Pharm110 Chp 18 Agents that dilate blood vessels

Question 1

Coronary vasodilators

Answer 1

Treat coronary artery disease
-Inadequate delivery of blood, nutrients and oxygen to the tissues.

Angina
-Supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle aches.

Question 2

Signs of a heart attack

Answer 2

• Lightheadedness
• Arms, back, jaws, neck, between shoulders (pain, discomfort, numbness)
• Chest (Pain, pressure, fullness or squeezing)
• Lungs (Trouble breathing)
• Stomach (Upset stomach, urge to vomit)
• Skin (Cold sweat)

Other signs in women

• Very tired for days for weeks
• Heartburn
• Cough
• Heart flutters
• Loss of appetite

Question 3

Nitroglycerin

Answer 3

Has a large first pass effect.
Taken prophylactically to prevent heart attacks
Most commonly used to treat angina pectoris.
Permitted at Pts. bedside
Bottle should be relabled with the open date so unused meds can be discarded within 6 months of opening.
-Causes central and peripheral vasodilation (Relaxes smooth muscles)
-Potent dilating effect on coronary arteries

Question 4

Vasodilator drug agents

Answer 4

3 main objectives

• Minimize frequency, duration and intensity of angina episodes
• Offer few side effects
• Prevent myocardial infarctions - death

Therapeutic objectives

• Increase blood flow to ischemic heart muscle
• Decrease myocardial oxygen demand

Question 5

Nitroglycerin patient teaching

Answer 5

• Outpatients informed a fresh supply should be obtained every 3 months
• Drug my product hypotension, Pt. should be lying or sitting down when taking
• Tolerance may occur so dose may need to be increased.
• May cause flushing and headaches
• These side effects disappear after 30-60 minutes

Question 6

New instructions for client teaching

Answer 6

Take one nitro pill for chest pain, wait 5 minutes if another episode of pain occurs, take another nitro and call 911, wait another 5 minutes if another episode of pain take another pill.

Question 7

Nitrates

Answer 7

Long acting example
Isosorbide dinitrate  
Provides 
-Acute relief of angina
-Long term prophylaxis of angina

Adverse effects

• Postural hypotension
• Tolerance (Remove patch or cream at night for 8 hours, or take oral form for 16 hours a day)

Interactions
Additive hypotension with use of
-Alcohol
-Beta blockers

Question 8

Adjuvent drugs used to treat angina

Answer 8

Acetylsalicylic acid (Aspirin antiplatelet drug)
Calcium channel blockers
Beta blockers
Angiotensin II receptor blockers

Question 9

Calcium channel blockers

Answer 9

Verapamil
Reduce calcium ion influx
-reduction of myocardial oxygen consumption
-coronary artery dilation

Adverse effects
-Dizziness, flushing, supraventricular arrhythmias

Question 10

Beta-adrenergic blocking agents

Answer 10

Atenolol
Block beta receptors
-reduce heart rate 
-reduce contractility 
-reduce BP

Adverse effects

• flushing
• bradycardia
• bronchospasm

Question 11

Peripheral vasodilators

Answer 11

Angiotensin II receptor blockers

• block adrenergic receptors or
• Direct action (interfere with epinephrine action)

Sympathetic nervous system is not stimulated
-result: decreased BP

Adverse effects
-Orthostatic hypotension

Question 12

Acetylsalicylic acid (Aspirin)

Answer 12

Inhibits platelet clumping

• Given as a preventive agent
• Given when a person is experiencing a myocardial infarction

Question 13

Method for applying Nitroglycerine ointment

Answer 13

1-Client lie down
2-Baseline BP
3-Wash hands and glove
4-Remove previous dose and wipe clean
5-Measure prescribed dose
6-Select site for application, non hairy
7-Avoid accidental contact with drug
8-Place measured ointment on paper and apply to client skin
9-Remove gloves
10-Tape paper down
11-Wash hands
12-After 5 minutes check BP, if drop or complaints of headache notify Dr.
13-Chart procedure and clients response