Podcast
Questions and Answers
A patient reports chest pain that occurs with exertion but is relieved by rest. Which type of angina is the patient likely experiencing?
A patient reports chest pain that occurs with exertion but is relieved by rest. Which type of angina is the patient likely experiencing?
- Preinfarction angina
- Vasospastic angina
- Unstable angina
- Chronic stable angina (correct)
A patient with a history of angina is prescribed nitroglycerin. What is the primary expected outcome of this medication?
A patient with a history of angina is prescribed nitroglycerin. What is the primary expected outcome of this medication?
- Increase cardiac output
- Increase heart rate
- Increase blood pressure
- Decrease myocardial oxygen demand (correct)
Which route of nitroglycerin administration provides the most rapid relief of acute anginal pain?
Which route of nitroglycerin administration provides the most rapid relief of acute anginal pain?
- Intravenous infusion
- Oral capsule
- Sublingual tablet (correct)
- Transdermal patch
A patient using a nitroglycerin transdermal patch asks why they need to remove it each evening. What is the correct rationale?
A patient using a nitroglycerin transdermal patch asks why they need to remove it each evening. What is the correct rationale?
A patient taking nitroglycerin reports experiencing headaches. Which instruction should the nurse provide?
A patient taking nitroglycerin reports experiencing headaches. Which instruction should the nurse provide?
What instruction should the nurse provide a patient prescribed sublingual nitroglycerin for angina?
What instruction should the nurse provide a patient prescribed sublingual nitroglycerin for angina?
A patient with angina and hypertension is prescribed a beta-blocker. What is the primary mechanism by which beta-blockers reduce chest pain?
A patient with angina and hypertension is prescribed a beta-blocker. What is the primary mechanism by which beta-blockers reduce chest pain?
Which beta-blocker characteristic is most important to consider when prescribing for a patient with asthma?
Which beta-blocker characteristic is most important to consider when prescribing for a patient with asthma?
A patient taking metoprolol for angina reports feeling dizzy upon standing. What should the nurse advise?
A patient taking metoprolol for angina reports feeling dizzy upon standing. What should the nurse advise?
For a patient with angina and diabetes, which instruction regarding beta-blockers is crucial?
For a patient with angina and diabetes, which instruction regarding beta-blockers is crucial?
Which mechanism do calcium channel blockers use to treat angina?
Which mechanism do calcium channel blockers use to treat angina?
A patient with Prinzmetal angina is prescribed a calcium channel blocker. How does this medication manage this type of angina?
A patient with Prinzmetal angina is prescribed a calcium channel blocker. How does this medication manage this type of angina?
A patient prescribed diltiazem for angina reports constipation. What dietary recommendation will help alleviate this side effect?
A patient prescribed diltiazem for angina reports constipation. What dietary recommendation will help alleviate this side effect?
Which statement is most important for the nurse to include when teaching a patient about amlodipine?
Which statement is most important for the nurse to include when teaching a patient about amlodipine?
Prior to administering atenolol, what assessment finding would cause the nurse to hold the dose and contact the provider?
Prior to administering atenolol, what assessment finding would cause the nurse to hold the dose and contact the provider?
Which statement indicates a patient understands teaching about proper storage for sublingual nitroglycerin tablets?
Which statement indicates a patient understands teaching about proper storage for sublingual nitroglycerin tablets?
A patient receiving isosorbide dinitrate develops reflex tachycardia. Which compensatory mechanism is causing this?
A patient receiving isosorbide dinitrate develops reflex tachycardia. Which compensatory mechanism is causing this?
Which statement best describes ischemia?
Which statement best describes ischemia?
A patient is prescribed atenolol for long-term management of angina. What is the purpose of this therapy?
A patient is prescribed atenolol for long-term management of angina. What is the purpose of this therapy?
A nurse is teaching about nitrates, and emphasizes that they cause vasodilation because of:
A nurse is teaching about nitrates, and emphasizes that they cause vasodilation because of:
What is the primary therapeutic effect of ACE inhibitors in treating heart failure?
What is the primary therapeutic effect of ACE inhibitors in treating heart failure?
What laboratory value should the nurse monitor in a patient taking lisinopril?
What laboratory value should the nurse monitor in a patient taking lisinopril?
A patient taking valsartan should be assessed for which therapeutic effect?
A patient taking valsartan should be assessed for which therapeutic effect?
How do beta-blockers improve heart failure?
How do beta-blockers improve heart failure?
Why are aldosterone antagonists beneficial in heart failure?
Why are aldosterone antagonists beneficial in heart failure?
What is a known side effect of hydralazine/isosorbide dinitrate, a drug primarily intended for Black individuals?
What is a known side effect of hydralazine/isosorbide dinitrate, a drug primarily intended for Black individuals?
An intravenous medication used only in the intensive care unit for short-term management of heart failure.
An intravenous medication used only in the intensive care unit for short-term management of heart failure.
What effect does digoxin have on myocardial contractility?
What effect does digoxin have on myocardial contractility?
What electrolyte imbalance increases the risk of digoxin toxicity?
What electrolyte imbalance increases the risk of digoxin toxicity?
A patient with heart failure is prescribed digoxin. What assessment finding should prompt the nurse to suspect digoxin toxicity?
A patient with heart failure is prescribed digoxin. What assessment finding should prompt the nurse to suspect digoxin toxicity?
If digoxin toxicity is suspected and the patient become hyperkalemic, what is the most important drug to administer?
If digoxin toxicity is suspected and the patient become hyperkalemic, what is the most important drug to administer?
What instruction is most important for patients taking antidysrhythmic medications?
What instruction is most important for patients taking antidysrhythmic medications?
What is a result of all dysrhythmic medications?
What is a result of all dysrhythmic medications?
Which factor determines the Vaughan Williams classification of antidysrhythmic drugs??
Which factor determines the Vaughan Williams classification of antidysrhythmic drugs??
How does Class Ia antidysrhythmics manage specific dysrhythmias?
How does Class Ia antidysrhythmics manage specific dysrhythmias?
What is an adverse effect of procainamide, a Class 1A antidysrhythmic?
What is an adverse effect of procainamide, a Class 1A antidysrhythmic?
Why specifically are those with ventricular fibrillation and heart block NOT to be given procainamide?
Why specifically are those with ventricular fibrillation and heart block NOT to be given procainamide?
For a patient with ventricular dysrhythmias, which finding is a significant effect of lidocaine?
For a patient with ventricular dysrhythmias, which finding is a significant effect of lidocaine?
A patient administered lidocaine demonstrates confusion and twitching. What condition may they be exhibiting?
A patient administered lidocaine demonstrates confusion and twitching. What condition may they be exhibiting?
What are flecainide and propafenone used for?
What are flecainide and propafenone used for?
Which statement best describes the effects of beta-blockers on the heart's conduction system?
Which statement best describes the effects of beta-blockers on the heart's conduction system?
A patient with a history of asthma is prescribed an antidysrhythmic. Which antidysrhythmic should be avoided?
A patient with a history of asthma is prescribed an antidysrhythmic. Which antidysrhythmic should be avoided?
A patient with a history of asthma is prescribed an antidysrhythmic. Which electrolyte is important to monitor with amiodarone, in addition to other routine assessments?
A patient with a history of asthma is prescribed an antidysrhythmic. Which electrolyte is important to monitor with amiodarone, in addition to other routine assessments?
A patient receiving diltiazem complains of dizziness. What is an expected pharmacodynamic effect of diltiazem relevant to this side effect?
A patient receiving diltiazem complains of dizziness. What is an expected pharmacodynamic effect of diltiazem relevant to this side effect?
What is the primary use of adenosine in treating dysrhythmias?
What is the primary use of adenosine in treating dysrhythmias?
A patient with variant angina is prescribed a calcium channel blocker. What is the primary mechanism by which this medication provides relief?
A patient with variant angina is prescribed a calcium channel blocker. What is the primary mechanism by which this medication provides relief?
A patient taking atenolol for angina also has diabetes mellitus. What is an important consideration regarding their medication regimen?
A patient taking atenolol for angina also has diabetes mellitus. What is an important consideration regarding their medication regimen?
A patient is prescribed isosorbide dinitrate for chronic stable angina. How does this medication primarily reduce the occurrence of anginal episodes?
A patient is prescribed isosorbide dinitrate for chronic stable angina. How does this medication primarily reduce the occurrence of anginal episodes?
A patient is started on nitroglycerin and complains of dizziness upon standing. Which instruction is most appropriate for the nurse to provide?
A patient is started on nitroglycerin and complains of dizziness upon standing. Which instruction is most appropriate for the nurse to provide?
What is the rationale for instructing patients to avoid hot baths or saunas when taking antianginal medications?
What is the rationale for instructing patients to avoid hot baths or saunas when taking antianginal medications?
What is the rationale behind the recommendation, for patients using nitroglycerin patches, to have a nitrate-free period each day?
What is the rationale behind the recommendation, for patients using nitroglycerin patches, to have a nitrate-free period each day?
Prior to administering diltiazem, the nurse reviews the patient's medical history. Which pre-existing condition would raise the most concern?
Prior to administering diltiazem, the nurse reviews the patient's medical history. Which pre-existing condition would raise the most concern?
A patient is prescribed sublingual nitroglycerin. Which statement indicates they understand the proper storage of the medication?
A patient is prescribed sublingual nitroglycerin. Which statement indicates they understand the proper storage of the medication?
A patient taking metoprolol for angina reports persistent fatigue. What is the most appropriate initial nursing intervention?
A patient taking metoprolol for angina reports persistent fatigue. What is the most appropriate initial nursing intervention?
A patient with angina is prescribed amlodipine. What should the nurse include in patient teaching regarding common side effects?
A patient with angina is prescribed amlodipine. What should the nurse include in patient teaching regarding common side effects?
A patient with a history of angina is prescribed nitroglycerin PRN. What instruction should the nurse give regarding the administration of nitroglycerin for chest pain?
A patient with a history of angina is prescribed nitroglycerin PRN. What instruction should the nurse give regarding the administration of nitroglycerin for chest pain?
Which assessment finding would be most concerning for a patient taking atenolol?
Which assessment finding would be most concerning for a patient taking atenolol?
What is the primary purpose of nitroglycerin in the management of chest pain associated with angina?
What is the primary purpose of nitroglycerin in the management of chest pain associated with angina?
What is the rationale for administering intravenous nitroglycerin to a patient with acute pulmonary edema?
What is the rationale for administering intravenous nitroglycerin to a patient with acute pulmonary edema?
Which statement is most important for the nurse to include when teaching a patient who is starting atenolol for angina?
Which statement is most important for the nurse to include when teaching a patient who is starting atenolol for angina?
A patient with heart failure is prescribed lisinopril. Which laboratory value should the nurse prioritize when monitoring for potential adverse effects?
A patient with heart failure is prescribed lisinopril. Which laboratory value should the nurse prioritize when monitoring for potential adverse effects?
A patient is newly prescribed valsartan for heart failure. During a follow-up visit, which assessment finding would indicate a positive therapeutic effect of the medication?
A patient is newly prescribed valsartan for heart failure. During a follow-up visit, which assessment finding would indicate a positive therapeutic effect of the medication?
For a patient with heart failure taking digoxin, which assessment finding would warrant holding the dose and contacting the provider?
For a patient with heart failure taking digoxin, which assessment finding would warrant holding the dose and contacting the provider?
A patient is prescribed spironolactone as an adjunct treatment for heart failure. What electrolyte imbalance is of greatest concern with this medication?
A patient is prescribed spironolactone as an adjunct treatment for heart failure. What electrolyte imbalance is of greatest concern with this medication?
A patient with heart failure is receiving intravenous milrinone in the ICU. Which assessment parameter requires the most immediate attention?
A patient with heart failure is receiving intravenous milrinone in the ICU. Which assessment parameter requires the most immediate attention?
Which of the following instructions is most important for a patient taking digoxin at home?
Which of the following instructions is most important for a patient taking digoxin at home?
A patient receiving amiodarone for ventricular tachycardia develops a persistent dry cough and shortness of breath. What is the priority nursing action?
A patient receiving amiodarone for ventricular tachycardia develops a persistent dry cough and shortness of breath. What is the priority nursing action?
The nurse is caring for a patient receiving lidocaine for ventricular dysrhythmias. Which assessment finding indicates a potential adverse effect of this medication?
The nurse is caring for a patient receiving lidocaine for ventricular dysrhythmias. Which assessment finding indicates a potential adverse effect of this medication?
What mechanism is responsible for dizziness as an adverse effect of diltiazem?
What mechanism is responsible for dizziness as an adverse effect of diltiazem?
When administering adenosine for supraventricular tachycardia (SVT), what is the most important action for the nurse to anticipate?
When administering adenosine for supraventricular tachycardia (SVT), what is the most important action for the nurse to anticipate?
Why should solutions of lidocaine that contain epinephrine not be given intravenously?
Why should solutions of lidocaine that contain epinephrine not be given intravenously?
During the administration of IV amiodarone, a patient develops a prolonged QT interval on the ECG. What action should the nurse take?
During the administration of IV amiodarone, a patient develops a prolonged QT interval on the ECG. What action should the nurse take?
The nurse is preparing to administer diltiazem IV for the treatment of atrial fibrillation. What baseline assessment is most critical before administering this medication?
The nurse is preparing to administer diltiazem IV for the treatment of atrial fibrillation. What baseline assessment is most critical before administering this medication?
A patient is prescribed a Class IC antidysrhythmic medication for a severe ventricular dysrhythmia. What is an accurate teaching point about this drug?
A patient is prescribed a Class IC antidysrhythmic medication for a severe ventricular dysrhythmia. What is an accurate teaching point about this drug?
A client with a history of glaucoma is prescribed an Atrial Fibrillation medication. What is the most important precaution needed when prescribing amiodarone?
A client with a history of glaucoma is prescribed an Atrial Fibrillation medication. What is the most important precaution needed when prescribing amiodarone?
A patient is started on quinidine for atrial fibrillation. What patient sign/symptom requires the nurse to notify the health provider?
A patient is started on quinidine for atrial fibrillation. What patient sign/symptom requires the nurse to notify the health provider?
After administering adenosine, a patient experiences asystole. What is the priority nursing intervention?
After administering adenosine, a patient experiences asystole. What is the priority nursing intervention?
Which of the following considerations are needed when administering Anti-dysrhythmic drugs?
Which of the following considerations are needed when administering Anti-dysrhythmic drugs?
Which of the following nursing considerations are needed when administering diltiazem?
Which of the following nursing considerations are needed when administering diltiazem?
The nurse is administering a new prescription, lidocaine. What should be assessed in this patient prior to administering?
The nurse is administering a new prescription, lidocaine. What should be assessed in this patient prior to administering?
A nurse is preparing to administer a new prescription, adenosine. What is a key contraindication for this client.
A nurse is preparing to administer a new prescription, adenosine. What is a key contraindication for this client.
A patient with a supraventricular dysrhythmia has been prescribed diltiazem intravenously. While administering the medication, the patient reports, "something wet is spilling on one arm" the heart rate is unchanged. What is the appropriate action by the nurse?
A patient with a supraventricular dysrhythmia has been prescribed diltiazem intravenously. While administering the medication, the patient reports, "something wet is spilling on one arm" the heart rate is unchanged. What is the appropriate action by the nurse?
A patient with chronic stable angina is prescribed isosorbide mononitrate. What is the most important teaching point regarding its administration?
A patient with chronic stable angina is prescribed isosorbide mononitrate. What is the most important teaching point regarding its administration?
A patient with hypertension and angina is started on metoprolol. Which assessment best indicates that the drug is effective?
A patient with hypertension and angina is started on metoprolol. Which assessment best indicates that the drug is effective?
A patient is prescribed diltiazem for the management of chronic stable angina. What should the nurse emphasize regarding lifestyle modifications?
A patient is prescribed diltiazem for the management of chronic stable angina. What should the nurse emphasize regarding lifestyle modifications?
Which symptom should the nurse teach the patient to report immediately when taking amlodipine?
Which symptom should the nurse teach the patient to report immediately when taking amlodipine?
A patient who has just started atenolol therapy for angina reports persistent dizziness. What is the most appropriate initial nursing action?
A patient who has just started atenolol therapy for angina reports persistent dizziness. What is the most appropriate initial nursing action?
A patient on digoxin therapy for heart failure reports nausea, vomiting, and anorexia. What is the priority nursing action?
A patient on digoxin therapy for heart failure reports nausea, vomiting, and anorexia. What is the priority nursing action?
A nurse teaches a patient about potential interactions with antidysrhythmic drugs. Which substance is most important to avoid?
A nurse teaches a patient about potential interactions with antidysrhythmic drugs. Which substance is most important to avoid?
A patient who is started on amiodarone requires continuous monitoring. What is the most critical parameter to monitor?
A patient who is started on amiodarone requires continuous monitoring. What is the most critical parameter to monitor?
A patient with atrial fibrillation is prescribed diltiazem. What is the primary expected outcome of this medication?
A patient with atrial fibrillation is prescribed diltiazem. What is the primary expected outcome of this medication?
A patient with ventricular tachycardia is prescribed lidocaine. The nurse monitors for which adverse effect, if present.
A patient with ventricular tachycardia is prescribed lidocaine. The nurse monitors for which adverse effect, if present.
A patient is prescribed lisinopril for heart failure. What should the nurse emphasize regarding monitoring?
A patient is prescribed lisinopril for heart failure. What should the nurse emphasize regarding monitoring?
When administering intravenous milrinone, what assessment is crucial for the nurse to perform?
When administering intravenous milrinone, what assessment is crucial for the nurse to perform?
A patient is started on digoxin. What electrolyte imbalance increases the toxicity risk?
A patient is started on digoxin. What electrolyte imbalance increases the toxicity risk?
A patient with heart failure is prescribed spironolactone. What dietary instruction is most important?
A patient with heart failure is prescribed spironolactone. What dietary instruction is most important?
What is the key action of Class Ia antidysrhythmics?
What is the key action of Class Ia antidysrhythmics?
Why is procainamide contraindicated in patients with heart block?
Why is procainamide contraindicated in patients with heart block?
Which assessment finding suggests lidocaine is having a therapeutic effect in a patient with ventricular dysrhythmias?
Which assessment finding suggests lidocaine is having a therapeutic effect in a patient with ventricular dysrhythmias?
What is a unique adverse effect associated with amiodarone?
What is a unique adverse effect associated with amiodarone?
How do Class II antidysrhythmics (beta-blockers) work to treat dysrhythmias?
How do Class II antidysrhythmics (beta-blockers) work to treat dysrhythmias?
What is the primary goal of antidysrhythmic drug therapy?
What is the primary goal of antidysrhythmic drug therapy?
Flashcards
Angina Pectoris
Angina Pectoris
Chest pain due to insufficient oxygen and nutrients in the blood.
Ischemia
Ischemia
Poor blood supply to an organ, often leading to ischemia.
Myocardial Infarction
Myocardial Infarction
Necrosis/death of cardiac tissue, disabling or fatal.
Chronic stable angina:
Chronic stable angina:
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Unstable angina
Unstable angina
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Vasospastic angina
Vasospastic angina
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Antianginal Therapeutic Objectives
Antianginal Therapeutic Objectives
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Nitrate Types: Rapid vs. Long
Nitrate Types: Rapid vs. Long
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Nitrate - Mechanism of Action
Nitrate - Mechanism of Action
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Nitrate - Adverse Effects
Nitrate - Adverse Effects
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Nitroglycerin Administration
Nitroglycerin Administration
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Nitroglycerin
Nitroglycerin
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Nitrate Tolerance
Nitrate Tolerance
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Nitrate - Contraindications
Nitrate - Contraindications
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Beta-Blockers
Beta-Blockers
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Beta-Blockers - Action
Beta-Blockers - Action
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Myocardial Infarction Heart Irritation
Myocardial Infarction Heart Irritation
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Beta-Blocker Indications
Beta-Blocker Indications
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Antianginal Beta-Blockers
Antianginal Beta-Blockers
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Beta-Blocker - Contraindications
Beta-Blocker - Contraindications
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Beta-Blockers and Diabetes
Beta-Blockers and Diabetes
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Beta-Blockers - Adverse Effects
Beta-Blockers - Adverse Effects
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atenolol
atenolol
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metoprolol tartrate
metoprolol tartrate
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CCBs for Angina
CCBs for Angina
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CCBs: Mechanism
CCBs: Mechanism
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CCB Indications
CCB Indications
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CCB Contraindications
CCB Contraindications
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CCB Side Effects
CCB Side Effects
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diltiazem hydrochloride
diltiazem hydrochloride
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amlodipine
amlodipine
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Antianginal - Assessment
Antianginal - Assessment
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Report These S/S...
Report These S/S...
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Alcohol and Heat...
Alcohol and Heat...
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Nitro Burning = Potent
Nitro Burning = Potent
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Sublingual Nitro...
Sublingual Nitro...
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IV Nitro - Give Special
IV Nitro - Give Special
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Beta-blocker pulse
Beta-blocker pulse
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CCB = Fiber
CCB = Fiber
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Heart Failure
Heart Failure
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Positive chronotropic
Positive chronotropic
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Positive inotropic drugs
Positive inotropic drugs
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Positive chronotropic drugs
Positive chronotropic drugs
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Positive dromotropic drugs
Positive dromotropic drugs
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ACE Drug ending
ACE Drug ending
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ARB Drug ending
ARB Drug ending
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Certain Beta-blockers
Certain Beta-blockers
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Aldosterone Inhibitors
Aldosterone Inhibitors
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hydralazine/isosorbide dinitrate
hydralazine/isosorbide dinitrate
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Study Notes
Antianginal Drugs
- Angina pectoris is chest pain caused by insufficient oxygen and nutrients in the blood to meet the heart's demands.
- Angina indicates the heart muscle is "aching" due to an inadequate supply of oxygen to meet its needs.
- Ischemia is a condition characterized by poor blood supply to an organ.
- Ischemic heart disease occurs due to poor blood supply to the heart muscle, often caused by atherosclerosis or coronary artery disease.
- Myocardial infarction is necrosis or death of cardiac tissue and can be disabling or fatal.
Types of Angina
- Chronic stable angina is also known as classic or effort angina.
- Unstable angina is also known as preinfarction angina.
- Vasospastic angina, is also known as Prinzmetal or variant angina.
Drug Therapy
- Drug therapy aims to restore the supply and demand balance in the heart.
- Drug therapy seeks to minimize the frequency, duration and intensity of attacks and anginal pain.
- Drug therapy can help improve the patient's functional capacity with minimal adverse effects.
- Drug therapy aims to prevent or delay myocardial infarction since it is the worst possible outcome.
- First action for chest pain associated with mowing the lawn on a hot day is to stop and sit or lie down.
Drugs for Angina
- Nitrates and nitrites are a common drug used for angina
- Beta-blockers are also frequently used
- Calcium channel blockers are another pharmacological treatment for angina
Nitrates and Nitrites
- Nitrates and nitrites are are available in several forms like sublingual, chewable tablets, and oral capsules/tablets.
- Other formulations include intravenous solutions, transdermal patches, ointments, and translingual sprays,
- Some forms, like IV and transdermal, bypass the liver, avoiding the first-pass effect.
- Nitrates and nitrites cause vasodilation due to the relaxation of smooth muscles and have a potent dilating effect on coronary arteries.
- rapid-acting forms are used to treat acute anginal attacks; can use sublingual tablets/spray or IV infusion
- long-acting forms are used to prevent anginal episodes
- Nitroglycerin is available in both rapid and long-acting formulations.
- Isosorbide dinitrate is both rapid and long acting.
- Isosorbide mononitrate is primarily long acting.
- In an emergency involving extremely high blood pressure, intravenous infusion of nitroglycerin is the most appropriate choice.
- Nitroglycerin is the prototypical nitrate and the most important drug for symptomatic treatment of ischemic heart conditions like angina.
- Nitroglycerin can be administered via the oral, sublingual, metered-dose aerosol, intravenous, and topical routes.
- Nitroglycerin's intravenous form is used to control blood pressure in perioperative hypertension, heart failure, ischemic pain, pulmonary edema, and hypertensive emergencies.
- Sublingual nitroglycerin's onset of action happens within 2-3 mins, and the duration of action is 0.5-1 hr.
- Adverse effects includes include headaches, which usually diminish with continued use, reflex tachycardia, and postural hypotension.
- Tolerance may develop with regular use.
- If chest pain continues after sitting down, a patient experiencing chest pain should call 911 if one sublingual tablet doesn't provide relief after 5 minutes.
- Tolerance is prevented by allowing a regular nitrate-free period to allow enzyme pathways to replenish.
- Transdermal forms: patients may be instructed to remove the patch at bedtime for 8 hours, then apply a new one in the morning.
- Isosorbide dinitrate is an organic nitrate, available in rapid-acting sublingual tablets and long-acting oral dosage forms.
- Isosorbide exerts similar effects to other nitrates in treating angina
- Contraindications include known drug allergy, severe anemia, closed-angle glaucoma, and hypotension
- Avoid erectile dysfunction drugs like sildenafil citrate (Viagra®), tadalafil (Cialis®), and vardenafil hydrochloride (Levitra®).
- A nursing teaching about B₂-blocking drugs should include information about the need to contact the healthcare if a weight gain of 1 kg or more occurs in 24 hours (2.3 kg in 1 week).
- A nurse should instruct the patient to apply the nitroglycerin patch to hairless areas of the body.
Beta-Blockers
- Are a mainstay in the treatment of cardiovascular diseases like angina, myocardial infarction, hypertension and dysrhythmias.
- Beta-blockers block β₁-receptors on the heart, decreasing heart rate, myocardial oxygen demand, and myocardial contractility.
- By blocking the effects of catecholamines, beta-blockers improves survival after a myocardial infarction.
- Beta-blockers are used for angina, hypertension, cardiac dysrhythmias, myocardial infarction, migraine headaches, essential tremors, and stage fright.
- atenolol, metoprolol, propranolol hydrochloride, and nadolol can reduce angina
- Systolic heart failure patients should avoid beta-blockers.
- Beta-blockers should be used with caution by patients with bronchial asthma, diabetes mellitus and peripheral vascular disease.
- Adverse effects of Beta blockers can include bradycardia, hypotension, atrioventricular block, hyperglycemia/hypoglycemia, hyperlipidemia, dizziness, fatigue, depression, lethargy, erectile dysfunction, wheezing, and dyspnea.
- Atenolol is a cardioselective beta-adrenergic receptor blocker, indicated for prophylactic treatment of angina pectoris.
- The use of atenolol after myocardial infarction has been shown to decrease mortality.
- Beta-blockers main benefit for a patient after a myocardial infarction is slowing of the heart rate.
- Metoprolol is a cardioselective beta-adrenergic receptor blocker, used for prophylactic treatment of angina.
Calcium Channel Blockers
- Amlodipine, diltiazem, nifedipine, and verapamil hydrochloride can help those with chronic stable angina
- Calcium channel blockers cause coronary artery vasodilation, reduce the workload of the heart, and decrease myocardial oxygen demand.
- CCBs depress the automaticity of and conduction through the sinoatrial and atrioventricular nodes.
- These node can help with angina, hypertension, supraventricular tachycardia and atrial fibrillation/flutter.
- Other indications include coronary artery spasms (Prinzmetal angina), migraine headaches, Raynaud's disease and cerebral artery spasms associated with aneurysm rupture.
- Contraindications include known drug allergy, acute myocardial infarction, second/third-degree atrioventricular block (unless patient has a pacemaker) and hypotension.
- Adverse effects include hypertension, palpitations, tachycardia/bradycardia, constipation, nausea, and dyspnea.
- Diltiazem hydrochloride is effective for angina pectoris resulting from coronary insufficiency and hypertension.
- It is also effective for atrial fibrillation, flutter and paroxysmal supraventricular tachycardia.
- Amlodipine besylate is the most popular calcium channel blocker of the dihydropyridine subclass.
- Amlodipine is useful for angina and hypertension uses and available only for oral use.
Nursing Considerations
- Obtain a complete health history to check for contraindications for use.
- Obtain baseline vital signs, including respiratory patterns and rate, and assess for drug interactions.
- Patients should report blurred vision, persistent headache, dry mouth, edema, fainting episodes, weight gain of 1 kg in 24 hours/2.3 kg in 1 week, pulse rate less than 60 beats/min and dyspnea,
- Avoid alcohol consumption and hot baths or whirlpools, hot tubs, or saunas.
- Change positions slowly, and keep a record of anginal attacks.
- Instruct them in proper technique and guidelines for taking sublingual nitroglycerin for anginal pain and to never chew/swallow the sublingual form.
- A burning sensation felt with sublingual forms indicates that the drug is still potent and to retain a fresh supply of medication,stored in an airtight, dark glass bottle with a metal cap and no cotton filler.
- Patients should remove topical forms at bedtime and apply new doses in the morning, and take as-needed nitrates at the first hint of anginal pain.
- When angina attacks occur, the patient should to stop the activity and sit or lie down and take a sublingual tablet.
- A patient taking nitroglycerin may lie down to prevent dizziness/fainting.
- Intravenous forms of nitroglycerin must be given with special non-polyvinyl chloride tubing and bags.
- Beta-blockers: pulse rates should be monitored daily, and rates lower than 60 beats/min or dizziness/fainting should be reported.
- B-blockers should never be abruptly discontinued and they are only for longterm angina prevention.
- Calcium channel blockers: constipation is a common problem so it's important to instruct patients to take in adequate fluids and eat high-fiber foods.
Heart Failure Drugs
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Heart failure is a clinical syndrome resulting from functional or structural heart impairment and ejection of blood or ventricular filling.
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The heart is unable to pump sufficient blood from ventricles to meet metabolic needs.
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Heart failure is a common reason for hospitalization in Canada; 5,000 annual deaths occur from heart failure.
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The NY Association classifies heart failure from Class I (no limitation) through IV (Symptoms at rest).
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Drugs used to treat heart failure include positive inotropic, chronotropic, and dromotropic drugs.
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Positive Inotropic Drugs*:Increases the force of myocardial contraction
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Positive Chronotropic Drugs*: Increases heart rate.
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Positive Dromotropic Drugs*: Accelerates cardiac conduction
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Angiotensin-converting enzyme (ACE) inhibitors (such as lisinopril, enalapril maleate, and captopril) and angiotensin II receptor blockers (such as valsartan) are recommended for the treatment of Heart Failure.
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The nurse anticipates administering a positive inotrope for a patient with heart failure in the ED that presents with difficulty in breathing, cough and edema in the lower extremities
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The primary mechanism for ACE inhibitors is to inhibit aldosterone secretion.
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Loop diuretics (furosemide) reduce symptoms of heart failure caused by fluid overload only, while aldosterone inhibitors (spironolactone, eplerenone) are added as the heart failure progresses.
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The nurse anticipates the administration of milrinone, if patients are re-admitted to the ICU.
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Dobutamine can be used, this drug is recommended specifically for Black patients
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ACE inhibitors prevent sodium and water resorption by inhibiting aldosterone secretion.
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ACE Inhibitor therapeutic drugs are
- Aldosterone: which decreases sodium and water which are being retained
- Angiotensin II: which has potent vasoconstrictor
- Bradykinin: which is a Potent vasodilator
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An example of an ACE inhibitor is Lisinopril (Prinivil) which is used for hypertension, heart failure, and acute myocardial infarction. It can cause hyperkalemia dry cough, and decreased renal function
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Angiotensin II Receptor Blockers decreases systemic vascular resistance (afterload) and are used alone or in combination with diuretics for hypertension or heart failure. An example is Valsartan: shares many of the same adverse effects as lisinopril (the angiotensin to treat), has has an increase in blood sugar,
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Beta Blockers and a cardioprotective quality that block prevent reducing or blocking sympathetic nervous system stimulation to the heart and the hear's conduction system and is use Metoprolol (which has the same characteristics as atenolol), carvedilol
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Aldosterone Antagonists are known as Spironolactone and eplerenone and useful in severe stages of heart failure from causing retention of the renin-angiotensin which leads to edema that can worsen heart failure
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Miscellaneous Drugs:
- hydralazine/isosorbide and is specifically used for individuals who are Black
- dobutamine hydrochloride: structurally similar to dopamine
- B₁-selective vasoactive adrenergic drug
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Phosphodiesterase Inhibitors help manage heart failure of patients that are in critical care and increases calcium for myocardial muscle contraction and the drug in this category is Milrinone (and remember furosemide must NOT be injected into intravenous lines with milrinone)
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Cardiac Glycosides were originally obtained from the Digitalis plant (foxglove), such as Digoxin, and have now been shown to reduce mortality. Digoxin is the prototype and is used in heart failure and helps control ventricular to atrial defibrillation and the correct order for digoxin for new-onset atrial fibrillation is Digoxin 0.75 mg, which is an IV push and then at 0.125 mg.
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Digoxin has a very narrow therapeutic window that required drug level to be closely monitored
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There are adverse effects when taking the Digoxin or being with the effects of toxicity, these can include vision, fatigue, malaise, confusion, convulsions and or coloured vision
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Important Info to remember about toxicity = > is hyperkalemia
hypercalcemia • Conditions That Predisposes Digoxin Toxicity
- Use of cardiac pacemaker
- Atrioventricular block
- Dysrhythmias
- respiratory, or renal disease
Heart Failure Drugs: Nursing
- Always make note of a through drug alleriges, history & contraindications to be aware of that the patient had
- When assessing be aware of the blood pressure, a apical pulse for 1 full minute, heart & breath sounds.
- Always keep a good monitor and record of weight, input, and electrogradiogram. Important and remember to check check dosage and avoid give Digoxin with high-fibre foods. Monitor out-put to have good balance. Remember with the increase of weight or pulse is high, you cannot be too careful.
Nursing Implications
- Teach patients taking B-blockers, digoxin, and other drugs how to take their own radial pulse for 1 full minute and to notify their, and a few thereputic responses
- Decrease of blood pressure for hypretension
- Deacrease Edema or fatigue
- A more a improved regular pulse
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