Chapter 23 Pharm Unit 2

Question 1

What is chest pain?

Answer 1

Angina

Question 2

1 killer in the U.S.

Answer 2

Ischemic heart disease

Question 3

can be triggered by exertion or other stress

Answer 3

Chronic stable angina or effort angina

Question 4

Drugs for Angina
(Hint: NAMAD)

Answer 4

nitroglycerin, atenolol, metoprolol, amlodipine, diltiazem

Question 5

What are the Nitrates or nitrites

Answer 5

Nitroglycerin (both rapid and long acting)

Question 6

What are the beta blockers?

Answer 6

Atenolol and Metoprolol

Question 7

What are the Calcium channel blockers?

Answer 7

Amlodipine and Diltiazem

Question 8

Sublingual, Transdermal patches, Ointments, IV solutions, and Translingual sprays are available forms for what?

Answer 8

Nitrates and Nitrites

Question 9

Mechanism of Action:

-cause vasodilation because of relaxation of smooth muscles
-potent dilating effect on coronary arteries
-result: oxygen to ischemic myocardial tissue
-used for prevention and treatment of angina

Answer 9

Nitrates and Nitrites

Question 10

-used to treat acute anginal attacks
-sublingual tablets; IV infusion
-Bypass first-pass effect

Answer 10

Rapid-acting forms

Question 11

-used to PREVENT anginal episodes
-Nitroglycerin (both rapid and long acting)

Answer 11

Long-acting forms

Question 12

-large pass effect with oral forms
-used for symptomatic treatment of ischemic heart conditions (angina)
-IV form used for BP control
-ischemic pain (angina)

Answer 12

Nitrates

Question 13

Adverse effects:

-headaches, reflex tachycardia, postural hypotension

Answer 13

Nitrates

Question 14

usually diminish in intensity and frequency with continued use

Answer 14

headaches

Question 15

-can occur quickly
-prevented by arranging a nitrate-free period
-remove patch at bedtime for 8 hours and reapply a new patch in the morning to help reduce tolerance

Answer 15

Transdermal Therapy (patch)

Question 16

What can result in severe hypotension and death?

Answer 16

Use of erectile dysfunction drugs

Question 17

Cardioselective (target b1)

Answer 17

atenolol

Question 18

Cardioselective (target b1)

Answer 18

metoprolol

Question 19

can mask hypoglycemia-induced tachycardia, MUST monitor blood glucose levels for high or low abnormalities

Answer 19

Diabetes mellitus

Question 20

What drug is this?

-cardioselective beta1-adrenergic receptor blocker
-decreases HR
-Indication: prophylactic treatment of angina pectoris
-only available in ORAL

Answer 20

Atenolol (Tenormin)

Question 21

What drug is this?

-cardioselective beta1-adrenergic receptor blocker
-decreases HR
-Indication: prophylactic treatment of angina
-Forms: oral and parenteral

Answer 21

Metoprolol (Lopressor, Toprol-XL)

Question 22

What are the two Calcium Channel Blockers?

Answer 22

amlodipine and diltiazem

Question 23

Mechanism of Action of?

-cause coronary artery vasodilation
-cause peripheral arterial vasodilation, thus decreasing systemic vascular resistance

Answer 23

Calcium Channel Blockers

Question 24

Preventing calcium from entering heart and vascular smooth muscle cells = prevention of muscle contraction—>Promotion of muscle relaxation

Answer 24

r

Question 25

Adverse effects of what kind of Blocker? -constipation (drink plenty of fluids and eat a high fiber diet) -Grapefruit juice DECREASES the metabolism of CCBs

Answer 25

Calcium Channel Blockers

Question 26

Nursing Implications: -obtain baseline vital signs, including respiratory patterns and rates -teach patients to change positions slowly to avoid postural BP changes

Question 27

-never to chew or swallow the sublingual form -burning sensation felt, indicates that the drug is still potent

Answer 27

Nitroglycerin

Question 28

-Including site rotation and removal of old medication with soap and water and wear what?

Answer 28

GLOVES

Question 29

To reduce tolerance, remove topical forms(patch) at bedtime and apply new patch in the morning, allowing for a nitrate-free period

Answer 29

Nitroglycerin

Question 30

-first hint of anginal pain -If experiencing chest pain, nitroglycerin should lie down to prevent or decrease dizziness and fainting that may occur because of hypotension

Answer 30

Nitroglycerin

Question 31

If what occurs from these effects? -Stop activity and sit or lie down immediately and take the first sublingual tablet -if there is no relief in 5 minutes, call 911 or emergency services, and take a second sublingual tablet -If there is no relief in 5 minutes, take a third sublingual tablet -DO NOT TRY TO DRIVE TO THE HOSPITAL

Answer 31

Anginal pain / chest pain

Question 32

IV forms of nitroglycerin must be given with what and bags.

Answer 32

special non-PVS tubing

Question 33

-monitor their pulse rates daily and report any rate lower than 60 beats/min or symptoms of relative bradycardia -report dizziness or fainting -NEVER be abruptly discontinued -long-term prevention of angina, not for immediate relief

Answer 33

Beta blockers

Question 34

-constipation is a common problem; instruct patients to take in adequate fluids and eat high fiber foods -avoid GRAPEFRUIT and GRAPEFRUIT JUICE - reduces the metabolism of nifedipine leading to possible toxicity

Answer 34

CCBs

Question 35

-adverse effects: allergic reactions, headache, lightheadness, hypotension, dizziness -Therapeutic effects: relief of angina, decreased BP, or both

Answer 35

Antianginal drugs