CAD Flashcards
1
Q
Nitrates: Rapid-acting forms function
A
- Rapid-acting forms
Used to treat acute anginal attacks
Sublingual tablets; intravenous infusion - Goal: ↓ O2 demand and/or ↑ O2 supply
- Dilate peripheral and coronary blood vessels
- Give sublingually (tablet) or by spray (faster)
- Should relieve pain in about 3 minutes and has a duration of action of 30-60 minutes
- If no relief in 5 minutes, call EMS; if some relief, repeat every 5 minutes for maximum 3 doses
- Can use prophylactically (5-10 minutes before exercise or sex)
2
Q
Nitrates: Long-acting forms function
A
- Long-acting forms
Used to PREVENT anginal episodes - Main side effects: headache, orthostatic hypotension
Methods of administration:
Oral
- Isosorbide dinitrate (Isordil)
- Isosorbide mononitrate (Imdur)
Nitroglycerin (NTG) ointment
- Teach patient administration technique
- Hairless part of upper body, rotate sites, rub off old area before new application
- Transdermal controlled-release NTG
3
Q
Nitrates: examples and characteristics
A
- Nitroglycerin (Nitrostat, Nitro-Bid, Nitro-Dur)
- Prototype nitrate
- Large first-pass effect with oral forms
- Used for symptomatic treatment of ischemic heart conditions (angina)
- IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain, pulmonary edema associated with acute MI, and hypertensive emergencies
Oral Forms:
- Isosorbide dinitrate (Isordil)
- Isosorbide mononitrate (Imdur)
NTG topical ointment:
- Nitropaste
4
Q
Nitrates: instructions
A
No previous nitroglycerine administration
- Take NTG sublingually
- If pain is not relieved in 5 minutes call 911
- If pain is relieved in 5 minutes notify physician of the CP episode
If previous NTG
- Take NTG sublingually
- If CP not improved call 911
- If CP is improved repeat for two doses 5 minutes apart (total of three doses)
- If CP not totally resolved after 3 doses, call 911
5
Q
Nitrates Adverse effects
A
- Headaches (Usually diminish in intensity and frequency with continued use)
- Reflex tachycardia
- Postural hypotension
Tolerance may develop
- May occur in patients taking nitrates around the clock and in those who take long acting nitrates
- Prevent with a nitrate free period (8 hour period?, recommend to take patch off at night)
6
Q
Nitroglycerine: Patient teaching
A
- Easy access to NTG
- Store away from light or heat sources; comes in dark bottle
- Loss of potency after about 3-6 months
- Teach to allow to dissolve under tongue; do not chew or swallow
- If it does not cause tingling (stinging), it may not be potent
- Can cause headache, dizziness, flushing
- Change positions slowly (can cause orthostatic hypotension)
- Report any change in the usual pattern of pain (increase in intensity or frequency)
7
Q
Nitrates: Nursing implications
A
Nitropaste-NTG topical ointment
- Dosed by the inch
- Placed on the upper body or arm, over a flat muscular area that is free of hair and scars
- Once absorbed, it produces anginal prophylaxis for 3 to 6 hours
Transdermal NTG drug administration offers the advantage of steady plasma levels within the therapeutic range during 24 hours, thus making only one application a day necessary.
- Instruct patients to take PRN nitrates at the first hint of anginal pain
- Monitor vital signs frequently during acute exacerbations of angina and during IV administration
- If experiencing chest pain, the patient taking sublingual nitroglycerin should lie down to prevent or decrease dizziness and fainting that may occur because of hypotension
- IV forms of nitroglycerin must be given with special non-PVC tubing and bags
- Discard parenteral solution that is blue, green, or dark red
- Typically IV nitroglycerine is administered to relieve chest pain (or decrease BP) and is titrated to the desired effect
- ***Should not give NTG if the SBP is less than 90 mm Hg
8
Q
Beta Blockers: Mechanism of Action
A
- Block beta 1 receptors on the heart
- Decrease HR, resulting in decreased myocardial oxygen demand and increased oxygen delivery to the heart
- Decrease myocardial contractility, helping to conserve energy or decrease demand
- Not used for an acute attack but for prevention
- Patients with CAD have to be on a beta blocker unless there is a documented reason why not
9
Q
Calcium Channel Blockers: Mechanism of Action
A
- Cause coronary artery vasodilation
- Cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance (SVR)
- Reduce the workload of the heart
- Result: decreased myocardial oxygen demand
- Drug category of choice in the management of Prinzmetal’s angina
10
Q
Other Anti-anginal Drug: Ranolazine (Ranexa): characteristics
A
- Partial fatty acid oxidation inhibitor
- ***Use of glucose for myocardial cell energy instead of fatty acids (this decreases myocardial oxygen demand)
- Ranolazine has anti-ischemic and antianginal effects that do not depend upon reductions in heart rate or blood pressure.
- Used for chronic angina that has not responded to other medications
11
Q
anti-anginal agents: general: Nursing Implications
A
- Patients should not take any medications, including over-the-counter medications, without checking with their physician
- Patients should be encouraged to limit caffeine intake
- Alcohol consumption and spending time in hot baths or whirlpools, hot tubs, or saunas will result in vasodilation, hypotension, and the possibility of fainting
- Teach patients to change positions slowly to avoid postural BP changes
- Encourage patients to keep a record of their anginal attacks, including precipitating factors, number of pills taken, and therapeutic effects
12
Q
Drugs to Treat Erectile Dysfunction: examples
A
- sildenafil (Viagra): First oral drug for treatment of ED
- vardenafil (Levitra)
- tadalafil (Cialis)
- alprostadil (Caverject)
VATS + -afil/adil
13
Q
Drugs to Treat Erectile Dysfunction: function
A
- Erection - Nerve impulse travels from brain to penis and chemicals are released causing relaxation of muscles (blood flow ^)
- Erection Reversal occurs when and enzyme PDE5 (only found in penis) breaks down the chemicals that cause relaxation in the first place.
- This causes muscular contraction which results in blood leaving the penis
- How sildenafil (Viagra) works - blocks the PDE5
- Allows the blood to stay in the penis longer
- Results in a longer erection
14
Q
Erectile Dysfunction drugs: adverse reactions
A
- Color Blindness, sudden loss of vision
- Flushing, headache
- Priapism (sustained erection)
- Hypotension (especially in combination with nitrates)
- Edema
- Dizziness
15
Q
Antilipemics: HMG-CoA Reductase Inhibitors: examples
A
Most potent LDL reducers:
aka statin or HMGs
- pravastatin (Pravachol)
- simvastatin (Zocor)
- atorvastatin (Lipitor)
- fluvastatin (Lescol)
- rosuvastatin (Crestor)
- pitavastatin (Livalo)
FAPPRS + -statin
