Ch 22 Angina

Question 0

How is anginal pain managed

Answer 0

Managed with organic nitrates, beta adrenergic blocking agents, calcium channel blockers, and ranolaxine.
Clients who have chronic stable angina should concurrently take an anti platelet agents such as aspirin or clopidogrel ( plavix), a cholesterol lowering agent or an ACE inhibitor to prevent myocardial infarction and death.

Question 1

What is angina

Answer 1

Anginal pain is a result of an imbalance between myocardial oxygen supply and demand

Question 2

Wha meds are of the class organic nitrate

Answer 2

Nitroglycerin 
Oral extended release capsule: Nitro- time
Sublingual tab: nitro stat
Translingual spray: nitro lingual
Topical ointment: nitro bid
Transdermal patch: nitro- dur
IV: nitro bid IV
Other meds; 
Sublingual: isosorbide dinitrate ( Isordil)
Oral: isosorbide mono nitrate ( Imdur)

Question 3

What are organic nitrates used for

Answer 3

Treatment of acute angina attack

Prophylaxis of chronic stable angina or variant angina

Question 4

What are adverse effects of organic nitrates

Answer 4

Headache
Orthostatic hypotension
Reflex tachycardia: administer a beta blocker if symptoms appear
Tolerance

Question 5

Organic nitrates should be used cautiously in who

Answer 5

Nitroglycerin is contraindicated in ppl who have traumatic head injury because the med may increase intracranial pressure
Use cautiously in ppl taking antihypertensive meds and ppl who have renal or lover dysfunction.

Question 6

What effect can alcohol have with nitroglycerins

Answer 6

It can contribute to the hypotensive effect

Question 7

What meds interact with organic nitrates

Answer 7

Antihypertensive meds such as beta blockers, calcium channel blockers, and diuretics can contribute to hypotensive effects

Question 8

Concurrently taking what meds can cause severe life threatening hypotension

Answer 8

The use of PDE5 inhibitors, sildenafil ( Viagra), talalafil ( Cialis),vardenafil( Levitra) and nitroglycerin.

Question 9

Anti angina agent

Answer 9

Prototype drug: ranolaxine ( Ranexa)

Question 10

What does the anti anginal agent ranolazine ( Ranexa) do?

Answer 10

It lowers cardiac oxygen demand and thereby improves exercise tolerance and decreases pain
Used for chronic stable angina in combination with amlodipine ( Norvasc), a beta adrenergic blocker or a organic nitrate.

Question 11

What are adverse effects of anti anginal agent ranolazine ( Ranexa)

Answer 11

QT prolongation

Elevated BP

Question 12

What is a nursing consideration of ranolazine( Ranexa)

Answer 12

Administer as a extended release tab twice daily wi or without food do not crush or chew
Obtain baseline and monitor digoxin level with concurrent use