Anti-aginal/anticoagulants/thrombolytic/thombolytics Flashcards
Anti-anginal drug
Used to:
-Relieve cardiac pain and acute anginal attacks
-Prevent angina
-Treat chronic stable angina pectoris
Anti-anginal medications
Nitroglycerine: store in cool dark place, if given topically wear gloves
Isosorbide: headache
Nitroprusside: black box warning (often used for HTN crisis) major hypotensive response
Anti-anginal drug adverse reactions
CNS Reactions:
-Headache (severe and persistent)
-Dizziness
-Weakness
-Restlessness
Expected reactions:
Other Reactions:
-Hypotension
-Flushing
-Rash
Anti-anginal ongoing assessment
Monitor frequency and severity of any episodes of anginal pain
-Ongoing assessment is usually conducted on an outpatient basis
-Teach the client or family to monitor vital signs frequently during administration
-If client’s heart rate falls below 60 bpm or if the systolic BP is below 90 mm Hg, hold the drug and notify the provider
Anti-anginal implementations
-Most blockers can be taken without regard to meals, but if GI upset occurs, take with food
-Verapamil should be taken with food and can be opened and sprinkled on food or mixed with fluids
-Diltiazem caplets can be crushed and mixed with food or fluids
Anti-anginal implementation
-Teach clients proper administration of nitrates that are prescribed via sublingual or buccal route
-Teach clients that have a nitroglycerin spray to spray the drug onto or under the tongue; do not shake the canister or inhale the spray
-Dose of sublingual nitroglycerin or spray can be repeated every 5 minutes until pain is relieved or until client has received 3 doses in a 15-minute period; contact provider if angina is not relieved
-Sustained release oral tablet should not be crushed or chewed
Anti-anginal implementation #2
-Promoting Optimal Response to Therapy—Administering Transdermal Nitroglycerin
*Be mindful that tolerance can occur
*Apply the patch in the morning and leave in place for 10 to 12 hours; remove patch and leave off for 10 to 12 hours
*Best time to apply transdermal patch is after morning bath or shower or cleansing routine; thoroughly dry skin
Anti-anginal implementation #3
-Promoting Optimal Response to Therapy—Administering Transdermal Nitroglycerin (continued)
*Inspect the skin at the site of application; shave if necessary; optimal sites are chest, abdomen, and thighs; do not apply to extremities
*When removing old patch, fold the adhesive side onto itself to avoid inadvertent adhesion to another person or pet
*New patch should be labeled with a fiber-tipped pen: initials, date, and time of application
*Document location of application
Anti-anginal implementation #4
-Monitoring and Managing Client Needs
-Injury Risk
*If orthostatic hypotension occurs, teach client to rise slowly from laying to sitting to standing (1 to 2 minutes in each position) or to seek assistance getting out of a chair or bed
*Client should take the medication in one position and remain in that position until symptoms disappear
*Monitor blood pressure frequently
Anti-antianginal implementation #5
-Monitoring and Managing Client Needs
-Injury Risk—Lifespan Considerations
*Men: If client is taking medications for erectile dysfunction, severe hypotension can occur if client takes nitrates; assess for use of ED drugs in all male clients who have been prescribed nitrates
Anti-anginal client education
-Teach client about diet restrictions and to avoid salt substitutes unless a particular brand is approved by the primary healthcare provider
-If client is at risk for orthostatic hypotension, teach client and family safety methods to prevent injury and falls at home
Anticoagulants and thrombolytic drugs
-Prevent clot formation
- break apart existing clot
Thrombosis
Formation of a blood clot
Examples:
pulmonary embolism
Deep vein thrombosis
Which can lead to a myocardial infraction
Anticoagulants
prevent the formation and growth of an existing one; used prophylactically in clients at risk for clot formation (“blood thinners”)
Warfarin: oral and parenteral anticoagulant
Heparin sodium: prevents clots (taken IV or Subcut)
Anticoagulants #2
Low–molecular-weight heparins (LMWHs) or fractionated heparins: enoxaparin
*Produce stable responses when administered at recommended dosages; bleeding less likely to occur
-Direct-acting oral anticoagulants (DAOCs)
*Direct thrombin inhibitors: dabigatrin
-Factor X inhibitors: rivaroxaban
