chapter 25- antianginals and MI

Question 1

what are the signs and symptoms of angina

Answer 1

• steady, intense pain in anterior chest
• pain radiating to left shoulder, left arm, spine, and jaw
• fear of impending death
• pallor, dyspnea, diaphoresis
• tachycardia, elevated blood pressure

Question 2

angina usually subsides when…

Answer 2

with physical REST and/or stress reduction

Question 3

unstable angina is when episodes occur…

Answer 3

more FREQUENTLY, more INTENSE, and DURING periods of REST

Question 4

angina vs. MI

Answer 4

• angina causes pain, MI causes damage

- thrombolytics are given if patient is having MI

Question 5

factors that affect myocardial oxygen supply

Answer 5

• narrowing or occlusion of a coronary artery

- narrowing causes myocardial ischemia

Question 6

role of the nurse in pharmacological management of patients with angina and MI

Answer 6

• monitor client’s condition
• provide education of prescribed drug treatment
• obtain vital signs and medical and drug history
• obtain info on lifestyle and dietary habits
• obtain description of symptoms and pharmacological treatment initiated by client

Question 7

drugs for angina reduce myocardial demand for O2 by…

Answer 7

• slowing heart rate
• reducing preload
• reducing contractility
• lowering blood pressure (reduced afterload)

Question 8

NITRATE prototype drug and mechanism of action

Answer 8

-nitroglycerin (Nitrostat)

• mechanism of action: relax BOTH arterial and venous smooth muscle; dilate coronary arteries
  
  • short acting- terminates acute angina episode
  • long-acting- decreases severity and frequency of episodes

Question 9

adverse effects of nitrates

Answer 9

hypotension, dizziness, headache, flushing of face, rash

Question 10

if hypotension occurs…

Answer 10

HOLD NITRATES

Question 11

beta-adrenergic blockers to treat angina

Answer 11

atenolol (Tenormin)
-reduces cardiac workload by slowing heart rate and reducing contractility

• primary use: for prophylaxis of stable angina
• adverse effects: fatigue, insomnia, drowsiness, impotence, bradycardia, confusion

Question 12

nitroglycerin: everything you need to know

Answer 12

• watch BP (extreme vasodilator)
• may cause bad headaches (causing blood to rush to head)
• melt under tongue when having chest pain every 5 MINUTES up to 3 TIMES..
• DO NOT take alcohol
• can develop a tolerance
• need to have a “holiday time” while on this med- don’t take around the clock…take during day but not at night)
• VIAGRA+NITROGLYCERIN= SEVERE HYPOTENSION…LETHAL ERECTION

Question 13

what is the first question you ask when giving patient thrombolytics?

Answer 13

“When did symptoms first occur?”

Question 14

thrombolytics: everything you need to know

Answer 14

• DISSOLVES all clots
• antidote is AMINOCAPROIC ACID
• adverse effects: hemorrhage, cardiac issues, hypersensitivity with streptokinase
• ONLY GIVE IV
• put on heart monitor (patient can have reperfusion arrhythmias; watch for bleeding and changes in LOC)