NURS 321: CAD, MI, and Angina (meds)

What are the TWO TYPES of ANGINA MEDICATIONS?

1.) Organic nitrates: Nitroglycerin

2.) Antianginal medications: Ranolazine

What is a MEDICATION EXAMPLE for ORGANIC NITRATES?

Nitroglycerin

What are the ADMINISTRATION ROUTES for NITROGLYCERIN?

Oral extended-release capsules

Sublingual tablet

Intravenous

Transdermal patch

Topical ointment

What is the most COMMON ROUTE OF ADMINISTRATION for NITROGLYCERIN?

Sublingual tablet

What are the THERAPEUTIC USES of NITROGLYCERIN?

Nitroglycerin prevents or reduces coronary artery spasm to increase oxygen supply

What is NITROGLYCERIN used to TREAT?

acute angina attack in chronic stable angina or variant angina

How does NITROGLYCERIN affect BP?

decreases BP

Who is NITROGLYCERIN usually given to?

chest pain and heart failure patients

What INTERACTIONS should be avoided with NITROGLYCERIN?

nitroglycerin and Sildenafil aka Viagra

How is NITROGLYCERIN administered?

3 doses maximum, 5 minutes apart

Can NITROGLYCERIN be SWALLOWED?

no, must be taken sublingual

What should be done if a CHRONIC ANGINA PATIENT takes NITROGLYCERIN at home and does not have relief after 5 minutes of the FIRST DOSE?

call 911

How should TOPICAL/TRANSDERMAL NITROGLYCERIN PATCHES be applied?

remove old before putting new, rotate sites, on clean dry hairless area, wear gloves

Can NITROGLYCERIN PATCHES be worn IN THE SHOWER?

yes

What are ROUTES OF ADMINISTRATION for NITROGLYCERIN that are QUICK ONSET?

Intravenous (IV)

Sublingual tablets

Buccal tablets

What are ROUTES OF ADMINISTRATION for NITROGLYCERIN that are SLOW ONSET?

Patch

Ointment

Why is taking NITROGLYCERIN and VIAGRA together LETHAL?

cause extremely low BP

When should NITROGLYCERIN NOT be taken?

Systolic BP below 100 or drops by 30 mmHg

What are LOW BLOOD PRESSURE SIGNS?

Confusion, agitation, sweating, pallor

What are NORMAL SIDE EFFECTS of NITROGLYCERIN? MNEMONIC?

HHH

Headache

Hypotension

Hot flushing

When do SIDE EFFECTS of NITROGLYCERIN usually occur?

after the first dose

What PATIENT EDUCATION should be provided about NITROGLYCERIN?

original container that is a dark glass bottle, store in dry cool place, always carry medication

What is the MEDICATION EXAMPLE for ANTIANGINAL AGENT?

Ranolazine

What is the USE for RANOLAZINE?

Chronic stable angina

What are the COMPLICATIONS of RANOLAZINE?

QT prolongation and elevated blood pressure

What should RANOLAZINE NOT INTERACT with?

Digoxin; can cause digoxin toxicity

What should be done before NURSING ADMINISTRATION?

Obtain ECG for QT prolongation

Can RANOLAZINE be taken with other ANTIANGINAL MEDICATIONS

yes, can be taken with nitroglycerin

Can RANOLAZINE be used for ACUTE ANGINAL ATTACK?

No, used for long-term management

How long does ANGINA occur?

SHORT; less than 20 minutes

How long does MI occur?

LONG, PERSISTENT; more than 20 minutes

What is the GOAL of ANGINA?

Prevent progression to MI

What is the GOAL of MI?

Restore blood flow IMMEDIATELY

Is there CELL/TISSUE DEATH in ANGINA?

no

Is there CELL/TISSUE DEATH in MI?

yes

What is the TROPONIN LEVEL in ANGINA?

normal

What is the TROPONIN LEVEL in MI?

elevated

What are LIPID LOWERING MEDICATIONS?

Lower the serum levels of cholesterol and various lipids

What is HYPERLIPIDEMIA?

increase in the level of lipids in the

blood

What are the SIX EXAMPLES of ANTILIPIDEMIC MEDICATIONS?

1.) HMG-CoA Reductase Inhibitors (Statins)

2.) Cholesterol Absorption Inhibitors

3.) Bile Acid Sequestrants (Resins)

4.) Fibrates

5.) Nicotinic Acid

6.) PCSK-9 Monoclonal Antibody Inhibitor

What are MEDICATION EXAMPLES of HMG-CoA Reductase Inhibitors?

Atorvastatin

Simvastatin

Rosuvastatin

What are the INDICATIONS/USES for HMG-CoA Reductase Inhibitors?

Hypercholesterolemia,

prevention of CAD

What is the MODE OF ACTION for HMG-CoA Reductase Inhibitors?

decrease LDL and increase HDL production by inhibiting HMG-CoA Reductase to lower cholesterol in the blood

Are STATIN a cure for CAD and hyperlipidemia?

No

Who should NOT take STATINS?

pregnant

What are COMPLICATIONS of STATINS?

Hepatotoxicity, muscle pain (myopathy), rhabdomyolysis

What is RHABDOMYOLYSIS?

when statins cause muscle breakdown to myoglobin is released and clogs the kidneys resulting in kidney damage

What are S/S of RHABDOMYOLYSIS?

• Muscle pain, tenderness, or weakness

• Dark tea-colored urine

What NURSING ACTIONS should be taken for STATINS?

Monitor lipid levels, monitor liver/kidney function, and CK

(creatine kinase) levels

What CLIENT EDUCATION should be provided about STATINS?

avoid alcohol and grapejuice, report muscle pain and dark urine, take with dinner

Why should STATINS be taken during DINNER?

cholesterol is synthesized at night

What is a MEDICATION EXAMPLE of CHOLESTEROL ABSORPTION INHIBITORS?

Ezetimibe

What is the INDICATION for Ezetimibe?

Hypercholesterolemia

What is the MODE OF ACTION for Ezetimibe

Inhibits absorption of cholesterol in the small intestine

What are the SIDE EFFECTS of EZETIMIBE?

Hepatotoxicity, muscle pain

What are the NURSING ACTIONS for EZETIMIBE?

Monitor liver function and CK levels

What are MEDICATION EXAMPLES for BILE ACID SEQUESTRANTS?

Colesevelam

Cholestyramine

What is the MOA for Colesevelam and Cholestyramine?

Binds bile acids in the GI tract to ↓ LDL production

What are INTERACTIONS for Colesevelam and Cholestyramine?

like everything, including birth control

What are SIDE EFFECTS for Colesevelam and Cholestyramine?

Constipation, GI upset

What CLIENT EDUCATION should be provided for Colesevelam and Cholestyramine?

increase fiber and fluid, take with food and water, interferes with absorption of fat-soluble vitamins, take other medications 1 hour before or 4 hours after

What are MEDICATION EXAMPLES of FIBRATES?

Gemfibrozil

Fenofibrate

What are INDICATIONS for gemfibrozil and fenofibrate?

Hypercholesterolemia

What is the MODE OF ACTION for gemfibrozil and fenofibrate?

DECREASED Triglyceride production and

transport, INCREASED HDL production

What are SIDE EFFECTS of gemfibrozil and fenofibrate?

GI upset, gallstones, hepatoxicity, muscle pain

What are the NURSING ACTIONS of gemfibrozil and fenofibrate?

Monitor liver function

What are the MEDICATION EXAMPLES for PCSK-9 Monoclonal Antibody

Inhibitors?

Alirocumab

Evolocumab

What are INDICATIONS for Alirocumab and Evolocumab?

Used as an adjunct to dietary modifications in clients who have elevated LDL cholesterol

What is the MODE OF ACTION for Alirocumab and Evolocumab?

decrease LDL production

What is the SIDE EFFECT for Alirocumab and Evolocumab?

Hypersensitivity, local injection site reaction

What is the NURSING ACTIONS for Alirocumab and Evolocumab?

Administer via subcutaneous route

What is the MEDICATION EXAMPLE for NICOTINIC ACID?

Niacin

What is the MODE OF ACTION of NIACIN?

decreased lipoprotein and triglyceride synthesis

What are the CONTRAINDICATIONS for NIACIN?

Use cautiously in patients with diabetes

What are the SIDE EFFECTS for NIACIN?

Flushing of the face, GI upset, pruritus, hepatoxicity, hyperglycemia

What are the NURSING ACTIONS for NIACIN?

Monitor liver function

What is the PAIN DURATION of CAD?

Often asymptomatic