Cardiac Pharmacology Anti-Anginals (Exam 3)

Question 1

Anti-Anginals: Relieve Chest Pain

Answer 1

Nitrates

Beta Blockers

Calcium Channel Blockers

Ranolazine

Question 2

Anti-Anginals: Reduces HLD

Answer 2

Lipid Lowering drugs (Statins)

Aspirin and Clopidogrel

Question 3

Anti-Anginals: Improve Morbidity and Mortality

Answer 3

Ace inhibitors

ARBS

Question 4

How do nitrates help angina?

Answer 4

Dilate veins, decreases preload

Question 5

How do beta blockers help angina?

Answer 5

Decrease heart rate and contractility

Question 6

How do calcium channel blockers help angina?

Answer 6

Dilate arterioles, decrease afterload and decrease heart rate / contractility

Question 7

How does ranolazine help with angina?

Answer 7

Help the myocardium generate energy more efficiently

Question 8

Nitroglycerin: MOA

Answer 8

Dilates veins and arteries decreases preload and afterload

Question 9

Nitroglycerin: Adverse Effects

Answer 9

Related to vasodilation:

H/A
Hypotension
Reflex tachycardia

TOLERANCE

Question 10

Nitrostat

Answer 10

Sublingual (most common)

Put underneath tongue

Repeat q 5 min x 3 as needed

Question 11

Transderm-Ntiro

Answer 11

Skin path

Apply to chest or thigh area daily

Question 12

Nitro-bid

Answer 12

Ointment

Apply 1-2 inches to chest or thigh area

Question 12

Nitrate teaching: Still not good after 5 min

Answer 12

Take another one and chew aspirin. Call 911

Question 13

Isosorbide

Answer 13

Sublingual or oral

LONG acting and given for prevention of anginal attacks. Tolerance build up over time

Question 14

Nursing Implications with Nitrates

Answer 14

1. Monitor for headache:
   -Take with analgesic
   -Subside in 20 min
2. Apply nitro patches in the morning and remove in the evening:
   -Hairless site and rotate
3. Pt ED: Treatment of acute chest pain
   -Take only as many as needed
   -Do not swallow
   -Fall precautions: Dizziness/Hypotension
   -No relief in 5 min- call 911. Take a second and third every 5 min after
4. IV form:
   -Glass bottle with special tubing
5. Long acting forms - taper when d/c to prevent increased chest pain from vasospasm

Question 14

When stopping isosorbide patients should

Answer 14

Taper off the medication

Question 15

Nitrate Interactions:

Answer 15

Severe hypotension when taken with

sildenafil, antihypertensives, and ETOH

Question 16

ranolazine: MOA

Answer 16

Unknown: Helps myocardium use energy more efficiently

Question 17

ranolazine: Warnings

Answer 17

Prolong OT interval

Question 18

ranolazine: NSG Consideration

Answer 18

CYP340 inhibitor - avoid grapefruit juice and other medication that are CYP inhibitors