drugs for coronary artery disease

Question 1

what are the actions of nitroglycerin?

Answer 1

• venous dilation (most effective)
• coronary artery dilation
• arteriole dilation

Question 2

what are the routes for nitroglycerin?

Answer 2

• sublingual
• topical ointment (nitropaste)
• transdermal patch
• intravenous drip

Question 3

what are the directions and teaching points for sublingual nitroglycerin?

Answer 3

• in a dark bottle due to light sensitivity
• expires 3-6 months after opening
• sit down while taking due to drop in BP
• take every 5 minutes, call 911 after the 3rd time

Question 4

what are the directions and teaching points for topical ointment nitroglycerin?

Answer 4

nitropaste

• only used in the hospital
• change every 6 hours
• wear gloves as a nurse to avoid a headache
• headache is a common side effect

Question 5

what are the directions and teaching points for transdermal patch nitroglycerin?

Answer 5

• apply in am and remove before bed to avoid tolerance
• change location
• pt. can use at home

Question 6

what are the directions and teaching points for IV nitroglycerin?

Answer 6

• in a glass bottle because it is flammable

- only given in the hospital

Question 7

what are the side effects of nitroglycerin?

Answer 7

• headache
• hypotension
• tachycardia to compensate with a decrease in BP
• interacts with erectile dysfunction med

Question 8

what kind of medication interacts with nitroglycerin?

Answer 8

erectile dysfunction

Question 9

how can angina be prevented?

Answer 9

cold weather

• raking leaves
• shoveling snow
• hunting

Question 10

what is sublingual availability with nitroglycerin?

Answer 10

pt. should always have it with them even if they are on long-acting nitroglycerin

Question 11

what are the two types of long-acting nitroglycerin?

Answer 11

• isosorbide mononitrate (1x a day)

- isosorbide dinitrate (2x a day)

Question 12

why would someone take isosorbide dinitrate instead of isosorbide mononitrate?

Answer 12

some people respond better to meds twice a day and some respond better to once a day

Question 13

what are the 2 side effects of isosorbide dinitrate and isosorbide mononitrate?

Answer 13

• headache (should diminish with time)

- decreased blood pressure

Question 14

what is ranolazine (ranexa) used for?

Answer 14

angina

Question 15

what is the action of ranolazine (ranexa)?

Answer 15

reduces Na and Ca accumulation in myocardial cells

- exact action is unknown

Question 16

what group of people is ranolazine (ranexa) less effective in?

Answer 16

women

Question 17

is ranolazine (ranexa) a 1st line treatment for angina?

Answer 17

yes but it is not common

Question 18

what are the adverse effects of ranolazine (ranexa)?

Answer 18

• prolonged QT interval - prolonged ventricular repolarization which can lead to v.tach and cardiac arrest
• increased BP
• numerous drug interaction

Question 19

is nitroglycerin or ranolazine (ranexa) safer?

Answer 19

nitroglycerin

Question 20

what do statins do?

Answer 20

lower LDL

Question 21

what is an example of statin?

Answer 21

atorvastatin (Lipitor)

Question 22

what is the action of statin?

Answer 22

decrease LDL levels by inhibiting the HMG-COA enzyme which controls a step in cholesterol synthesis

Question 23

what kind of drug is statin?

Answer 23

HMG-COA enzyme inhibitor

Question 24

what are the side effects of statin?

Answer 24

• headache
• GI disturbances
• myopathy/myalgias (muscle pains and ache)
• liver dysfunction/hepatotoxicity - monitor for elevated liver enzyme (AST & ATL)

Question 25

what teaching is needed with statin?

Answer 25

- no grapefruit juice - poorly absorbed with the 1st dose - absorbs better with a meal - taking it at night could make it more effective

Question 26

what drug should not be taken with grapefruit juice?

Answer 26

statins

Question 27

what is the primary action of cholesterol absorption inhibitors?

Answer 27

decrease LDL and total cholesterol

Question 28

what drug is a cholesterol absorption inhibitor?

Answer 28

ezetimibe (Zetia)

Question 29

what is the action of ezetimibe (Zetia)?

Answer 29

decrease LDL and overall cholesterol levels but blocking the absorption of cholesterol

Question 30

can ezetimibe (Zetia) be used with statins?

Answer 30

yes it can be or it can be used alone

Question 31

what are the side effects of ezetimibe (Zetia)?

Answer 31

- diarrhea | - increased risk of cholelithiasis

Question 32

what is cholelithiasis?

Answer 32

gallstones

Question 33

what is the primary action of fibrates (fibric acid derivates)

Answer 33

decrease triglycerdies

Question 34

what drug is a fibrate?

Answer 34

gemfibrozil (Lopid)

Question 35

what are the actions of fibrate - gemfibrozil (Lopid)?

Answer 35

- decrease triglycerides by increased lipoprotein lipolysis - reduce cholesterol formation early in biosynthesis, mobilize cholesterol from tissue, decrease lipoprotein and triglyceride synthesis

Question 36

what are the side effects of fibrate - gemfibrozil (Lopid)?

Answer 36

- GI upset - increased risk of cholelithiasis (gallstones) - myopathy (muscle weakness) - cardiac arrhythmias - flu-like symptoms - hypersensitivity

Question 37

a nurse should expect muscle pain if a pt is on what two medications?

Answer 37

statins and fribrates

Question 38

what other drug does fibrate - gemfibrozil (Lopid) effect?

Answer 38

coumadin - it would require a lower dose because if displaces anticoagulants on plasma proteins

Question 39

when would fibrates be used?

Answer 39

a pt with normal HDL and LDL, but high triglycerides

Question 40

what is the primary action of nicotinic acid - niacin?

Answer 40

increases HDL

Question 41

what is nicotinic acid - niacin also known as?

Answer 41

vitamin B3 - but a higher dose

Question 42

what are the actions of nicotinic acid - niacin?

Answer 42

- increase HDL - also decreases triglycerides, total cholesterol, VLDL, and LDL - inhibit hepatic VLDL synthesis

Question 43

what are the side effects of nicotinic acid - niacin?

Answer 43

- hyperglycemia - increased blood pressure - hyperuricemia/gout - vasodilation that can cause flushing, rash, tingling, and warmth (Asprin can help and it goes away in a few weeks)

Question 44

when should nicotinic acid - niacin not be used?

Answer 44

- PUD (peptic ulcer disease) - hepatic disease - hypotension - ischemic heart disease - cerebrovascular disease - hemorrhage

Question 45

when would nicotinic acid - niacin be used?

Answer 45

in a pt with normal LDL levels but low HDL

Question 46

what is the primary action of bile acid sequestrant - cholestyramine (Questran)?

Answer 46

decrease LDL

Question 47

what drug is a bile acid sequestrant?

Answer 47

cholestyramine (Questran)

Question 48

what is the prefix for bile acid sequestrants?

Answer 48

cole or chole

Question 49

what are the actions of bile acid sequestrant - cholestyramine (Questran)?

Answer 49

- decrease LDL | - blocks intestinal reabsorption of bile

Question 50

does bile acid sequestrant - cholestyramine (Questran) have to be used with other meds?

Answer 50

yes - with niacin or statins

Question 51

bile acid sequestrant - cholestyramine (Questran) slightly increases what?

Answer 51

triglycerides - so pt who is on this drug must have controlled triglycerides

Question 52

what teaching must be given with bile acid sequestrant - cholestyramine (Questran)?

Answer 52

it interacts with other drugs so other drugs must be taken 1 hour before or 4-6 hours after

Question 53

what are the side effects of bile acid sequestrant - cholestyramine (Questran)?

Answer 53

- abdominal pain - gallstones - compliance issues - constipation - impaired absorption of fat-soluble vitamins - tastes awful

Question 54

what is most pt's biggest complaint with bile acid sequestrant - cholestyramine (Questran)?

Answer 54

it tastes awful