Angina - CP

Question 1

Means: Squeezing Pain

Answer 1

Angina

Question 2

Angina ______ with age

Answer 2

Increases

Question 3

Stable angina: 
Lasts less than \_\_\_ minutes.
Is triggered by exertion or emotional \_\_\_\_\_\_\_.
Requires greater than \_\_\_% stenosis
Involves reversible \_\_\_\_\_\_\_\_\_ injury

Answer 3

20
stress
70
myocyte

Question 4

What is it if angina lasts longer than 20 min?

Answer 4

Myocardial infarction

Question 5

In which type of angina does everything work under normal circumstances but when something abnormal happens (Like running up stairs) patient feels the pain.

Answer 5

Stable Angina

Question 6

Signs and Symptoms of Stable angina: (4)

Answer 6

• Chest pain less than 20 minutes
• Pain that radiates
• Diaphoresis
• SOB

Question 7

Type of angina that occurs at rest

Answer 7

unstable

Question 8

Unstable Angina:
Involves a ruptured \_\_\_\_\_\_\_\_\_\_ and thrombosis.
Only \_\_\_\_\_\_\_\_ occlusion results.
Reversible \_\_\_\_\_\_\_\_\_ injury
Is blood flow still present?

Answer 8

plaque
partial
myocyte
Yes, but decreased.

Question 9

Type of angina that:

• Is caused by vasospasm
• Is unrelated to exertion
• Has reversible myocyte injury (If less than 20 minutes)

Answer 9

Prinzmetal

Question 10

Angina = ___ demand is greater than supply

Answer 10

O2

Question 11

Best option for a person suffering angina: Decrease what?

Answer 11

The work of the heart

Question 12

When you decrease the HR you decrease the work of the heart but you also increase _________ and the coronary artery perfusion (fill) during.

Answer 12

Diastole

Question 13

When does the heart “eat” (fill).

Answer 13

Diastole

Question 14

Most anginas come with an EKG that reflects what?

Answer 14

ST depression

Question 15

What type of angina comes with ST elevation?

Answer 15

Prinzmetal

Question 16

1. Prinzmetal angina comes with ST elevation because?

2. ST elevation is what also shows up when a patient is having a ____ ?

Answer 16

blood flow is totally cut off

MI

Question 17

What does STEMI stand for?

Answer 17

ST elevated MI

Question 18

How should a nurse teach a patient taking nitroglycerine to position themselves and why?

Answer 18

Sit or lie down before taking because it will work really quickly and drop blood pressure.

Question 19

Why is nitroglycerine dissolved under the tongue?

Answer 19

To avoid first pass metabolism.

Question 20

What happens if nitroglycerine doesn’t relieve the pain in 5 minutes?

Answer 20

Take another one

Question 21

Nitroglycerine is indicated for Q5M. How many doses can be taken?

Answer 21

3

Question 22

Ways that nitro can be administered? (5)

Answer 22

Sublingual tabs
Translingual spray
oral capsules SR
transdermal patch
topical ointment

Question 23

Can you crush isosorbide mononitrate?

Answer 23

No

Question 24

How long does isosorbide mononitrate last?

Answer 24

12 hours

Question 25

What kind of drug is isosorbide mononitrate?

Answer 25

Nitrate

Question 26

MOA of nitrates:

Answer 26

reduces cardiac oxygen demand by decreasing left ventricular pressure and preload

Question 27

Discuss why a client might take nitroglycerin prior to a stressful event.

Answer 27

Rapid-acting preparations also can be used for acute prophylaxis of angina. For this purpose, they are taken just before anticipated exertion

Question 28

Identify which clients might benefit from a long acting or transdermal nitrate:

Answer 28

These would be for someone looking to prevent an angina episode. These are not for an acute attack.

Question 29

Because sublingual administration of nitroglycerine works fast, this route is ideal for (2):

Answer 29

1. Terminating an ongoing attack and | 2. Short-term prophylaxis when exertion is anticipated.

Question 30

Effects of sublingual nitroglycerin begin rapidly—in ___ to ___ minutes—and persist up to __ hour.

Answer 30

1-3 | 1 hour

Question 31

By lowering the blood pressure, nitroglycerin can activate what reflex?

Answer 31

baroreceptor reflex,

Question 32

By lowering the blood pressure, nitroglycerin can activate baroreceptor reflex causing:

Answer 32

(reflex tachycardia) sympathetic stimulation of the heart

Question 33

What can prevent the reflex tachycardia response that comes with nitroglycerine:

Answer 33

Pretreatment with a beta-blocker or verapamil can prevent

Question 34

How does increasing time spent in diastole help the client with angina?

Answer 34

It increases the time blood flows through myocardial vessels.

Question 35

What is the goal heart rate when administering a beta blocker?

Answer 35

50-60 beats per minute

Question 36

Why cant you use beta blockers to treat prinzmetal angina?

Answer 36

Because it involves coronary vasospasm and beta blockers can make that worse.

Question 37

Adverse effects of isosorbide mononitrate?

Answer 37

Headache (50%), Orthostasis, Flushing (esp the face), Dizziness

Question 38

Nitroglycerine can be taken every ___ minutes

Answer 38

5

Question 39

Nitrates have interactions with drugs containing:

Answer 39

PDE 5 (The enzyme that breaks down cGmp)