Rapid Fire Pharmacology Quiz Game

Questions and Answers

What is the primary role of opioid antagonists in a patient with acute coronary syndrome?

To relieve pain directly by interacting with opioid receptors.

To reverse the effects of opioid analgesics in case of respiratory depression. (correct)

To reduce myocardial oxygen demand by inducing vasodilation.

To enhance the sedative effects of analgesics.

Which of the following side effects is commonly associated with the use of nitrates in cardiac interventions?

Reflex tachycardia caused by excessive blood pooling. (correct)

Bradycardia due to enhanced peripheral vasodilation.

Hypertension from increased cardiac output.

Increased myocardial oxygen demand leading to angina.

How do platelet inhibitors function in the treatment of acute coronary syndrome?

By promoting platelet aggregation to enhance clot formation.

By increasing the viscosity of the blood to prevent thrombus formation.

By inhibiting the synthesis of clotting factors in the liver.

By blocking specific receptors on platelets, reducing their activation. (correct)

When providing patient education for medications in a cardiac setting, which statement is most important to reinforce?

You should always inform your healthcare provider about any other medications you take. Signup and view all the answers

What is a critical consideration regarding blood pressure when administering certain drugs for cardiac interventions?

Medications should be adjusted based on changes in blood pressure to avoid hypotension. Signup and view all the answers

What is the primary action of Naloxone (Narcan) in the context of opioid administration?

Blocks opioid receptors to reverse effects Signup and view all the answers

Which of the following are common side effects of nitrates during treatment for acute myocardial infarction?

Headache and dizziness Signup and view all the answers

What is the mechanism of action of nitrates to alleviate ischemic pain?

Directly relaxes smooth muscle Signup and view all the answers

During patient teaching, how should a patient be instructed to take sublingual nitroglycerin?

Sitting or lying down Signup and view all the answers

What is a critical nursing intervention regarding blood pressure and the administration of nitroglycerin?

Monitor blood pressure closely after administration Signup and view all the answers

Which side effect is associated with morphine sulfate use during acute myocardial infarction?

Severe hypotension Signup and view all the answers

How should nitrates be stored to maintain their effectiveness?

In a dark glass container Signup and view all the answers

What should a patient do if chest pain does not improve after taking sublingual nitroglycerin?

Call 911 after the second dose Signup and view all the answers

How can the effects of an opioid agonist overdose be effectively reversed?

Administer an opioid antagonist such as naloxone Signup and view all the answers

Which of the following is a common side effect of nitrates?

Throbbing headaches due to rapid blood vessel dilation Signup and view all the answers

What is the primary mechanism of action of platelet inhibitors?

Inhibits platelet clumping Signup and view all the answers

When should nitroglycerin not be administered based on blood pressure readings?

If blood pressure is below 90/60 Signup and view all the answers

Which item is important to teach patients about the use of platelet inhibitors?

Signs of excessive bleeding should be monitored Signup and view all the answers

Which of the following is NOT an adverse effect associated with platelet inhibitors?

Hypertension Signup and view all the answers

What interaction increases the risk of bleeding when taking platelet inhibitors?

Alcohol consumption Signup and view all the answers

What symptom is associated with excessive use of nitrates?

Reflex tachycardia Signup and view all the answers

What is the primary goal of medical treatment in a patient with acute coronary syndrome?

Restore blood flow to the myocardium Signup and view all the answers

Which of the following is NOT typically considered a nursing implication when caring for a patient with acute coronary syndrome?

Starting a high-calorie diet immediately Signup and view all the answers

In the treatment of acute coronary syndrome, what role does aspirin play?

It reduces platelet aggregation Signup and view all the answers

What complication can occur if arteries become plugged with thrombi?

Oxygen deprivation leading to cell death Signup and view all the answers

Which of the following should be assessed immediately in a patient with acute coronary syndrome?

Pain level and vital signs Signup and view all the answers

What is the most appropriate intervention for reversing the effects of an opioid agonist overdose?

Administer an opioid antagonist such as naloxone. Signup and view all the answers

Which side effect is common and occurs due to rapid blood vessel dilation in patients taking nitrates?

Throbbing headaches Signup and view all the answers

At what blood pressure reading should nitroglycerin not be administered?

90/60 Signup and view all the answers

What is a potential adverse effect of taking aspirin as a platelet inhibitor?

Excessive bleeding Signup and view all the answers

Which of the following is a commonly recognized interaction that increases the bleeding risk for patients on platelet inhibitors?

Alcohol Signup and view all the answers

Which symptom is associated with thrombocytopenia as an adverse effect of platelet inhibitors?

Unexplained bruising Signup and view all the answers

What is an important patient teaching point for individuals receiving platelet inhibitors?

Monitor for signs of bleeding. Signup and view all the answers

Which of the following is NOT a common side effect of nitrates?

Vitamin B deficiency Signup and view all the answers

What is the primary effect of morphine sulfate when used during an acute myocardial infarction?

Binds to opioid receptors in the CNS Signup and view all the answers

What is a key nursing intervention when administering morphine sulfate?

Monitor for hypotension and respiratory depression Signup and view all the answers

What is the primary mechanism of action of nitrates in treating ischemic pain?

Relax smooth muscle in blood vessels Signup and view all the answers

What should a patient do if they experience chest pain after taking sublingual nitroglycerin?

Call 911 if symptoms do not improve after the second dose Signup and view all the answers

Which of the following is a side effect of nitrates that may occur during treatment?

Severe postural hypotension Signup and view all the answers

What instruction is critical for a patient when using sublingual nitroglycerin?

Take while sitting or lying down Signup and view all the answers

What vital sign must be closely monitored when administering nitroglycerin?

Blood pressure Signup and view all the answers

Which of the following can significantly decrease the effect of nitrates?

Methylphenidate Signup and view all the answers

What should be monitored to assess the effectiveness of adenosine treatment?

Heart rate Signup and view all the answers

What effect does caffeine have when administered shortly before adenosine?

Inhibits the effect of adenosine Signup and view all the answers

Which symptom indicates a potential side effect of medication management in cardiac patients?

Hypotension Signup and view all the answers

Which nursing intervention is critical when administering medications for dysrhythmias?

Continuous monitoring of respiratory rate Signup and view all the answers

What should be reported immediately to the healthcare provider during medication management for heart conditions?

Cough or wheezing Signup and view all the answers

What is the primary action of adenosine in the context of cardiac treatment?

Slows conduction through the AV node Signup and view all the answers

Which of the following medications is primarily used to manage severe ventricular tachycardia?

Amiodarone Signup and view all the answers

What is a significant interaction to be aware of when administering calcium channel blockers?

Increased toxicity of digoxin Signup and view all the answers

Which condition is warfarin primarily used to prevent?

Stroke due to atrial fibrillation Signup and view all the answers

What effect do beta-adrenergic blockers have on heart function?

Decrease sinus rate and heart output Signup and view all the answers

Which of the following agents is classified as an inotropic agent?

Dopamine Signup and view all the answers

What precaution should be taken when administering dobutamine and dopamine?

Monitor apical pulse and blood pressure Signup and view all the answers

What is a common side effect of digoxin toxicity to monitor for?

Changes in visual perception Signup and view all the answers

What is the primary benefit of using nitrates in angina management?

Dilates blood vessels to improve oxygen supply Signup and view all the answers

Which effect do nitrates have on preload and afterload?

Decrease both preload and afterload Signup and view all the answers

What is a common side effect experienced by more than 50% of patients using nitrates?

Throbbing headaches Signup and view all the answers

Which statement best describes the use of rapid-acting nitrates?

They are effective in relieving pain during acute angina episodes. Signup and view all the answers

What is a common long-term reaction for patients using nitrates?

Headaches typically become less severe over time. Signup and view all the answers

Which condition can result from the use of nitrates during sudden posture changes?

Severe postural hypotension Signup and view all the answers

How do nitrates contribute to reducing myocardial oxygen demand?

By dilating blood vessels and decreasing workload Signup and view all the answers

What role do long-acting nitrates play in managing angina?

They prevent the occurrence and severity of angina attacks. Signup and view all the answers

What should be assessed first before administering a nitrate drug?

Patient's medication history for drug interactions Signup and view all the answers

Which effect can be caused by combining nitrates with alcohol?

Severe hypotension and tachycardia Signup and view all the answers

What is the expected onset of throbbing headaches when taking nitrates?

Quickly after taking the drug Signup and view all the answers

What is a significant risk associated with the reduction of blood flow to the heart muscle?

Potential for a heart attack or myocardial infarction Signup and view all the answers

What is the effect of pseudoephedrine on nitrate effectiveness?

Decreases its effectiveness Signup and view all the answers

What is a common risk associated with the use of nitrates in conjunction with medications for erectile dysfunction?

Severe hypotension Signup and view all the answers

What symptom should be monitored closely in patients experiencing the administration of high doses of nitrates?

Severe vertigo Signup and view all the answers

Which assessment is important when evaluating the effectiveness of nitrates in treating acute angina?

Onset, duration, and characteristics of the pain Signup and view all the answers

What should a patient do if symptoms do not improve after the first dose of nitroglycerin?

Call 911 immediately Signup and view all the answers

How many doses of nitroglycerin can a patient take in a 15-minute period?

3 doses Signup and view all the answers

If chest pain persists after taking the third dose of nitroglycerin, what action should be taken?

Call 911 immediately Signup and view all the answers

What is the recommended time interval between doses of nitroglycerin after the first dose?

5 minutes Signup and view all the answers

Which condition indicates that a patient should call 911 when using nitroglycerin?

Symptoms worsen after the first dose Signup and view all the answers

What is the recommended method for administering sublingual NTG for effective absorption?

Place the tablet under the tongue without chewing Signup and view all the answers

Why is it important to remove old NTG paste before applying a new dose?

To reduce potential overdose from cumulative doses Signup and view all the answers

Which form of NTG is specifically designed for longer action when taken orally?

Isosorbide Signup and view all the answers

What precaution should be taken by healthcare providers when applying NTG paste?

Wear gloves to prevent absorption through their skin Signup and view all the answers

Which of the following statements regarding NTG administration is incorrect?

Sublingual NTG should be chewed for better effect. Signup and view all the answers

What should be done if a patient's blood pressure is recorded at 85/55 mm Hg before administering NTG?

Avoid administering NTG. Signup and view all the answers

How can patients manage the headache often caused by NTG?

Take a pain reliever like acetaminophen. Signup and view all the answers

What is a critical aspect of NTG administration to ensure its effectiveness over time?

Provide a consistent break from the drug. Signup and view all the answers

What is a common adjustment period for headaches experienced after starting NTG?

Headaches typically resolve within a few weeks. Signup and view all the answers

What is the appropriate action regarding the timing of an NTG patch to prevent decreased effectiveness?

Remove the patch at bedtime and reapply in the morning. Signup and view all the answers

What is the maximum daily dosage for isosorbide mononitrate extended release?

240 mg Signup and view all the answers

What should be done to avoid tolerance when using nitroglycerin patches?

Include a nitrate-free interval as directed Signup and view all the answers

What is the recommended storage method for nitroglycerin tablets?

In a dark glass container Signup and view all the answers

When administering sublingual nitroglycerin for chest pain, what is the recommended method?

Place the tablet under the tongue Signup and view all the answers

What is a common side effect of using nitroglycerin medications?

Headache Signup and view all the answers

How many doses of sublingual nitroglycerin can be administered within 15 minutes if chest pain persists?

3 doses Signup and view all the answers

What size of the transdermal patch is appropriate for administration?

0.1-0.8 mg/h Signup and view all the answers

What should be monitored closely while a patient is taking nitrates?

Blood pressure Signup and view all the answers

What should be done if nitroglycerin patches come off during use?

Discard the patch and apply a new one at a different site. Signup and view all the answers

Why should patients taking nitrates avoid consuming alcoholic beverages?

Alcohol can cause severe drops in blood pressure with nitrates. Signup and view all the answers

Which statement accurately describes the role of the sinoatrial node in the heart?

It is the primary pacemaker that creates and conducts electrical impulses. Signup and view all the answers

What is a crucial precaution to take when using NTG spray?

Avoid using it near flammable items. Signup and view all the answers

How should nitroglycerin tablets be stored to maintain their effectiveness?

In a dark glass container. Signup and view all the answers

What is the recommended approach to maintain skin health when using transdermal patches?

Rotate application sites daily to prevent irritation. Signup and view all the answers

What should patients using nitroglycerin do if they experience an increase in the frequency of angina attacks?

Notify their healthcare provider immediately. Signup and view all the answers

Why should patients using nitrates avoid erectile dysfunction medications like sildenafil?

It can cause a dangerous drop in blood pressure. Signup and view all the answers

What is the primary goal of using antidysrhythmic drugs?

To restore a normal heart rhythm and maintain cardiac output Signup and view all the answers

Which class of antidysrhythmic drugs is known as sodium channel blockers?

Class I Signup and view all the answers

Which condition is a common cause of dysrhythmias?

Hypoxia from coronary artery blockage Signup and view all the answers

What role does digoxin play in treating dysrhythmias?

It strengthens heart contractions and slows the heart rate Signup and view all the answers

Which of the following describes Class II antidysrhythmic drugs?

Beta blockers that decrease sympathetic stimulation and heart rate Signup and view all the answers

What characterizes atrial fibrillation as a dysrhythmia?

It has a rapid heart rate starting in the atria with an irregular rhythm Signup and view all the answers

What is a crucial consideration when treating patients with dysrhythmias?

The potential for drugs to cause further dysrhythmias Signup and view all the answers

Which class of antidysrhythmic drugs selectively blocks calcium from entering heart muscle cells?

Class IV Signup and view all the answers

What defines a dysrhythmia?

An abnormal heart rhythm that can be fast or slow, regular or irregular Signup and view all the answers

Which of the following actions is associated with Class III antidysrhythmic drugs?

Lengthening the refractory period and making cells less excitable Signup and view all the answers

Study Notes

Opioid Agonists and Antagonists

Opioid agonists, like morphine, can cause strong adverse reactions or overdose.
Naloxone is an opioid antagonist that can reverse the effects of opioid overdose.

Nitrate Side Effects and Contraindications

Common side effects of nitrates include throbbing headaches, severe postural hypotension, reflex tachycardia, and paradoxical bradycardia.
Nitroglycerin should not be administered if blood pressure is below 90/60 mmHg.

Platelet Aggregation

Issues with platelet function can lead to coronary artery occlusion.
Aspirin (325 mg) is administered immediately for suspected acute coronary syndrome (ACS) to prevent clotting.

Platelet Inhibitors

Used in cardiovascular care to inhibit platelet clumping during unstable angina and acute myocardial infarction (AMI).
Common examples include Aspirin, Clopidogrel (Plavix), and Prasugrel (Effient).

Side and Adverse Effects of Platelet Inhibitors

Side effects can include bleeding, epigastric discomfort, bruising, gastric ulceration, and rash.
Adverse effects may involve excessive bleeding, new cardiovascular events, thrombocytopenia, and neutropenia.

Drug Interactions with Platelet Inhibitors

Alcohol, vitamin K, oral contraceptives, diet, and herbal supplements can alter the effectiveness and increase bleeding risk.

Nursing Implications for Platelet Inhibitors

Assess medications, signs of bleeding, and monitor lab results.
Teach patients to take medications with food and recognize signs of bleeding.

Treatment Goals in Acute Coronary Syndrome

Establish reperfusion, reduce infarct size, prevent complications, and provide emotional support and education.

Medical Treatments for Acute Myocardial Infarction

Pain relief, oxygenation, platelet aggregation prevention, and restoration of blood flow are critical interventions.

Pain Management in AMI

Morphine sulfate is used for pain relief and anxiety reduction, acting on central nervous system opioid receptors.

Side Effects and Adverse Reactions of Morphine

Side effects include hypotension, respiratory depression, bradycardia, nausea, and sedation.
Adverse effects can lead to severe respiratory depression, hypotension, oliguria, and excessive sedation.

Nursing Interventions for Morphine Administration

Titrate doses of 2-4 mg IV every 5-10 minutes, while monitoring level of consciousness (LOC) and vital signs.
Have naloxone readily available for any adverse reactions.

Nitrates Function and Administration

Nitrates are vasodilators that reduce ischemic pain by relaxing smooth muscle and decreasing myocardial oxygen demands.
Administer sublingually while patient is sitting or lying down; maximum of three doses in 15 minutes if pain persists.

Side Effects and Drug Interactions of Nitrates

Common side effects include headaches, flushing, tachycardia, dizziness, and orthostatic hypotension.
Interactions with antihypertensives, pseudoephedrine, and sildenafil can lead to increased or decreased effects, with potential severe hypotension.

Patient Teaching for Nitrate Administration

Store medication in a dark glass container and instruct to call 911 if symptoms do not improve after initial doses.
Common teaching also includes the importance of using nitrates while seated to prevent falls from hypotension.

Topical Administration of Nitrates

Use gloves when handling nitrate ointments or patches.
Careful measurement and adherence to administration protocols are essential for effectiveness.

Treatment Goals

Establish reperfusion to restore blood flow.
Reduce infarct size to limit heart damage.
Prevent and manage complications during acute coronary syndrome (ACS).
Provide emotional support and patient education.

Medical Treatment

Administer pain relief, primarily using morphine.
Ensure adequate oxygenation of the myocardium.
Prevent platelet aggregation to avoid further clotting.
Restore blood flow through appropriate interventions.

Nursing Implications

Conduct immediate assessments of the patient.
Establish intravenous access for medication administration.
Administer oxygen therapy, aspirin, nitroglycerin, and morphine as needed.

Pain Relief During Acute Myocardial Infarction (AMI)

Initial pain treated with intravenous morphine sulfate for effectiveness.

Morphine Sulfate

Provides pain relief and reduces anxiety by binding to CNS opioid receptors.
Side effects include hypotension, bradycardia, nausea, and sedation.
Adverse effects can lead to respiratory depression and severe hypotension.
Titration involves administering 2-4 mg IV push every 5-10 minutes, requiring monitoring of level of consciousness and vital signs.
Naloxone (Narcan) must be readily available for potential overdose reversal.

Nitrates

Act as vasodilators to alleviate ischemic pain.
Mechanism involves relaxing smooth muscle, reducing myocardial oxygen demand, and enhancing coronary perfusion.
Common side effects: headache, dizziness, tachycardia, and orthostatic hypotension.
Adverse effects include severe postural hypotension and paradoxical bradycardia.

Drug Interactions with Nitrates

Antihypertensive medications may augment the effects.
Pseudoephedrine and methylphenidate can diminish efficacy.
Combining nitrates with sildenafil can lead to severe hypotension.

Sublingual Administration of Nitrates

Patient education emphasizes taking while sitting or lying down, and storing in a dark container.
Administer doses 5 minutes apart, with a maximum of 3 doses (15 minutes total).
Instruct patients to call emergency services if chest pain persists after two doses.

Topical Administration of Nitrates

Utilize gloves and measure the paste accurately.
Remove previous patches or ointments according to instructions and rotate application sites.

Platelet Aggregation

Platelet inhibitors are crucial for managing conditions like unstable angina and acute myocardial infarction.
Aspirin (325 mg) is administered immediately to patients with suspected ACS to prevent clots.

Examples of Platelet Inhibitors

Common medications include Aspirin, Clopidogrel (Plavix), and Prasugrel (Effient).
They function by inhibiting platelet clumping to reduce clotting risks.

Side Effects and Adverse Effects of Platelet Inhibitors

Potential side effects: bleeding, epigastric discomfort, and bruising.
Adverse effects may include excessive bleeding, thrombocytopenia, and new cardiovascular events.

Drug Interactions with Platelet Inhibitors

Alcohol increases bleeding risks.
Combined effects with Vitamin K, oral contraceptives, dietary factors, and herbal supplements should be monitored.

Nursing Implications for Platelet Inhibitors

Assess medications and monitor for signs of bleeding.
Educate patients on taking medications with food and recognizing bleeding signs.

Adenosine (Adenocard)

Slows AV node conduction, interrupts reentry pathways, restores normal sinus rhythm in paroxysmal supraventricular tachycardia (PSVT).

Amiodarone (Pacerone)

Prolongs action potential duration and effective refractory period.
Noncompetitive inhibition of alpha and beta-adrenergic receptors.
Increases P-R and Q-T intervals; decreases sinus rate and peripheral vascular resistance.
Used for severe ventricular tachycardia, atrial fibrillation, ventricular fibrillation, and cardiac arrest when first-line agents fail.

Antiarrhythmic Agents

Mexiletine, Propafenone (Rythmol), Tocainide: Decrease cardiac muscle excitability and suppress conduction tissue automaticity.
Beta-Adrenergic Blockers: Propranolol, Sotalol, Acebutolol, Esmolol, Metoprolol, Carvedilol; used for heart rate control and dysrhythmias.

Calcium Channel Blockers

Verapamil (Calan), Diltiazem (Cardizem): Treat supraventricular tachycardia, control rapid atrial tachycardia; induce dilation of coronary arteries.

Inotropic Agents

Dobutamine (IV), Dopamine (IV): Increase myocardial contractility, cardiac output, BP, and renal blood flow; use with caution in congestive heart failure (CHF).

Anticoagulants

Warfarin (Coumadin): Prevents stroke in atrial fibrillation patients by reducing embolization complications; requires continuous monitoring of blood pressure, heart rate, urinary output, and peripheral pulses.
Frequent monitoring of prothrombin time and international normalized ratio (PT/INR); consistent intake of vitamin K is essential to avoid fluctuations.

Nursing Interventions

Continuous monitoring of BP, pulse, respirations; assess for headaches, dizziness, GI complaints, and new dysrhythmias.
Avoid caffeine 4-6 hours before adenosine administration, as it can inhibit the drug's effect.
Watch for adverse effects: hypotension, bradycardia, sinus arrest, heart failure, and dyspnea.
Caution with patients having bronchospastic disease; monitor for respiratory distress, cough, wheezing, or shortness of breath.
Monitor pulse and BP carefully, and report any new dysrhythmias or vital sign changes.

Overview of Angina and the Importance of Antianginals

Coronary arteries are essential for supplying blood, oxygen, and nutrients to the heart muscle.
Atherosclerosis can lead to plaque formation, resulting in reduced blood flow, lack of oxygen, and chest pain known as angina.
Severe reduction in blood flow can lead to myocardial infarction (heart attack).
Major classes of antianginal drugs include nitrates, beta blockers, and calcium channel blockers, all of which aim to improve circulation and decrease myocardial oxygen demand.

Nitrates

Mechanism of Action

Nitrates relax vascular smooth muscle, leading to dilation of blood vessels in both the venous and arterial systems.
Venous dilation reduces preload by increasing venous blood pooling, while arterial dilation reduces afterload by lowering the pressures the heart must pump against.
These combined effects enhance oxygen delivery to the heart and facilitate easier pumping.

Uses

Rapid-acting nitrates like sublingual nitroglycerin (NTG) are prescribed for acute angina pain relief.
Long-acting formulations (oral nitrates, topical NTG paste, transdermal patches) prevent and reduce the frequency/severity of angina attacks.
Nitrates are also beneficial post-myocardial infarction and in patients with heart failure to decrease cardiac workload.

Expected Side Effects

Throbbing headaches occur in over 50% of patients due to rapid blood vessel dilation, usually resolving quickly with low doses.
High doses may require acetaminophen or analgesics for headache relief.
With long-term use, headaches tend to diminish in severity.
Slight hypotension is common after administration due to venous dilation.

Adverse Effects

Possible reactions include severe postural hypotension, reflex tachycardia, paradoxical bradycardia, vertigo, and significant weakness.

Drug Interactions

Alcohol, antihypertensives, opioids, and diuretics can potentiate nitrate effects, causing tachycardia and severe hypotension.
Caffeine, pseudoephedrine, methylphenidate, and specific antidiabetics may diminish the efficacy of nitrates.
Concurrent use with erectile dysfunction medications, like sildenafil, can result in critical hypotension.

Nursing Implications and Patient Teaching

Obtain a comprehensive patient history, including OTC and prescription medications, to prevent drug interactions.
Conduct a baseline assessment of heart rate and blood pressure before nitrate administration.
For acute angina, gather detailed information on the patient's symptoms, including onset and pain characteristics.
Inquire about past experiences of similar pain and relief methods, aiding in tracking the effectiveness of nitrates.

Taking Nitroglycerin for Chest Pain

Begin by sitting or lying down to minimize the risk of falls or injury during chest pain episodes.
Administer one dose of Nitroglycerin (NTG) sublingually or via spray immediately when chest pain starts.
If symptoms worsen or do not improve, contact emergency services (911).

Subsequent Doses

If the initial dose alleviates symptoms partially but does not fully relieve them, a second dose can be taken after 5 minutes.
Again, if symptoms worsen or fail to improve, call 911.

Third Dose Protocol

Should symptoms continue to improve but still not resolve, a third dose may be taken 5 minutes after the second dose.
If after the third dose symptoms are still present or worsen, it is crucial to call 911.

Dose Limitations

Do not exceed three doses within a 15-minute period to avoid potential overdose and serious side effects.

Emergency Situations

Immediate action is required if:
- Symptoms persist or worsen after 5 minutes following the first dose.
- Improvement halts after the second dose.
- Chest pain remains unresolved 5 minutes after the third dose.
- There is uncertainty about the total number of doses taken.

Nitrates Overview

Nitroglycerin (NTG) and other nitrates exist in multiple forms, offering flexibility in treatment.
NTG tablets are designed for sublingual absorption, providing rapid relief in emergency situations.

Administration and Absorption

Sublingual NTG is effective when placed under the tongue; swallowing destroys its efficacy.
Alternative forms such as isosorbide provide a longer-lasting effect and are administered orally.
NTG can also be delivered via a paste or a transdermal patch, which allows for absorption through the skin.

Intravenous NTG

Intravenous NTG is titrated carefully to relieve severe angina pain.

Dosage Guidelines

Proper administration practices are crucial for the effectiveness of NTG.
Emphasize the importance of not chewing or swallowing sublingual NTG tablets.
For NTG paste, precise measurement is essential; use measuring paper as directed.
Remove all remnants of old NTG paste before applying a new dose to avoid cumulative effects.

Safety Precautions

Always wear gloves while handling NTG paste to prevent unintended absorption through the skin.

Monitoring NTG Response

Careful monitoring is essential for patients taking Nitroglycerin (NTG) due to its effects on blood pressure.
Almost all patients experience a drop in blood pressure since NTG functions as a vasodilator.

Administration Criteria

NTG should not be administered if blood pressure is below 90/60 mm Hg to avoid complications.

Common Side Effects

Headaches are a frequent side effect after taking NTG.
Administration of acetaminophen or other pain relievers can alleviate these headaches.
Headaches typically diminish within a few weeks as patients acclimatize to NTG.

Tolerance Development

Patients develop tolerance to NTG over time, necessitating periodic breaks from the medication to maintain its effectiveness.
For example, an NTG patch should be applied in the morning and removed at bedtime to prevent diminished efficacy.

Importance of Timing

Continuous application of the NTG patch for 24 hours can lead to reduced effectiveness for subsequent doses.
Taking time off during the night is crucial to ensure the drug remains beneficial for the patient.

Additional Resources

Refer to Table 9.7 for further information on NTG and relevant nursing implications.

Isosorbide Mononitrate

Available in two forms: immediate-release (Ismo, Monoket) and extended-release (Imdur).
Immediate-release dosage: 20 mg orally twice daily, administered 7 hours apart.
Extended-release dosage: 30–60 mg orally once daily; maximum dosage can reach 240 mg per day.

Nitroglycerin (NTG)

Multiple forms available including sublingual, buccal, oral capsules, topical ointment, and transdermal patches.
Sublingual or buccal administration: 0.3–0.6 mg, repeatable every 5 minutes up to three doses.
Sublingual or lingual spray: 1–2 sprays, repeat every 5 minutes up to three doses.
Oral sustained-release capsules: 2.5–6.5 mg taken three to four times daily.
Topical 2% ointment: 1–2 inches applied every 6–8 hours; nitrate-free interval of up to 12 hours is required.
Transdermal patch dosage: 0.1–0.8 mg/h, worn for 12–14 hours daily, also includes a nitrate-free interval of 10–12 hours.

Patient Monitoring and Education

Close monitoring of blood pressure is essential due to the drug's potential to cause hypotension.
For immediate-release isosorbide mononitrate, maintaining a schedule of 7-hour intervals helps prevent tolerance to nitroglycerin.
Headaches may occur due to vasodilation; mild cases can be treated with acetaminophen.
When applying NTG ointment or paste, use gloves to avoid dermal absorption of the drug.
Used patches should be removed as directed, typically at bedtime, to ensure a drug-free period.
Rotate application sites for paste or patches to prevent skin irritation; preferred sites include hairless areas on the upper arms, back, or chest.
For acute chest pain, sublingual NTG or lingual spray is preferred for rapid absorption.
NTG tablets should be stored in a dark glass container to avoid degradation; check expiration dates regularly to ensure effectiveness.
Warn male patients against combining nitrates with erectile dysfunction medications due to the risk of serious hypotension.

Patient and Family Teaching

NTG tablets must be stored in a dark glass container to avoid degradation.
Check expiration dates regularly; expired NTG tablets are ineffective for chest pain relief.
Alcohol should be avoided while taking nitrate products; consult healthcare provider before any special occasions involving alcohol consumption.
For NTG spray users, avoid smoking or proximity to open flames due to flammability of the drug.
Apply transdermal patches to hairless areas to ensure effective adhesion; do not cut the patch as it alters medication dosage.
If a patch detaches, replace it with a new one at a different site to prevent skin irritation; rotate application sites daily.
Avoid erectile dysfunction drugs like sildenafil (Viagra) as they can cause severe drops in blood pressure.
Keep a log of angina attacks; report any increase in frequency or change in symptoms to healthcare provider.

Antidysrhythmics Overview

The heart contains an electrical conduction system that generates and relays electrical impulses, responsible for muscle contractions and blood pumping.
The sinoatrial node serves as the primary pacemaker, triggering orderly contractions in the atria and ventricles, creating a regular pulse.
Increased physical exertion raises heart rate to meet oxygen demands; drops in blood pressure trigger the heart to increase rate for restoration.
Disruption in pacemaker function can lead to arrhythmias, effectively reducing cardiac output.
Symptoms of dysrhythmias vary based on severity; some may be benign while others are life-threatening.

Dysrhythmia Causes and Classification

Common factors contributing to dysrhythmias include hypoxia, electrolyte imbalances, medication side effects, and cardiac interventions.
Dysrhythmias are categorized by the origin (atria, supraventricular, or ventricles) and rhythm pattern (regular or irregular).
Atrial fibrillation is an example where the rhythm originates in the atria, exhibiting an irregular rate.
Ventricular tachycardia signifies rapid heartbeats initiated in the ventricles.

Action of Antidysrhythmic Drugs

Aim to regularize heart rhythm and mitigate serious dysrhythmias while enhancing cardiac function.
Non-pharmacological therapies (like pacemakers) complement drug treatments for abnormal heart rhythms.
Antidysrhythmic drugs target irregularly beating cells through various phases of the heart's electrical conduction system.

Vaughan-Williams Classification System

Class I: Sodium Channel Blockers (e.g., quinidine) prolong cells' refractory period and reduce excitability.
Class II: Beta Blockers (e.g., propranolol) lessen sympathetic stimulation, decreasing heart rate and contractility.
Class III: Potassium Channel Blockers (e.g., amiodarone) reduce excitability and can slow heart rate.
Class IV: Calcium Channel Blockers (e.g., diltiazem) block calcium entry into heart cells, slowing conduction through pacemaker cells.
Additional medications include digoxin and magnesium sulfate, among others.

Drug Uses

Dysrhythmia treatment is dictated by underlying causes; goal is normalization of heart rhythm and maintenance of cardiac output.
Digoxin effectively manages heart failure and rapid dysrhythmias by slowing sinoatrial node firing and increasing cardiac muscle contraction strength.
Toxicity from digoxin may induce dysrhythmias; beta-adrenergic blockers (e.g., sotalol) also modulate heart activity and responses to neurotransmitters.

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This quiz covers key concepts in pharmacology, focusing specifically on opioid agonists and the management of adverse reactions. Test your understanding of opioid antagonist administration and side effects associated with opioid use. Engage with practical scenarios to enhance your clinical reasoning.