Antianginal

Question 1

a complete blockage of coronary arteries causing pain, discomfort, pressure, tightness or heaviness

Answer 1

Heart attack

Question 2

Pathophysiology of angina and heart attack

Answer 2

due to atherosclerosis (fatty plaque build up in the coronary arteries)
Angina - occurs when coronary arteries were narrowed limiting blood supply to the heart. Heart compensates by beating faster. Stable angina indicates that your heart needs to rest

Heart attack - occurs when the fatty plaque in the coronary arteries ruptured, blood clot forms causing a complete blockage of the blood flow to the heart. this can cause permanent damage to the heart

Question 3

difference of stable angina and unstable angina

Answer 3

Stable - occurs from narrowing of the coronary arteries due to fatty plaque build up restricting blood supply and oxygen to the heart. usually relieved by REST.

Unstable - also referred as acute coronary syndrome causing chest pain EVEN AT REST. usually relieved with blood thinners and opioids for sever pain.

Question 4

nitroglycerin or GTN (nitrates) pharmacodynamics

Answer 4

forms nitric oxide in the smooth muscle cells increasing cGMP (which relaxes smooth muscle tissues and vascular smooth muscles) > decreased calcium influx > decreased smooth muscle contractility

Heart - venous return is decreased (preload is decreased) > O2 demand in the myocardium is reduced enhancing collateral circulation > myocardial workload is decreased (afterload is decreased)

Question 5

adverse effects of nitrates

Answer 5

postural hypotension - sympathetic nerves are not fast enough to stimulate the blood vessels to constrict and supply blood in the brain causing dizziness and risk of falling

tachycardia and bradycardia (contradictory)

throbbing headache, syncope (fainting), weakness

Question 6

nursing consideration for administering nitrates

Answer 6

sublingual spray - sit and rest hold bottle upright and spray under tongue, close mouth immediately. IF chest pain HAS NOT EASED FOR 5 MINS after second dose or pain has intensified CALL AMBULANCE.

transdermal patch - apply to upper arm or chest, remove metal-containing systems before magnetic resonance imaging

Question 7

GTN meds

Answer 7

isosorbide mononitrate (tablets)

Question 8

nitrates severe drug interactions

Answer 8

sildenafil and tadalafil (PDE type-5 inhibitors) - may cause profound hypotension since they’re both vasodilators