Anti-Angina/CAD

Pharmacology Exam 3

What is the therapeutic effect of nitrates?

Vasodilation decreases preload and myocardial oxygen demand, relieving angina

How do nitrates decrease cardiac workload?

Dilate veins, decreasing venous return (preload) and oxygen demand

What are common adverse effects of nitrates?

Headache, hypotension, dizziness, and reflex tachycardia

What should be assessed before administering nitroglycerin?

Blood pressure, heart rate, and chest pain

How is sublingual nitroglycerin administered?

Place under the tongue and allow to dissolve

Do not swallow

What should a patient do if chest pain persists after nitroglycerin?

Call 911 if pain persists after 5 minutes

Repeat every 5 minutes, up to 3 doses, while awaiting EMS

How should nitroglycerin tablets be stored?

In the original dark glass container, tightly closed, away from heat, light, and moisture

Which medications should never be combined with nitrates?

PDE-5 inhibitors such as sildenafil (Viagra), tadalafil, and vardenafil

Risk of severe hypotension

What is the purpose of long-acting nitrates?

Prevent angina episodes; they do not treat acute angina attacks

Why are nitrate-free intervals necessary?

Prevent nitrate tolerance and maintain effectiveness

What is nitrate tolerance?

Decreased response to nitrates after continuous exposure

What should patients do before taking nitroglycerin?

Sit or lie down to prevent injury from dizziness or hypotension

What is the primary therapeutic purpose of nitrates in CAD?

Relieve and prevent chest pain by reducing myocardial oxygen demand

What are common adverse effects of anti-dysrhythmic medications?

Bradycardia, hypotension, dizziness, and potentially new or worsening dysrhythmias (pro arrhythmia)

What is adenosine used for?

Acute termination of paroxysmal supra ventricular tachycardia (PVST)

What is adenosine’s mechanism of action?

Temporarily blocks AV node conduction, interrupting reentry tachycardia

How is adenosine administered?

Rapid IV push followed immediately by a rapid saline flush

What monitoring is required with adenosine?

Continuous ECG and blood pressure monitoring

What are expected adverse effects of adenosine?

Brief flushing, chest discomfort, dyspnea, and transient asystole

What should the nurse teach a patient receiving adenosine?

They may briefly feel chest pressure, flushing, or shortness of breath

Effects usually resolve within seconds

What is amiodarone used for?

Serious ventricular dysrhythmias, including ventricular tachycardia and ventricular fibrillation

What are major adverse effects of amiodarone?

Pulmonary toxicity, thyroid dysfunction, liver toxicity, bradycardia, and QT prolongation

What assessments are important with amiodarone?

ECG, heart rate, liver function, thyroid function, and pulmonary symptoms

What should patients taking amiodarone report?

New cough, shortness of breath, vision changes or unusual fatigue

What patient teaching is important for amiodarone?

Avoid excessive sun exposure and attend scheduled thyroid, liver, and pulmonary monitoring

What is flecainide used for?

Treatment of selected serious supra ventricular and ventricular dysrhythmias

What are adverse effects of flecainide?

Proarrhythmia, dizziness, visual disturbances, and worsening heart failure

What is digoxin used for?

Improves cardiac contractility in heart failure and controls ventricular rate in atrial fibrillation

What is digoxin’s mechanism of action?

Inhibits sodium-potassium ATPase, increasing intracellular calcium and cardiac contractility

What is the therapeutic effect of digoxin?

Increased cardiac output and decreased heart rate

What pulse should be assessed before administering digoxin?

Apical pulse for a full minute

When should digoxin generally be held in an adult?

If apical pulse is below 60 bpm; notify the provider and follow prescribed parameters

What is a commonly targeted digoxin level for heart failure?

0.5-0.9 ng/mL

What are signs of digoxin toxicity?

Nausea, vomiting, anorexia, confusion, bradycardia, and yellow or blurred vision

Which electrolyte imbalance increases digoxin toxicity?

Hypokalemia (low potassium)

What is the antidote for digoxin toxicity?

Digoxin immune Fab (DigiFab)

What should nurses monitor for patients taking digoxin?

Apical pulse, digoxin level, potassium, magnesium, and renal function

What is milrinone used for?

Short-term IV treatment of severe acute decompensated heart failure

What is milrinone’s mechanism of action?

PDE-3 inhibitor that increases cardiac contractility and causes vasodilation

What is therapeutic effect of milrinone?

Increases cardia output and decreases preload and afterload

What are major adverse effects of milrinone?

Hypotension and ventricular dysrhythmias

What should nurses monitor during milrinone administration?

Continuous ECG, blood pressure, heart rate, and fluid status