

vasospastic angina

-aka variant angina, Prinzmetal angina -caused by coronary artery spasm -occurs at rest without precipitating cause

nitrate drug interactions (4)

-alcohol -erectile dysfunction drugs -beta blockers -calcium channel blockers

unstable angina

-early stage of CAD (coronary artery disease) -often ends in an MI -occurs at rest or with minimal exertion