Lilley Chapter 24 - Antianginal Drugs Flashcards
Which is a true statement concerning the administration of topical nitroglycerin ointment?
a. The ointment should be applied on the chest over the heart.
b. The ointment should be used only in the case of mild angina episode.
c. The old ointment should be removed before the new ointment is applied.
d. The ointment should be massaged gently into the skin and then covered with plastic wrap.
c. The old ointment should be removed before the new ointment is applied.
The nurse is administering intravenous nitroglycerin to a patient who has just been admitted for an acute myocardial infarction. Which statement is true in regard to the administration of this medication?
a. It must be contained in special non-polyvinyl chloride IV bags.
b. It is stable for only 24 hours after preparation.
c. It can be given in infusions with other medications.
d. An IV filter will absorb the drug.
a. It must be contained in special non-polyvinyl chloride IV bags.
A 53-year-old male patient has been admitted for evaluation of chest pain. He has been diagnosed with angina and prescribed sublingual nitroglycerin tablets. What important instructions for using this medication should the nurse give the patient?
a. Take up to five doses at 15 minute intervals after an anginal attack.
b. If the tablet does not dissolve quickly, chew the tablet for maximal effect.
c. If the chest pain is not relieved, go to hospital immediately.
d. Sit or lie down when taking a tablet; change positions slowly to avoid falling or fainting.
d. Sit or lie down when taking a tablet; change positions slowly to avoid falling or fainting.
A 74-year-old professional golfer has chest pain that occurs toward the end of his golf games. He says the pain usually goes away after he takes one or two sublingual nitroglycerin tablets and rests. What type of angina does he have?
a. Classic angina
b. Variant angina
c. Unstable angina
d. Prinzmetal’s angina
a. Classic angina
A female patient arrived in the ED with severe chest paint. She has had pain off and on for a week. Which assessment finding indicates a need for cautious use of nitrates and nitrites.
a. BP of 110/78
b. History of liver disease
c. History of heart failure
d. Anemia
d. Anemia
The correct answer is d. Anemia because nitrates (and nitrites) work by dilating blood vessels to reduce myocardial oxygen demand. In a patient with anemia, there’s already a reduced oxygen-carrying capacity in the blood due to low hemoglobin levels. Giving nitrates can further decrease oxygen delivery to the tissues (including the heart) by lowering blood pressure and preload, which can worsen myocardial ischemia or lead to hypoxia.
A patient is taking a calcium channel blocker as part of his therapy after myocardial infarction. What important information or instructions should the nurse give the patient about this medication?
a. The tablet should be chewed for faster release of the medication.
b. A frequent adverse effect is hypertension, which should be reported immediately.
c. If adverse effects of chest pain, fainting, or dyspnea occur, discontinue the medication immediately.
d. A high-fibre diet with plenty of fluids will help to prevent the constipation that may occur.
d. A high-fibre diet with plenty of fluids will help to prevent the constipation that may occur.
A patient has been prescribed transdermal nitroglycerin patches. What important instructions for applying these patches should the nurse give the patient?
a. Use the patches on any non-hairy area on the body.
b. Use the patches only on the chest area.
c. Temporarily remove the patch while swimming.
d. Apply the patch to the same site consistently.
a. Use the patches on any non-hairy area on the body.
A patient has developed tolerance to transdermal nitroglycerin therapy. Which instruction is the best one for the nurse to give the patient?
a. Omit one dose once a week.
b. Leave the patch on for 2 days at a time.
c. Use only half of a patch until the tolerance subsides.
d. Remove the patch at bedtime, then apply a new one in the morning.
d. Remove the patch at bedtime, then apply a new one in the morning.
Unstable angina is the most dangerous type of angina?
True or false?
True
Unstable angina is the most dangerous, as it is the clinical presentation of acute coronary syndrome with cardiac ischemia without persistent ST-segment elevation as seen on an electrocardiogram and no detectable release of the enzymes and biomarkers of myocardial necrosis. If often ends in a myocardial infarction.
Calcium channel blockers are indicated for patients experiencing an acute MI.
True or false?
False
Contraindications include known drug allergy, acute MI, second or third degree AV block (unless the patient has a pacemaker), and hypotension.
The onset of action of metoprolol is 1 hour.
True or false?
True
Most available β-blockers demonstrate antianginal efficacy.
True or false?
True
Amlodipine (Norvasc) can be used to treat both angina and hypertension.
True or false?
True
A person who is experiencing chest pain while playing tennis has brought along a bottle of sublingual nitroglycerin. In this situation, which action is appropriate for this person to take
Select all that apply:
a. Stop the activity and lie down or sit down.
b. Call 911 immediately.
c. Place a tablet under the tongue.
d. Place a tablet in the space between the gum and cheek.
e. If chest pain is not relieved after 1 minute, take another sublingual tablet.
f. Take another sublingual tablet if chest pain is not relieved after 5 minutes.
g. Take a sip of liquid to help dissolved the pill.
h. Call 911 if the pain is not relieved within 5 minutes after taking one sublingual tablet.
a. Stop the activity and lie down or sit down.
c. Place a tablet under the tongue.
f. Take another sublingual tablet if chest pain is not relieved after 5 minutes.
h. Call 911 if the pain is not relieved within 5 minutes after taking one sublingual tablet.
