Anginal and MI Drugs Flashcards
Why are anti-anginal drugs used? What are the 3 main pharmacological goals of these drugs?
Indications: restore and supply demand of oxygen delivery to the myocardium when rest is not enough.
Goals:
1. Decrease the frequency and intensity of angina pectoris episodes (this is the primary goal).
- Improve exercise tolerance and allow the patient to do ADLs.
- Extend lifespan by preventing consequences of ischemic heart disease.
What are some lifespan considerations related to children, pregnant people, and older adults?
Children:
- Not used for CAD
- Used for HTN and Arrhythmias
- Dose is determined by weight/age
Pregnancy:
- Safety has not been established. It crosses the placenta and enters human milk.
Older Adults:
- Safety measures if hypotension/arrhythmias occur.
- Start on a low dose.
The nurse educator knows that the nursing students can differentiate short-acting nitrates and long-acting nitrates when they correctly match the prototypes.
Short-Acting Nitrate: Nitroglycerin
- Route: PO, SL spray, SL tablet, Buccal tablet, Transdermal Patch, Topical Ointment, and IV.
Long-Acting Nitrate: Isosorbide Dinitrate
- Route: PO
“Can I continue taking Viagra with my Isosorbide Medication?” asks the patient. The nurse reeducates about drug interactions such as?
No the patient can not take Viagra with the medication.
- Phosphodiesterase-5 Inhibitors (Viagra) can cause life-threatening hypotension or CV collapse.
- Alcohol can cause life-threatening hypotension or CV collapse.
What is the MOA of Diltiazem and what drug class does this belong to?
MOA:
- Decreases preload and afterload by vasodilation
- Decreases resistance and muscle tone
Class: Calcium Channel Blocker
A 50-year-old patient who appeared comfortable 5 hours ago goes into cardiac arrest. The nurse should restart the heart and restore normal blood pressure with which medication?
Vasopressors
The nurse can restore blood supply to the damaged myocardium as quickly as possible with which medication?
Thrombolytics
Mary Smith is recovering from an MI. She tells the nurse that she is in pain. Her pain level is 8/10 and she feels anxious. What should the nurse administer to manage MI pain and anxiety?
Narcotic Analgesics
John is a 45-year-old male who came into the emergency room reporting worsening chest pain. The pain has not been relieved by nitroglycerin or rest. What will the nurse administer and why? Include the medication, dose, moa, and why it helps.
Administer ASA, 160-325mg.
MOA:
- antiplatelet action decreases platelet aggregation and thus decreases the formation or enlargement of thrombi.
- anti-inflammatory properties decrease formation of C-reactive protein.
What are the contraindications of thrombolytic drugs?
- Recent surgery/trauma
- Internal bleed
- Active Peptic Ulcer
- Within 10 days Postpartum
- History of Intracranial Hemorrhage
- Suspected ischemic stroke within the past 3 months
- Bleeding disorders
- Severe liver disease
- Thrombocytopenia
What is the MOA of Nitroglycerin/Isosorbide Dinitrate?
- Relaxes and dilates veins, arteries, and capillaries.
- Decreases BP
- Decreases vasospasms of arteries
- Allows increased blood flow
“I’m feeling pretty dizzy and I have a flushed face. This happened after taking my Nitroglycerin tablet, should I be worried?” asks the patient.
The nurse should advise the patient to do the following and inform them about which adverse effects?
Advise that this is a common reaction to the medication and to monitor it.
A/E:
- CNS: HA, dizzy, weak
- Skin: Flushing of face, contact dermatitis
- CV: Hypotension, orthostatic hypotension, syncope, and reflex tachycardia.
Tolerance with long-acting forms.
The nursing student understands the contraindications of Nitroglycerin and Isosorbide Dinitrate when they list the following.
- Allergy
- Preexisting hypotension
- Severe anemia
- Head trauma
- Cerebral hemorrhage
The new grade nurse is deemed competent regarding the administration of sublingual nitroglycerin when they understand the following. This applies to patients taking the medications at home as well.
- Always check the expiration date
- Check under the tongue for any lesions/abrasions
- Check the BP before each administration.
- Patient should take a sip of water before taking the medication.
- Patient should lie down before taking medication.
- Patient should not swallow the medication.
GIVE 1 DOSE every 5 MINS X 3 , IF UNRELIEVED CHEST PAIN PERSISTS, THINK MI. CALL EMS.
“I have been getting pretty itchy skin after removing my Nitroglycerin patch. Whenever I put a new one on it gets stuck on my hands”. What should the nurse re-educate this patient on regarding administration of a transdermal patch?
- Always check BP before each administration.
- Remove the old on and wash the area.
- Do not get the med on your hands. It will cause a brutal headache.
- Teach them how to use the paste and papers.
- Long-term Use may need Medication free periods.
