Pharm Ch. 23 - Antianginal

5 A 68-year-old man has been taking the nitrate isosorbide dinitrate (Isordil) for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a prescription for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber? a "He will have to be switched to isosorbide mononitrate if he wants to take sildenafil." b "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists." c "I'll write a prescription, but if he uses it, he needs to stop taking the isosorbide for one dose." d "These drugs are compatible with each other, and so I'll write a prescription."

b "Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists."

7. The order reads, "Give metoprolol (Lopressor) 300 mg/day PO in 2 divided doses." The tablets are available in 50-mg strength. How many tablets will the patient receive per dose?

3 tablets per dose (150 mg per dose)

Which instruction should be included in the discharge teaching for a patient with a transdermal nitroglycerin patch? A. "Apply the patch to a nonhairy, nonirritated area of the upper torso or arms." B. "Apply the patch to the same site each day to maintain consistent drug absorption." C. "If you get a headache, remove the patch for 4 hours and then reapply." D. "If you get chest pain, apply a second patch right next to the first patch."

A. "Apply the patch to a nonhairy, nonirritated area of the upper torso or arms." Correct A nitroglycerin patch should be applied to a nonhairy, nonirritated area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

When titrating intravenous nitroglycerin, which assessment findings does the nurse monitor? (Select all that apply.) A. Blood pressure B. Heart rate C. Chest pain D. Respiratory rate

A. Blood pressure B. Heart rate C. Chest pain

Nitrates relieve angina pain by reducing preload. How would the nurse explain the term preload to a patient? A. It is the blood volume within the heart. B. It is the pressure within the superior vena cava. C. It is the pressure against which the heart must pump. D. It is the oxygen demand of the heart.

A. It is the blood volume within the heart. Preload is determined by the amount of blood in the ventricle just before contraction.

Which statement indicates that the patient understands discharge teaching about nitroglycerin? A. "I will need to refill my prescription once a year in order to maintain potency." B. "I will need to keep the nitroglycerin stored in the bottle it comes in." C. "I will take a nitroglycerin tablet every 15 minutes until my chest pain is gone." D. "I should take a nitroglycerin tablet 2 hours before I want to engage in activity that will cause chest pain."

B. "I will need to keep the nitroglycerin stored in the bottle it comes in." Nitroglycerin needs to be stored away from heat, humidity, and light, all of which can decrease its potency. Keeping it in the brown light-resistant bottle helps achieve this. It should be replaced every 3 to 6 months in order to maintain potency. Nitroglycerin is used every 5 minutes for pain relief or just before engaging in activity that is known to cause chest pain.

The patient asks how nitroglycerin should be stored while traveling. What is the nurse's best response? A. "You can protect it from heat by placing the bottle in an ice chest." B. "It's best to keep it in its original container away from heat and light." C. "You can put a few tablets in a resealable bag and carry in your pocket." D. "It's best to lock them in the glove compartment of your car to keep them away from heat and light."

B. "It's best to keep it in its original container away from heat and light." Although nitroglycerin needs to be kept in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and needs to be kept away from light, not in a clear plastic bag.

When applying nitroglycerin ointment, the nurse should perform which action? 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. Apply two thick lines of ointment over the prescribed measured area on the nitroglycerin paper.

B. Apply the ointment to a nonhairy part of the upper torso. Absorption is best over a nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves when applying to prevent transdermal absorption by the applier. The ointment is measured as one straight line on the nitroglycerin patch and is gently spread over paper and applied, but not rubbed, into the skin. Rubbing would increase absorption and risks of side effects.

A patient receiving intravenous nitroglycerin at 20 mcg/min complains of dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse's best action? A. Assess the patient's lung sounds. B. Decrease the intravenous nitroglycerin by 10 mcg/min. C. Increase the intravenous nitroglycerin by 10 mcg/min. D. Recheck the patient's vital signs in 1 hour.

B. Decrease the intravenous nitroglycerin by 10 mcg/min. Nitroglycerin, as a vasodilator, causes a decrease in blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.

Which are common side effects of nitroglycerin? (Select all that apply.) A. Blurred vision B. Flushing C. Headache D. Hypotension

B. Flushing C. Headache D. Hypotension

A patient who is taking sublingual nitroglycerin is complaining of flushing and headaches. What is the nurse's best response? A. "This is a normal response to your chest pain." B. "Stop taking the nitroglycerin because you are probably allergic to it." C. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin." D. "These symptoms are not related to your sublingual nitroglycerin. You should notify your doctor for diagnostic testing."

C. "These are the most common side effects of nitroglycerin. They should subside with continued use of nitroglycerin." Headache and flushing are the most common side effects of nitroglycerin and will subside with continued use.

In order to prevent the development of tolerance, the nurse instructs the patient to perform which action? A. Apply the nitroglycerin patch every other day. B. Switch to sublingual nitroglycerin when the patient's systolic blood pressure elevates to >140 mm Hg. C. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night. D. Use the nitroglycerin patch for acute episodes of angina only.

C. Apply the nitroglycerin patch for 16 hours each and remove for 8 hours at night. Tolerance can be prevented by maintaining an 8-hour nitrate-free period each day.

What is included in the priority assessment before administering isosorbide mononitrate (Imdur)? A. Serum electrolytes B. Blood urea nitrogen (BUN) and creatinine C. Blood pressure D. Level of consciousness

C. Blood pressure Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

When caring for a patient with angina, the nurse would question an order for a noncardioselective beta blocker in a patient with what coexisting medical diagnosis? A. Hypertension B. Atrial fibrillation C. Bronchial asthma D. Myocardial infarction

C. Bronchial asthma Noncardioselective beta blockers should be used with caution in patients with bronchial asthma since any level of blockade of beta2-receptors can promote bronchoconstriction through unopposed parasympathetic (vagal) tone.

Calcium channel blockers reduce myocardial oxygen demand by reducing afterload. How would the nurse explain afterload to the patient? A. It is the blood volume within the heart. B. It is the pressure within the heart. C. It is the pressure against which the heart must pump. D. It is the contractility of the heart muscle.

C. It is the pressure against which the heart must pump. Afterload is determined by the pressure in the aorta just before systole.

Which statement by the patient demonstrates a need for further education regarding nitroglycerin? A. "If I get a headache, I should keep taking my nitroglycerin and use Tylenol for pain relief." B. "I should keep my nitroglycerin in a cool, dry place." C. "I should change positions slowly to avoid getting dizzy from the nitroglycerin's effect on my blood pressure." D. "I can take up to four tablets at 5-minute intervals for chest pain."

D. "I can take up to four tablets at 5-minute intervals for chest pain." Patients are taught to take up to three tablets 5 minutes apart. According to current guidelines, if the chest pain or discomfort is not relieved in 5 minutes, after one dose, the patient (or family member) must call 911 immediately.

Patient teaching regarding sublingual nitroglycerin should include which statement? A. "You can take up to five doses every 3 minutes for chest pain." B. "Chew the tablet for the quickest effect." C. "Keep the tablets locked in a safe place until you need them." D. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness."

D. "Sit or lie down after you take a nitroglycerin tablet to prevent dizziness." Nitroglycerin is a vasodilator and can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. It should be placed under the tongue and allowed to dissolve.

It is most important to instruct a patient prescribed nitroglycerin to avoid which substance(s)? A. Antacids B. Grapefruit juice C. Thiazide diuretics D. Erectile dysfunction medications

D. Erectile dysfunction medications Concurrent administration of erectile dysfunction medications such as sildenafil citrate (Viagra) can cause an acute exacerbation of nitrate-related hypotension.

Which nitrate preparation or dosage form has the longest duration of action? A. Sublingual nitroglycerin B. Sublingual isosorbide dinitrate C. Oral isosorbide dinitrate D. Transdermal nitroglycerin patch

D. Transdermal nitroglycerin patch The transdermal patch has an 8- to 12-hour duration of action, compared with 0.5 to 6 hours for the other choices.

3 Which statement by the patient reflects the need for additional patient 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."

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

a, c, e a A glass of wine c tadalafil (Cialis), an erectile dysfunction drug e carvedilol (Coreg), a beta blocker

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

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

1 A patient has a new prescription for transdermal nitroglycerin patches. The nurse teaches the patient that these patches are most appropriately used for which reason? a To relieve exertional angina b To prevent palpitations c To prevent the occurrence of angina d To stop an episode of angina

c To prevent the occurrence of angina

4 While assessing a patient 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