Antianginal Drugs Flashcards
Which is a true statement concerning the administration of topical nitroglycerin ointment?
a. The ointment should be applied on the chest over the heart.
b. The ointment should be used only in the case of a mild angina episode.
c. The old ointment should be removed before the new ointment is applied.
d. The ointment should be massaged gently into the skin and then covered with plastic wrap.
ANS: C
The old ointment should be removed before a new dose is applied; the ointment is not massaged or spread on the skin, and it is not indicated for the treatment of acute angina.
The nurse is administering intravenous nitroglycerin to a patient who has just been admitted for an acute myocardial infarction. Which statement is true in regard to the administration of this medication?
a. It must be contained in special non–polyvinyl chloride (non-PVC) intravenous
(IV) bags.
b. It is stable for only 24 hours after preparation.
c. It can be given in infusions with other medications.
d. An IV filter should be attached to the infusion tubing.
ANS: A
This medication must be contained in specifically designed non-PVC plastic IV bags. IV nitroglycerin is stable for 96 hours after preparation, it cannot be given with any other drugs, and IV filters will absorb the drug.
A 53-year-old male patient has been admitted for evaluation of chest pain. He has been diagnosed with angina and prescribed sublingual nitroglycerin tablets. What important instructions for using this medication should the nurse give the patient?
a. Take up to five doses at 15-minute intervals after an anginal attack.
b. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
c. If the chest pain is not relieved, go to hospital immediately.
d. Sit or lie down when taking a tablet; change positions slowly to avoid falling or
fainting.
ANS: D
Sublingual nitroglycerin may cause hypotension. Therefore, the patient should sit or lie down when taking a dose and should move slowly to avoid injury from falling or fainting. One tablet should be taken every 5 minutes, up to 3 tablets in 15 minutes. This drug should never be chewed. If chest pain is not relieved after the first tablet and within 5 minutes, call 911 to activate emergency medical services.
A 74-year-old professional golfer has chest pain that occurs toward the end of his golf games. He says the pain usually goes away after he takes one or two sublingual nitroglycerin tablets and rests. What type of angina does he have?
a. Classic angina
b. Variant angina
c. Unstable angina
d. Prinzmetal’s angina
ANS: A
The patient has classic angina. Also called chronic stable angina, it is triggered by either exertion or stress and usually subsides within 15 minutes with either rest or drug therapy.
A female patient arrives in the emergency department with severe chest pain. She has had pain off and on for a week. Which assessment finding indicates a need for cautious use of nitrates and nitrites?
a. Blood pressure of 110/78 mm Hg
b. History of liver disease
c. History of heart failure
d. Anemia
ANS: D
Anemia is a contraindication to the use of nitrates and nitrites.
A patient is taking a calcium channel blocker as part of his therapy after a myocardial infarction. What important information or instructions should the nurse give the patient about this medication?
a. The tablet should be chewed for faster release of the medication.
b. A frequent adverse effect is hypertension, which should be reported immediately.
c. If adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately.
d. A high-fibre diet with plenty of fluids will help to prevent the constipation that may occur.
ANS: D
Constipation is a common effect of calcium channel blockers. Consuming a diet high in fibre and drinking fluids will help to prevent constipation. Extended-release tablets should never be chewed or crushed. Calcium channel blockers may cause hypotension; because of the risks of rebound hypertension and worsening of tissue ischemia, they should never be discontinued abruptly.
A patient has been prescribed transdermal nitroglycerin patches. What important instructions for applying these patches should the nurse give the patient?
a. Use the patches on any nonhairy area on the body.
b. Use the patches only on the chest area.
c. Temporarily remove the patch while swimming.
d. Apply the patch to the same site consistently.
ANS: A
A transdermal patch should be applied to any nonhairy area on the body; the old patch should first be removed. The patch may be worn while swimming, but if it comes off, it should be replaced after the old site has been cleansed. Application sites should be rotated.
A patient has developed tolerance to transdermal nitroglycerin therapy. Which instruction is the best one for the nurse to give the patient?
a. Omit one dose once a week.
b. Leave the patch on for 2 days at a time.
c. Use only half of a patch until the tolerance subsides.
d. Remove the patch at bedtime, then apply a new one in the morning.
ANS: D
To prevent tolerance, remove the transdermal patch at night for 8 hours and apply a new patch in the morning.
A person who is experiencing chest pain while playing tennis has brought along a bottle of sublingual nitroglycerin. In this situation, which action is appropriate for this person to take? (Select all that apply.)
a. Stop the activity and lie down or sit down.
b. Call 911 immediately.
c. Place a tablet under the tongue.
d. Place a tablet in the space between the gum and cheek.
e. If chest pain is not relieved after 1 minute, take another sublingual tablet.
f. Take another sublingual tablet if chest pain is not relieved after 5 minutes.
g. Take a sip of liquid to help dissolve the pill.
h. Call 911 if the pain is not relieved within 5 minutes after taking one sublingual
tablet.
ANS: A, C, F, H
Stopping the activity and lying or sitting down, placing a tablet under the tongue, taking another sublingual tablet if chest pain is not relieved after 5 minutes, and calling 911 if the pain is not relieved within 5 minutes after taking one sublingual tablet are all correct actions. Calling 911 immediately is an incorrect action because 911 should be called only after 1 tablet has been taken and there is no relief within 5 minutes apart. “Place a tablet in the space between the gum and cheek” describes buccal administration. Taking another sublingual tablet if chest pain is not relieved after a minute is an incorrect action because tablets should be taken 5 minutes apart, and taking a sip of liquid to help dissolve the pill is incorrect because the patient should not drink any liquids while taking sublingual tablets.
Unstable angina is the most dangerous type of angina. T/F?
ANS: T
The statement is true. Unstable angina is the most dangerous, as it is the clinical presentation of acute coronary syndrome with cardiac ischemia without persistent ST-segment elevation as seen on an electrocardiogram and no detectable release of the enzymes and biomarkers of myocardial necrosis. It often ends in a myocardial infarction.
Calcium channel blockers are indicated for patients experiencing an acute MI
ANS: F
The statement is false. Contraindications include known drug allergy, acute MI, second- or third-degree AV block (unless the patient has a pacemaker), and hypotension.
The onset of action of oral metoprolol is 1 hour.
ANS: T
The statement is true. The onset of action of oral metoprolol is 1 hour, with a peal plasma concentration of 2 to 4 hours, an elimination half-life of 3 to 8 hours, and a duration of action of 10 to 20 hours.
Most available β-blockers demonstrate antianginal efficacy.
ANS: T
This statement is true. Most available β-blockers demonstrate antianginal efficacy, although not all have been approved for this use.
Amlodipine (Norvasc®) can be used to treat both angina and hypertension.
ANS: T
This statement is true. Amlodipine is indicated for both angina and hypertension
