(PrepU) Chapter 46: Antianginal Agents

A male patient who uses sublingual nitroglycerin tells the nurse that when he puts it under his tongue, he feels a fizzing sensation. Which response by the nurse would be most appropriate?

"That means that the drug is still potent and working." Fizzing indicates potency, not irritation or deterioration.

A client with asthma has been prescribed a beta-blocker for management of angina. For what adverse reaction should the nurse observe?

Bronchospasm When taking beta blockers, patients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung.

The 47-year-old client is experiencing chest pain and has taken three sublingual nitrogylcerin tablets, but the pain remains. What should the client do next?

Call 911. Nitroglycerin should be administered every five minutes, times three doses. If the pain persists, 911 or the emergency system should be activated. The client should not take additional medication. It is not safe to be transported by private car having chest pain.

Which would be important to do when administering nitroglycerin transbuccally?

Check the inside of the cheeks for ulcers or breakdown. Abrasions or ulcerations could interfere with the drug absorption. Sublingual tablets are placed under the tongue. Transbuccal tablets dissolve between the gums and cheek pocket. Amyl nitrate is supplied as a capsule that is broken and waved under the nose.

Beta-adrenergic blocking agents decrease the oxygen demands of the heart by what mechanism?

Decreasing the heart rate, allowing for longer filling time and increased blood to the heart Beta-blockers prevent the beta-adrenergic receptors from being stimulated. These drugs have multiple effects on the heart and cardiovascular system, including slowing the heart rate, depressing atrioventricular (AV) conduction, decreasing cardiac output, and reducing systolic and diastolic blood pressure at rest and during exercise. These effects decrease the oxygen demands of the heart and thereby decrease angina.

A client taking amlodipine (Norvasc) is having chest pain and is ordered sublingual nitroglycerin. The nurse evaluates the client for:

Hypotension When combined, nitrates and calcium channel blockers can cause symptomatic orthostatic hypotension.

A patient receiving amlodipine for angina reports dizziness. Which intervention should the nurse implement to help alleviate the condition?

Instruct the patient to lie down. Dizziness is a common central nervous adverse effect seen with calcium channel use. The nurse should instruct the patient to lie down until dizziness passes. Applying a cold cloth over the forehead will not relieve the dizziness. The dosage should not be reduced or altered unless instructed by the practitioner. Increasing the fluid consumption will also not help in alleviating dizziness.

A health care provider has prescribed sublingual nitroglycerin and the nitroglycerin patch for a client. When the nurse explains the medications to the client, what advantage of the patch might the nurse mention?

It has a longer duration of action than sublingual tablets. Although the nitroglycerin patch does not act as quickly as the sublingual version of the drug, it is effective for a longer period of time (12 or more hours).

After teaching a group of students about drugs used as antianginal agents, the instructor determines that the teaching was successful when the students identify which as a beta-blocker antianginal agent?

Nadolol Nadolol is a beta-blocker used as an antianginal agent. Amlodipine and verapamil are calcium channel blocker antianginal agents. Ranolazine is classified as a piperazine acetamide.

A patient arrives at the community health care center reporting chest pain and is diagnosed with angina pectoris. Which drug is administered for treating angina?

Nicardipine Nicardipine is the drug used in the treatment of angina. Nicardipine is a calcium channel blocker used as an anti-anginal drug. Isoxsuprine, papaverine, and cilostazol are peripheral vasodilating drugs used in the treatment of peripheral vascular diseases.

A client with a history of angina has sustained a mild head injury in a motor vehicle accident. When the client reports chest pain, what explanation should the nurse provide to support the decision not to treat the angina-related pain with nitroglycerin tablets?

Nitroglycerin will increase intracranial pressure. Nitroglycerin should be used cautiously in the presence of a head injury or cerebral hemorrhage because it may increase intracranial pressure. Nitroglycerin will lower blood pressure. Nitroglycerin can increase cerebral edema. Nitroglycerin does not have a direct effect on blood glucose.

The client is experiencing an acute onset of angina. The nurse would most likely administer which medication?

Nitrostat Nitrostat is administered for acute relief of angina. Nitro-Dur is used to prevent angina. Procardia and Norvasc are indicated for chronic angina.

Anti-anginal drugs are used in the treatment of cardiac disease for what purposes? (Select all that apply.)

Relieve the pain of acute anginal attacks. Prevent angina attacks. Treatment chronic stable angina pectoris. Anti-anginal drugs are used to relieve pain of acute anginal attacks, prevent angina attacks, and treat chronic stable angina pectoris. Antianginals have no effect on HDL or triglycerides.

The nurse would avoid administering nitrates to clients using which medication?

Sildenafil Clients taking phosphodiesterase inhibitors (erectile dysfunction drugs), such as sildenafil, should not use nitrates. Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used to treat hypertension. Simvastatin is an HMG-CoA reductase inhibitor known as a statin used to lower cholesterol and triglycerides. Albuterol is a bronchodilator used in the treatment of asthma to open airways to the lungs.

A health care provider has ordered 40 mg of isosorbide dinitrate for a client who reports chest pain. The nurse administers the medication after confirming the absence of what condition?

anemia Contraindications for nitrates, including isosorbide dinitrate, are severe anemia and hypotension. Neither jaundice nor sinusitis are contraindications to use of the drug. Headache is an adverse effect of nitrates and might be expected after administration.

Following the administration of a scheduled dose of 50-mg atenolol PO, the nurse should prioritize what assessment?

blood pressure (BP) Atenolol and other beta-blockers have an antihypertensive effect, making the monitoring of blood pressure a priority. They are unlikely to affect temperature, LOC, or oxygen saturation levels.

A client with a long-standing diagnosis of asthma is prescribed a beta-blocker for the treatment of angina. The nurse should consequently prioritize assessment for what health problem?

bronchospasm Clients with asthma should be observed for bronchospasm from blockage of beta2 receptors in the lung. The client will not experience hyperglycemia, pleural effusion, or pneumonia as a result of this medication.

A client with angina is prescribed propranolol. Following absorption of the drug, the nurse should monitor the client for what desired effect?

decreased heart rate Beta-blockers cause a slowing of the heart rate referred to as negative chronotropy. They do not normally cause drowsiness, short-term relief from fatigue, or a notable increase in SaO2 since the action of this medication is to inhibit beta2 receptors in the bronchial and vascular musculature.

The client has been started on nitroglycerin ointment for angina. The nurse identifies that the nitroglycerin ointment has been effective if the client reports:

no episodes of angina since ointment was initiated. Topical nitroglycerin is used to manage angina. The treatment is effective if the client reports no episodes of angina. Headache and dizziness are adverse effects of the medication.

What effect, if any, would extensive facial and oral trauma have on a client's sublingual nitroglycerin therapy prescribed to manage the angina?

route changed to transdermal Oral trauma would be expected to affect sublingual nitroglycerin circulation. Changing the route to transdermal will provide an effective route unaffected by the accident's trauma. Discontinuing the nitroglycerin will only endanger the client; increasing the sublingual dose does not change the potential for uneven absorption due to tissue trauma.