angina meds

Question 1

how would you assess angina?

Answer 1

-chest pain
-tingling
-pain in left arm
-nausea
-diaphoresis
-stomach/back pain

Question 2

stable angina

Answer 2

-triggered by known events: increase in physical activity, emotional excitement, large meals, cold exposure

Question 3

goal of stable angina

Answer 3

-reduce intensity and frequency of angina attacks, allow activity

Question 4

unstable angina

Answer 4

-unpredictable, even occurs at rest, while sleeping
-result of CAD complicated by coronary artery spasm, platelet aggregation thrombi

Question 5

goal of unstable angina

Answer 5

-medical emergency determine cause and treatment

Question 6

goal of treating angina

Answer 6

-decrease cardiac oxygen demand

Question 7

medications to treat angina

Answer 7

-nitrates
-ranolazone
-Bblockers
-Calcium channel blocker

Question 8

nitroglycerin action

Answer 8

relaxes vascular smooth muscle and dilates coronary arteries

Question 9

indications for nitroglycerin

Answer 9

-angina
-HTN
-heart failure

Question 10

type of nitroglycerin administration for acute angina

Answer 10

-sublingual
-transmucosal
-translingual spray

Question 11

type of nitroglycerin administration for chronic recurrent angina

Answer 11

-topical (NTG paste)
-transdermal
-transmuscosal or oral sustained-release

Question 12

type of nitroglycerin administration for significant hypertension

Answer 12

-administer IV

Question 13

adverse reaction of nitroglycerin

Answer 13

-headache
-orthostatic hypertension
-reflex tachycardia (may need beta blocker to calcium channel blocker)
-tolerance (8 hours drug free a day)

Question 14

nitroglycerin drug to drug interactions

Answer 14

-alcohol makes hypotension worse
-careful with Bp meds

Question 15

nitroglycerin assessment

Answer 15

-assess the patient’s BP & pulse prior to administration
-acute care: IV access established
-have the patient sit or lie down before taking NTG for acute pain
-repeat SL NTG every 5 minutes for up tp 3 doses; assume MI if no pain relief

Question 16

nitroglycerin teaching points

Answer 16

-start with as small a dose as possible
-remove the NTG from pt for 8-10 hours at night
-always remove one patch before administering the next
-avoid touching medication

Question 17

when does nitroglycerin lose potency?

Answer 17

-exposure to: light, humidity, heat, plastic IV bags of fluid

-SL requires replacement every 6 months

Question 18

what should a patient do if having asinine symptoms?

Answer 18

-if any pain persists after 1 dose, call 911. Take 2 more doses for a total of 3 doses 5 minutes apart if directed

Question 19

ranolazine action

Answer 19

-lowers cardiac O2 demand by inhibiting sodium and potassium channel currents

Question 20

ranolazine key points

Answer 20

-prolonged QT may occur - teach patients to report palpations, chest pain, dyspnea
-monitor for high BP, esp w/ renal disease
-avoid grapefruit juice

Question 21

can you use ranolazine with nitrates, amlodipine, or betablockers?

Answer 21

yes