Pharm - Chapter 23 - Antianginal Drugs

Which statement indicates that the patient understands teaching about the purpose of nitrate therapy for their angina? 1 "Nitrates dilate blood vessels." 2 "Nitrates have no adverse effects." 3 "Nitrates increase blood pressure." 4 "Nitrates slow conduction in the heart."

1 "Nitrates dilate blood vessels." Nitrates dilate blood vessels and increase blood flow to the heart muscle. Nitrates have several potentially adverse effects. They do not increase blood pressure or slow conduction in the heart.

Before the nurse administers isosorbide mononitrate, which nursing assessment is required? 1 Blood pressure 2 Serum electrolytes 3 Level of consciousness 4 Blood urea nitrogen and creatinine

1 Blood pressure Isosorbide mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering it. Electrolytes, level of consciousness, and blood urea nitrogen and creatinine do not need to be assessed before the administration of isosorbide mononitrate.

A calcium channel blocker has been prescribed for a patient. Which condition in the patient's history is a contraindication to this medication? 1 Hypotension 2 Hypokalemia 3 Dysrhythmias 4 Increased intracranial pressure

1 Hypotension Calcium channel blockers cause vasodilation and thus a drop in blood pressure. They are contraindicated in the presence of hypotension. They are not contraindicated for the patient with a history of hypokalemia, dysrhythmias, or increased intracranial pressure.

A patient who is receiving nitroglycerin intravenously by way of an infusion pump has a blood pressure of 92/60 mm Hg. Which intervention would the nurse take? 1 Slow the infusion. 2 Stop the medication. 3 Tell the patient to change positions slowly. 4 Monitor the patient's electrocardiogram (ECG).

1 Slow the infusion. The capacity of nitroglycerin to dilate arterioles is directly related to the dose; as the dosage increases, the chance of vasodilation increases. The medication dose may need to be decreased to increase the blood pressure to within normal range. The medication should not be stopped because the patient would then have pain. The patient changes positions slowly and ECG is monitored to prevent transient hypotension.

Which patient condition will benefit from the administration of a nitrate? 1 Unstable angina 2 Angina and hypotension 3 Chest pain with a history of severe anemia 4 Severe head injury with report of chest pain

1 Unstable angina A patient with unstable angina will benefit from nitroglycerin therapy because it decreases the intensity of angina pain. The vasodilatory effects of nitrates can worsen hypotension and head injury in a patient. Nitrates will compromise the already-reduced tissue oxygenation in patients with anemia due to hypotension.

Which condition is the primary cause of ischemic heart disease? 1 Clotting 2 Atherosclerosis 3 Angina pectoris 4 Myocardial infarction

2 Atherosclerosis Atherosclerosis is a disease of the coronary arteries that involves fatty plaque deposits in the arterial walls. This disease process causes ischemic heart disease. Clotting, angina pectoris, and myocardial infarction can be consequences of ischemic heart disease, but not the cause of the pathology.

Which medications should be used cautiously in a patient who has been prescribed nitrate therapy? Select all that apply. 1 Diuretics 2 Beta blockers 3 Phenothiazines 4 Calcium channel blockers 5 Phosphodiesterase 5 (PDE5) inhibitors

2 Beta blockers 3 Phenothiazines 4 Calcium channel blockers 5 Phosphodiesterase 5 (PDE5) inhibitors Nitrates interact with beta blockers, phenothiazines, and calcium channel blockers and may worsen hypotension in a patient taking one of these. Nitrates have also been known to cause death in patients as a result of an interaction with erectile dysfunction drugs (PDE5). Diuretics do not interact with nitrates.

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. Which action would the nurse take? 1 Assess the patient's lung sounds. 2 Decrease the intravenous nitroglycerin. 3 Stop the nitroglycerin infusion for 1 hour and then restart. 4 Continue the infusion and recheck the patient's vital signs in 15 minutes.

2 Decrease the intravenous nitroglycerin. Nitroglycerin is a vasodilator and 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 while changing the rate of the intravenous nitroglycerin infusion. There is no reason to assess lung sounds because this medication does not directly affect the lungs. Stopping the infusion may precipitate a myocardial infarction. The infusion should not be continued at the current rate because the patient's blood pressure is too low.

A patient received sublingual nitroglycerin and complains of flushing and headache. What is the best action by the nurse? 1 Administer aspirin. 2 Have the patient sit and rest. 3 Administer an antihistamine. 4 Call the health care provider.

2 Have the patient sit and rest. Headache and flushing are the most common side effects of nitroglycerin and will subside with continued use. The nurse would instruct the patient to sit and rest. For patients with cardiac disease, administering therapeutic acetaminophen for a headache is preferred over therapeutic aspirin. An antihistamine will not help. The health care provider does not have to be called for this side effect.

Which event is likely to increase orthostatic hypotension in a patient who is using nitroglycerin therapy for angina? 1 The patient stops the medication. 2 The patient takes a hot shower after a walk. 3 The patient takes a bronchodilator for asthma. 4 The patient drinks 2 to 3 liters of fluid per day.

2 The patient takes a hot shower after a walk. A hot shower or hot temperature increases orthostatic hypotension in a patient who is on nitroglycerin therapy, as a result of vasodilation. The other situations will not worsen hypotension, but they may cause other problems. If the drug is stopped suddenly, angina may result. Drinking fluid should help to decrease hypotension. A bronchodilator does not increase the risk of hypotension and could actually cause hypertension.

A patient is prescribed isosorbide mononitrate. Which medication in the patient's history would be a contraindication to administration of this medication? 1 Aspirin 2 Levothyroxine 3 Sildenafil 4 Verapamil

3 Sildenafil Sildenafil can cause severe hypotension when administered with a nitrate such as isosorbide mononitrate; therefore these medications should not be prescribed concurrently. The nurse would hold the medication and call the health care provider. Aspirin, levothyroxine, and verapamil are not contraindicated with the administration of a nitrate preparation.

The nurse is caring for a patient with a history of angina who complains of chest pain. Which nitroglycerin preparation would the nurse administer? 1 Isosorbide dinitrate 2 Isosorbide mononitrate 3 Sublingual nitroglycerin 4 Nitroglycerin transdermal patch

3 Sublingual nitroglycerin Sublingual nitroglycerin has an onset that is almost immediate. This preparation is given to patients with chest pain to vasodilate and increase oxygen supply to the heart muscle. Isosorbide dinitrate, isosorbide mononitrate, and nitroglycerin via transdermal patch have a longer onset of action and a longer duration of action.

Which indication is correct for the use of calcium channel blockers (CCBs)? 1 To prolong the QT interval 2 To reduce elevations in heart rate 3 To decrease the workload of the heart 4 To treat acute myocardial infarction (MI)

3 To decrease the workload of the heart CCBs decrease afterload and reduce the workload of the heart by decreasing muscle contraction and promoting muscle relaxation. CCBs do not prolong the QT interval. CCBs are contraindicated in patients with acute MI. Some calcium channel blockers decrease elevations in heart rate; however, this is not the primary indication for the use of calcium channel blockers.

Which patient instruction will help prevent tolerance to nitrate therapy? 1 "Apply the nitroglycerin patch every other day." 2 "Use the nitroglycerin patch for acute episodes of angina only." 3 "Use sublingual nitroglycerin if your systolic blood pressure is 140 mm Hg." 4 "Apply the nitroglycerin patch in the morning and remove it for 10 hours at night."

4 "Apply the nitroglycerin patch in the morning and remove it for 10 hours at night." Tolerance can be prevented by maintaining an 8- to 12-hour nitrate-free period each day. The patch is removed for 8 to 12 hours every night, and a new patch is applied in the morning. Applying the patch every other day will not have therapeutic effects. Sublingual nitroglycerin is administered for treating acute episodes of angina. Sublingual nitroglycerin is more effective for chest pain.

What is the duration of action of a nitroglycerin transdermal patch? 1 3 to 5 minutes 2 0.5 to 1 hour 3 4 to 6 hours 4 8 to 12 hours

4 8 to 12 hours The duration of action of a nitroglycerin transdermal patch is 8 to 12 hours. The duration of action of intravenous nitroglycerin is 3 to 5 minutes. The duration of action of a sublingual tablet is 0.5 to 1 hour. The duration of action of an immediate-release tablet is 4 to 6 hours.

Which beverage is contraindicated when a patient is taking nifedipine? 1 Tea 2 Milk 3 Mango juice 4 Grapefruit juice

4 Grapefruit juice Grapefruit juice can reduce the metabolism of calcium channel blockers, especially nifedipine. Tea, milk, and mango juice do not cause an interaction when ingested with calcium channel blockers.

A patient reports chest pain while performing daily activities and is prescribed metoprolol and verapamil. Which assessment is a priority when caring for this patient? 1 Cardiac enzymes every 8 hours 2 Electrocardiogram (ECG) daily 3 Lung sounds after medication is administered 4 Pulse before administration of medications

4 Pulse before administration of medications Verapamil is a calcium channel blocker (CCB). When a CCB is prescribed with a beta blocker such as metoprolol, the interaction can cause hypotension and bradycardia. The nurse would assess the pulse rate before administering medications and hold the dose when appropriate. Enzymes are assessed with chest pain when a myocardial infarction is suspected. Assessing the ECG daily is not necessary. Lung sounds should be assessed after administering beta blockers in patients with predisposing respiratory problems because beta blockers may cause bronchial constriction at higher doses. Assessment of pulse, however, is a priority because these two medications combined can have a profound effect on heart rate and blood pressure. Priorities of care are carried out first, and in this instance, assessment of heart rate must be done prior to administering the medication.