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Nursing Semester 2 > Monica - Final Exam: Anti-anginal, Anti-arrhythmic > Flashcards

Monica - Final Exam: Anti-anginal, Anti-arrhythmic Flashcards

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1
Q

angina

A

coronary atherosclerosis leads to angina (chest pain):

- plaque impairs elasticity and dilation leading to myocardial ischemia, which deprives cells of needed O2 and nutrients

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2
Q

Angina is precipitated by ______ or _______.

A

exertion or stress

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3
Q

Angina can be relieved with _____ and ______.

A

rest (decreased cardiac demand) and nitrates

- pain relief with decreased cardiac workload and increased O2 supply

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4
Q

sxs of angina in men

A

pressure, squeezing, “crushing” pain, radiating pain felt on left side
dyspnea, diaphoresis, tachycardia

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5
Q

sxs of angina in women

A

sxs are not as clear with women:

flu-like symptoms, nausea, fatigue, back pain, jaw pain

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6
Q

Goal of tx of angina:

A
  • inc. blood flow
  • dec. myocardial O2 demand
  • dec. duration + intensity of anginal pain
  • minimize freq of attacks
  • prevent MI
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7
Q

forms of rapid-acting nitroglycerin:

A

sublingual, spray

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8
Q

rapid-acting nitroglycerin forms are indicated for:

A

acute/emergency anginal episodes b/c SL and sprays bypass first pass.

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9
Q

forms of nitroglycerin for long-term management of angina:

A

PO, transdermal patch, isosorbide

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10
Q

nitroglycerin: action

A
  • vasodilation
  • dec. amount of blood returning to heart decreases workload and O2 demand
  • inc. blood flow to coronary arteries
  • inc. O2 supply
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11
Q

nitroglycerin: AEs

A

dizziness, *HA, tachycardia, hypotension

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12
Q

If a patient has a headache after taking nitroglycerin that means:

A

it’s working!

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13
Q

nitroglycerin: D-D interactions

A

concurrent use w/ sildenafil (Viagra), tadalafil (Cialis) increases risk of life-threatening hypotension

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14
Q

Nitrates should not be taken within ___ hours before or after using _____

A

24 hours of sildenafil or tadalafil

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15
Q

If an ER nurse needs to administer nitro to a patient, he should first ask:

A

if the patient has taken any medication for erectile dysfunction.

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16
Q

nitroglycerin: outcome

A
  • decreased frequency and severity of anginal attacks

- increased activity tolerance

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17
Q

How should SL nitro tabs be stored?

A

in a dark container

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18
Q

When should SL nitro tabs be taken?

A

first sign of chest pain

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19
Q

SL nitro tabs may be repeated q__min for __ doses.

A

q5min x 3 doses

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20
Q

If anginal pain is not relieved by SL nitro tabs:

A

call 911

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21
Q

Nitroglycerin ointment is administered using

A

dosing paper. Based on the order, an amount in inches is spread onto the paper and applied to the chest wall.

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22
Q

When applying nitroglycerin ointment the RN should:

A
  • wear gloves to prevent contact
  • rotate sites
  • removal all residual dose
  • write dose, date, and initial
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23
Q

A transdermal nitro patch should be left on for __-__ hours and then:

A

left on for 12-14 hours and removed for 10-12 hours at night.
*NOC RN may need to look at original order to know what time to remove patch

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24
Q

alpha-1 receptors: location - action

A

vascular smooth muscle - vasocontriction

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25
beta-1 receptors: location - action
heart - inc. conractility, HR, and conduction kidney - inc. renin secretion
26
beta-2 receptors: location - action
vascular/non-vascular smooth muscle - bronchodilation
27
Why are non-selective beta blockers contraindicated for patient s with COPD?
block beta-2 receptors causing bronchoconstriciton
28
Adrenergic receptors include ____, _____, and _____ and are activated by _______.
alpha-1, beta-1, and beta-2 are activated by catecholamines (epinephrine, norepinephrine)
29
Beta-adrenergic antagonists are called "___ _______"
beta-blockers
30
Which beta blockers are cardioselective/cardioprotective? Why?
selective beta-1 blockers b/c they protect the heart from catecholemines (epi/NE) by blocking beta-1 adrenergic receptors: - decreasing HR - reducing the force of contraction (dec. CO and O2 demand) - prevents renin release (dec. BP)
31
Selective beta-1 blockers may slow conduction of the heart.
True - decreased electrical impulses may lead to cardiac dysrhythmias
32
beta blocker drug names end in:
-lol
33
beta-1 blocker: atenolol | indications
- HTN - angina * * prevention of MI
34
beta-1 blocker: metoprolol | indications
- HTN - angina - prevention of MI * * dec. mortality if recent MI * * manage stable HF
35
beta-1 blockers (atenolol, metoprolol): AEs
dizziness, bradycardia, hypotension, erectile dysfunction, hypo/hyperglycemia, bronchospasm, wheezing
36
beta-1 blockers (atenolol, metoprolol): D-D interactions
anti-HTN, nitrates - hypotension digoxin, CCB - bradycardia hypoglycemics - fluctuations in glucose levels
37
beta-1 blockers (atenolol, metoprolol): implementation
- assess apical pulse (1 min) - hold if < 50 bpm or arrhythmia - abrupt d/c can cause rebound HTN, angina, life-threatening arrhythmia
38
beta-1 blockers (atenolol, metoprolol): outcome
- dec BP and HR - dec frequency of angina - prevention of MI * *only metoprolol - maintain stable HF
39
Beta-blockers are classified as _______ and _______.
antianginals, antihypertensives
40
non-selective beta-blocker: prototypical drug
carvedilol (Coreg)
41
non-selective beta-blockers block ______, ______, and ______ receptors.
beta-1 beta-2 alpha-1
42
carvedilol: indications
- HTN - management of HF (when unstable) - left ventricular function after MI (low EF, heart is not able to pump enough blood to meet the needs of the body)
43
Which drug would be more appropriate for a patient with unstable HF, metoprolol or carvedilol?
carvedilol
44
Non-selctive beta-blockers have the same side effects as selective beta-blockers, in addition to _____ ______.
orthostatic hypotension
45
Why do non-selective beta-blockers (carvedilol) cause orthostatic hypotension?
They block alpha-1 receptors leading to vasodilation.
46
Non-selective beta-blockers (carvedilol) have the same drug-drug interactions as selective.
True - anti-HTN/nitrates increased hypotension; digoxin/CCB leads to bradycardia; hypoglycemics leads alterations in glucose levels
47
carvedilol: contraindications
asthma and other bronchospastic disorders | - b/c carvedilol blocks beta-2 receptors causing bronchoconstriction
48
carvedilol: outcome
- decreased HR and BP - improved CO - slowing severity of HF
49
calcium channel blocker (CCB): prototypical drug
diltiazem (Cardizem)
50
prototypical selective beta-1 blockers
atenolol, metoprolol
51
prototypical nonselective beta-blocker
carvedilol
52
diltiazem: indications
- HTN - angina - supraventricular tachyarrhythmia (SVT) - rapid ventricular rates (RVR) in Afib * * SVT w/ RVR means heart is erratic and ineffective
53
diltiazem: action
- inhibits transport of Ca+ into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and contractions * * slows cardiac conduction - vessel vasodilation - coronary artery vasodilation: inc O2 supply and dec O2 demand
54
diltiazem: outcomes
- dec BP - dec frequency and severity of anginal attacks * * prevention of tacharrythmia
55
diltiazem: AEs
dizziness, arrhythmias, peripheral edema, sexual dysfunction
56
diltiazem: D-D interactions
- ant-HTN, nitrates - inc. hypotension | - beta-blockers, digoxin - risk of bradycardia
57
diltiazem: implementations
- assess BP and HR HOLD if: - SBP < 90 - HR < 50 bpm
58
prototypical cardiac (digitalis) glycoside
digoxin
59
digoxin: indication
- HF | - atrial fibrillation
60
digoxin: action and outcome
- increased force of myocardial contraction - increased CO, increased EF - slows contraction
61
digoxin: outcome
- increase CO - decrease severity of HF - decrease ventricular response
62
digoxin: AEs
fatigue, bradycardia, anorexia, n/v
63
digoxin: D-D interactions
concurrent use w/ beta-blockers and other anti-arrhythmics - bradycardia and inc. digoxin levels
64
What labs need to be monitored with digoxin?
electrolytes: hypoK+ and hypoMg+ can increase the risk of digoxin toxicity
65
digoxin: implementation
- assess apical pulse - HOLD if <60 bpm - drug monitoring
66
digoxin: therapeutic levels
very narrow! 0.5 - 2 ng/ml
67
sxs of digoxin toxicity
abd pain, anorexia, n/v, bradycardia, visual disturbances (ex. yellow/green halos)
68
How is digoxin toxicity treated?
It depends of the severity of sxs. | May only require d/c-ing the drug OR, if life-threatening, may require the antidote.
69
What is the antidote for digoxin?
digoxin immune Fab
70
digoxin: drug-food interaction
high-fiber meal may decrease absorption
71
Digoxin immune Fab
Digibind, DigiFab IV - complex formed with digoxin that prevents the drug from reaching tissues - excreted by kidneys * serum dig levels not valid 5-7 days after administration - assess for dig toxicity
72
Digoxin immune Fab: AE
hypokalemia

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