NITRATE UNIT 6 CHAPT 37

Question 1

Which of the following drugs are Nitrates?

A. Nitroglycerin
B. Amantidine
C. Celecoxib
D. Nystatin

Answer 1

A. Nitroglycerin

Nitrates were the first agents used to relieve angina. They affect coronary arteries and blood vessels in the venous circulation. Nitrates cause generalized vascular and coronary vasodilation, which increases blood flow through the coronary arteries to the myocardial cells. This group of drugs reduces myocardial ischemia but can cause hypotension.

Question 2

What is Nitrates used to treat?

Answer 2

Action
* Promote vasodilation
* Decrease preload and afterload
* Acute anginal pain:
* Sublingual – works in 1-3 minutes, lasts about 30

To control angina, AMI, hypertensive emergency, pulmonary edema, and heart failure
Mechanism of Action: Decreases myocardial demand for oxygen; decreases preload by dilating veins, indirectly decreasing afterload

Question 3

What is Angina?

Answer 3

Chest Pain and Nitrates are used to treat it or reduce its effects

Question 4

What is the common side effect of Nitroglycerin?

Answer 4

Side effects and adverse reactions
* Headache
* Flushing
* Dizziness, weakness
* Syncope

Question 5

What is the adverse effect of Nitroglycerin?

Answer 5

Orthostatic hypotension, chest pain, dyspnea, tachycardia, paradoxical bradycardia, palpitations, methemoglobinemia
Life threatening: MI, pulmonary edema

Question 6

Can Nitroglycerin cause hypertension or hypotension?

Answer 6

HYPOTENSION

Question 7

Interactions of Nitroglycerin

Answer 7

Drug: Increased effect with alcohol, beta blockers, calcium channel blockers, antihypertensives, aspirin, benzodiazepines, vasodilators; decreased effects of heparin Herbs: Hawthorn increases nitroglycerin levels.

Question 8

Should you use a betta blocker along with Nitroglycerin?

Answer 8

NO , DOUBLE THE EFFECT PTS WOULD BECOME BRADYCARDIAC AND HYPOTENSIVE

Question 9

Should you use Sildenafil with Nitroglycerin

Answer 9

NOOOO, both of them cause vasodilation which can cause the patient to become hypotensive

Question 10

Contrainindications of Nitroglycerin

Answer 10

Contraindinications
* Increased intracranial pressure
* Severe hypotension – caution
* Interactions
* Other antihypertensive meds
* Other meds that vasodilate
* Alcohol
* Do not abruptly discontinue
NITROGLYCERIN

Question 11

Patient teaching for administering Nitroglycerin SUBQ tablets

Answer 11

0.4 mg 3 tablets every 5 minutes to relive Angina, if chest pain doesn’t resolve after 3 tablets and 15 minutes call emergency services (911)

Question 12

9. A patient who has angina is prescribed nitroglycerin. Which are appropriate nursing interventions for nitroglycerin? (Select all that apply.)
   a. Have the patient sit or lie down when taking a nitroglycerin sublingual tablet.
   b. Teach the patient who has taken a tablet to call 911 in 5 minutes if chest pain persists.
   c. Apply the nitroglycerin patch to a hairy area to protect skin from burning.
   d. Call the health care provider after taking five tablets if chest pain persists.
   e. Warn the patient against ingesting alcohol while taking nitroglycerin.

Answer 12

A E

Question 13

11. The nurse is teaching a patient about the use of a transdermal nitroglycerin patch. Which statement by the patient indicates understanding of the teaching?
    A.”I will apply the patch as needed when I experience anginal pain.”
    B. “I will remove the old patch and replace it with a new one at bedtime each day.”
    C. “I should rotate sites when changing the patch to prevent skin irritation.”
    d. “When I am symptom-free,NI may stop using the patch on a regular basis.”

Answer 13

ANS: C
Patients should be taught to rotate application sites when using the transdermal nitroglycerin.
Transdermal nitroglycerin is not used as needed. Patients should remove the patch at bedtime to provide an 8- to 12-hour nitrate-free interval. Patients should use the patch even when symptom-free unless otherwise instructed by the provider.

Question 14

Patient teaching Nitrates

Answer 14

Teaching
* Sit down and rest when chest pain occurs and take nitro. If chest
pain not relieved or worse call 911
* Demonstrate how SL tablets are administered
* Storage of nitro in original container away from heat, moisture, and
light
* Rotate sites with patch or paste may apply on arms or thighs to
keep from hairy areas.
* May use acetaminophen for headache relief
* Do not stop beta blocker or calcium channel abruptly- teach to
monitor heart rate and blood pressure
* Notify HCP for consistent dizziness or faintness

Question 15

Nursing Intervention Nitroglycerin

Answer 15

• Nursing interventions
  Monitor vital signs.
  Position the patient sitting or lying down when administering a
  nitrate for the first time.
  Use gloves when applying topical patch or paste
  Apply to clean, dry, little hair area – may choose back of arm
  Administer SL nitroglycerin tablet if chest pain occurs.
  Give SL q 5 minutes up to 3 times evaluating pain between
  doses
  Monitor effects of fast acting nitro – including SL and IV
  Must keep out of light
  NURSING PROCESS: ANTIANGINAL
  DRUGS

Question 16

13. A patient who just started using transdermal nitroglycerin reports having headaches. The nurse will counsel the patient to perform which action?
    a. Call 911 when this occurs.
    b. Notify the provider.
    c. Reapply the patch three times daily.
    d. Take acetaminophen as needed.

Answer 16

d. Take acetaminophen as needed.

ANS: D
Headaches are one of the most common side effects of nitroglycerin, but they may become less frequent; acetaminophen is generally recommended for pain. If the headaches do not resolve after continued use it would be appropriate to discuss alternatives with the provider. The headaches are not an emergency, and the patient does not need to call 911. The patch is applied once daily.

Question 17

14. A patient is ordered to receive a nitrate to relieve stable angina. What side effect(s) will the nurse anticipate in a patient receiving this medication?
    a. Nausea and vomiting
    b. Increased blood pressure
    c. Pruritus and skin rash
    d. Headache

Answer 17

d. Headache

ANS: D
Headache is a common side effect to nitrates and is related to vasodilation of the cerebral vessels. Headaches often improve with continued use. Nitrates decrease blood pressure.

Question 18

15. A patient asks the nurse why nitroglycerin is given sublingually. The nurse will explain that nitroglycerin is administered by this route for which reason?
    a. To avoid hypotension
    b. To increase the rate of absorption
    c. To minimize gastrointestinal upset
    d. To prevent hepatotoxicity

Answer 18

b. To increase the rate of absorption

ANS: B
Nitroglycerin is given sublingually to avoid first-pass metabolism by the liver, which would occur if the drug is swallowed, and to increase the rate of absorption. It does not prevent hypotension. Gastrointestinal upset and hepatotoxicity usually do not occur.

Question 19

Should a patient take Nitroglycerin standing or sitting?

Answer 19

Because nitroglycerin can cause hypotension, patients should be cautioned to take them while sitting or lying down.

Question 20

A patient has angina pectoris. The patient’s BP
is 100/60 mm Hg. The nurse administers
nitroglycerin 0.4 mg sublingual (SL). It is most
important for the nurse to assess the patient for
the development of
A. bradycardia.
B. hypotension.
C. bradypnea.
D. hypokalemia.

Answer 20

B. hypotension.

ANS: B
A side effect of nitroglycerin is hypotension owing to the
vasodilation of blood vessels.

Question 21

A nurse is administering digoxin, 0.125 mg, to a patient. Which nursing interventions will the nurse implement? (Select all that apply.)
A. Checking the apical pulse rate before administration.
B. Monitoring the patient’s serum digoxin level.
C. Instructing patient to report pulse rate less than 60.
D. Advising patient to avoid foods high in potassium.
E. Always giving an antacid with digoxin to reduce GI distress.

Answer 21

ANS: A, B, C
The apical pulse should be taken before digoxin administration and the drug withheld if the heart rate is less than 60. The patient’s serum digoxin level should be monitored and withheld if in toxic range. Therapeutic level is 0.5 to 2 ng/mL. Patient should be advised to eat foods high in potassium. Patient should be advised to avoid taking antacids with digoxin because they
decrease absorption.

Question 22

1. The nurse is teaching the client diagnosed with angina about sublingual nitroglycerin (NTG). Which statement indicates the client needs more medication teaching?
2. “I will always carry my nitroglycerin in a dark-colored bottle.”
3. “If I have chest pain, I will put a tablet underneath my tongue.”
4. “If my pain is not relieved with one tablet, I will get medical help.”
5. “I should expect to get a headache after taking my nitroglycerin.”

Answer 22

3. “If my pain is not relieved with one tablet, I will get medical help.”

The client should put one tablet under the tongue every 5 minutes and, if the chest pain is not relieved after taking three tablets, the client should seek medical attention. This statement indicates the client needs more
teaching about the medication.