Antianginal Drugs

Question 1

What causes chest pain in Pts? What is an example of an activity that increases demand of O2?

Answer 1

Increases demand of O2 w/ decrease supply of O2

Exercising

Question 2

What type of drugs increase the supply of O2?

Answer 2

Beta blockers and dilators

Question 3

What are the 3 types of angina?

Answer 3

Exertional/stable
Variant/prinzmetal
Unstable

Question 4

What is another name for exertional angina?

Answer 4

Stable angina

Question 5

What is another name for variant angina?

Answer 5

Prinzmetal angina

Question 6

How is exertional/stable angina occur? What activity usually causes it?

Answer 6

Plaque build up in coronary arteries

Exercise

Question 7

How does variant/prinzmetal angina occur? When can it happen?

Answer 7

Caused by spasms in coronary artery

Can happen 24/7

Question 8

How does an unstable angina occur? What if the Tx for it?

Answer 8

When a vessel is almost completely occluded

Angioplasty
CABG(coronary artery bypass graft)

Question 9

What are the 4 goals of drugs used to Tx angina?

Answer 9

Minimize attacks
Improve pt capacity
Prevent MI
decrease heart workload

Question 10

What is the difference between NO and N2O? What does it cause?

Answer 10

NO=nitric oxide, causes vasodilation

N2O=laughing gas, causes sedation

Question 11

Why do you have to be sparing w/ nitrates?

Answer 11

Because tolerance can develop

Question 12

Why is nitrates indicated for stable angina?

Answer 12

Because it causes vasodilation to increase blood to get through partial occlusion

Question 13

What is ACS stand for?

Answer 13

Acute coronary syndrome

Question 14

Why are nitrates indicated for ACS?

Answer 14

Because it decreases the workload

Question 15

What are two conditions that are considered ACS?

Answer 15

Unstable angina and acute MI

Question 16

Why is nitrate indicated for CHF?

Answer 16

Decrease the preload

Question 17

Why are nitrates indicated for hypertensive emergencies?

Answer 17

Decreases BP thru vasodilation

Question 18

What is the course of action for a pt who has chest pain w/ a Hx of coronary disease and is prescribed nitro?

Answer 18

Stop
Sit down
Take 1x nitro PRN
wait 5 min
Call 911
Take 1x nitro PRN
wait 5 min
Take 1x nitro PRN

Question 19

What is the max dose of nitro a pt can take?

Answer 19

3 doses

Question 20

What drugs should be used for quick onset? How are they given?

Answer 20

Nitrostat-SL

Nitrolingual-pump spray

Question 21

True of false: nitrobid ointment is given prophylatically?

Answer 21

True

Question 22

What does prophylactically mean?

Answer 22

Prevention

Question 23

How is nitrobid ointment given? What PPE is needed?

Answer 23

Apply to chest of abdomen and lay occlusive dressing on top

Gloves

Question 24

What helps a pt from bldg up tolerance to nitrobid ointment?

Answer 24

Drug free period at night

Question 25

At what times is nitrobid ointment given to a pt?

Answer 25

QAM 6hrs later

Question 26

True or false: transdermal-nitro is used prophylactically?

Answer 26

True

Question 27

How does a pt not build up tolerance to transdermal-nitro?

Answer 27

Remove during sleep

Question 28

Where does a pt apply a transderm-nitro patch?

Answer 28

Upper arms or torso

Question 29

What is the onset and duration of nitrobid IV?

Answer 29

Quick onset Short duration

Question 30

What kind of bags and tubing should be used when delivering nitrobid IV?

Answer 30

Specific non-PVC plastic IV bag and tubing

Question 31

If nitrobid IV is not a clear solution or is discolored, what should be done?

Answer 31

Discard solution

Question 32

When a pt is taking nitrates, what must a nurse educate them on(3)?

Answer 32

Activities that increase risk of angina ADR Contraindications

Question 33

What are the activities that increase risk of angina?

Answer 33

Overexertion Emotional upset Over-eating

Question 34

What are the ADR of nitrates?

Answer 34

HA Flacial flushing Orthostatic hypotension Syncope

Question 35

What are the contraindications for nitrates?

Answer 35

Hypotension Coadministered w/ PDE5 inhibitors (ED drug) Increased intracranial pressure

Question 36

How do nondihydropyridines act as an anti angina medication?

Answer 36

Negative inotropic effect Negative chronotropic effect Vasodilator

Question 37

What does nondihydropyridine a work directly on?

Answer 37

Heart and arteries

Question 38

How does dihydropyridine prevent angina?

Answer 38

Dilating arteries

Question 39

What is the preferred therapy for exertional angina?

Answer 39

SL nitrate | Nitrate spray

Question 40

What Rx are used for a pt w/ exertional angina and HTN?

Answer 40

CCB or beta-blockers

Question 41

What is the preferred therapy for variant angina? If that does work then what is done?

Answer 41

CCB Add a nitrate

Question 42

What is the preferred therapy for unstable angina?

Answer 42

Anticoagulant therapy All drugs Nitro

Question 43

How long does potency last for nitroglycerin?

Answer 43

About 3mo after bottle has been opened

Question 44

What preserves the potency of nitroglycerin?

Answer 44

Storing the medication in a airtight, dark glass bottle w/ metal cap

Question 45

When using a patch or ointment nitroglycerin, what should be done in the location of placing the Rx?

Answer 45

Site rotation | Removal of old medication

Question 46

In order to reduce tolerance to a nitroglycerin what should be done?

Answer 46

Allow for a nitrate-free period

Question 47

What should a pt not do who has just taken nitro?

Answer 47

Don’t drive

Question 48

Contraindication for beta blockers?

Answer 48

<60 HR

Question 49

What is an ADR of beta-blockers?

Answer 49

Dizziness | Syncope

Question 50

What is a common problem w/ pt who take CCBs? How can this be resolved?

Answer 50

Constipation Increase fiber and fluid intake