Chest Pain

Question 1

Angina Pain…

Answer 1

-result from myocardium not getting enough oxygen

Question 2

Angina Pain: medications

Answer 2

1) organic nitrates
2) beta blockers
3) calcium channel blockers
4) antiplatelet agents
5) cholesterol-lowering agents
6) ACE inhibitors

Question 3

Organic Nitrates: medications

Answer 3

1) prototype = nitroglycerin
- sublingual tablet = Nitrostat
- translingual spray = Nitrolingual
- topical ointment = Nitro-Bid
- transdermal patch = Nitro-Dur
- IV = Nitro-Bid IV
2) other medications =
- sublingual = isosorbide dinitrate (Isordil)
- Oral = isosorbide mononitrate (Imdur)

Question 4

Organic Nitrates:

expected action

Answer 4

1) chronic stable angina
- dilates veins
- decreases preload
- decreases cardiac output
2) variant angina
- prevents or reduces coronary artery spasm

Question 5

Organic Nitrates: therapeutic uses

Answer 5

1) treatment of acute angina attack

2) prophylaxis of chronic stable angina

Question 6

Organic Nitrates: adverse effects

Answer 6

1) headache
2) orthostatic hypotension
3) reflex tachycardia
4) tolerance

Question 7

Organic Nitrates: nursing interventions/client education

Answer 7

1) use aspirin or acetaminophen
2) notify provider if symptoms persist
3) sit or lie if dizziness occurs
4) change positions slowly
5) monitor vital signs
6) administer beta-blocker (Lopressor) to control tachycardia
7) use lowest dose needed to achieve effects

Question 8

Nitrates: medication/food interactions and nursing interventions/client education

Answer 8

1) alcohol–avoid use
2) antihypertensive medications: hypotension effects–use nitroglycerin cautiously w/ these medications
3) sildenafil (Viagra), nitro: life-threatening hypotension–instruct not to take sildenafil if prescribed nitro

Question 9

Nitrates Administration: acute attacks

Answer 9

sublingual tablet

1) place tablet under tongue to dissolve
2) store tablets in original bottles in cool, dark place
3) discard tablets after 24 months unless indicated on package
4) spray translingual spray against oral mucosa

Question 10

Nitrates Administration: prophylaxis

Answer 10

1) swallow capsules w/o crushing or chewing
2) do not cut patches
3) place on hairless area of skin. rotate sites
4) remove patch at night to reduce risk of developing tolerance to nitro

Question 11

Nitrates Administration:

topical ointment and nursing interventions

Answer 11

1) slow onset
2) long term
- remove old dose prior to new dose
- measure specific dose on special paper
- avoid touching ointment with hands

Question 12

Nitrates Administration: IV and nursing interventions

Answer 12

1) control angina
2) control BP
3) HF after MI
- start at slow rate 5 mcg/min) and titrate gradually until pain relieved
- provide continuous monitoring during administration

Question 13

Treatment of Anginal Attack: Steps

Answer 13

1) stop activity
2) take dose of rapid-acting nitroglycerin immediately
3) if pain unrelieved in 5 min, call 911 or be driven to emergency dept
4) take up to 2 or more doses at 5-min intervals
5) do not stop taking long-acting nitroglycerin abruptly. follow provider instructions