QSEN Alert: Nitroglycerin Tolerance and Safety

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What is the effect of dilation of the veins on blood flow?

Decreases filling pressure (preload) (correct)

Decreases blood pressure

Increases cardiac output

Increases blood return to the heart

How do nitrates affect the systemic arteriolar bed?

They have no effect on arterioles

They relax the arteriolar bed, lowering blood pressure (correct)

They increase afterload

They constrict the arterioles

What is the purpose of applying topical nitroglycerin patches in the morning and removing them at bedtime?

To prevent the development of tolerance (correct)

To decrease myocardial oxygen requirements

To achieve a continuous high level of nitrate in the body

To alleviate pain of ischemia within 3 minutes

How do beta-blockers reduce myocardial oxygen consumption?

By blocking beta-adrenergic sympathetic stimulation to the heart Signup and view all the answers

Why should beta-blocker therapy not be stopped abruptly?

Because it may worsen angina and lead to MI Signup and view all the answers

What is the primary effect of calcium channel blockers on the ischemic myocardium?

Decrease the workload of the heart Signup and view all the answers

Which drug is commonly prescribed in addition to aspirin in patients at high risk for MI?

Heparin Signup and view all the answers

What is the main mechanism by which nitroglycerin relieves angina?

Venous dilation Signup and view all the answers

What is the risk associated with both clopidogrel and newer oral agents such as prasugrel and ticagrelor?

Bleeding from the GI tract or other sites Signup and view all the answers

What is the indication for IV administration of glycoprotein IIb/IIIa agents, such as abciximab or eptifibatide?

As adjunct therapy for PCI Signup and view all the answers

How is heparin therapy considered therapeutic?

When the activated partial thromboplastin time (aPTT) is 2 to 2.5 times the normal value Signup and view all the answers

How are organic nitrates like nitroglycerin converted in the body?

Converted to a vasodilator Signup and view all the answers

Which of the following best describes the action of antianginal drugs?

Dilating blood vessels to increase oxygen supply Signup and view all the answers

What influences the demand for oxygen by the heart muscle?

Heart rate and preload Signup and view all the answers

Which drug is described as a potent vasodilator that improves blood flow to the heart muscle?

Nitrates Signup and view all the answers

What type of vessels does nitroglycerin primarily dilate?

Veins Signup and view all the answers

Which of the following is NOT an influence on the demand for oxygen by the heart muscle?

Body temperature Signup and view all the answers

What is the primary purpose of nitrates in angina treatment?

Improving blood flow to the heart muscle Signup and view all the answers

What is the purpose of observing a 10- to 12-hour nitrate-free interval?

To prevent the development of tolerance to nitroglycerin Signup and view all the answers

When is the oral form of nitroglycerin useful?

For prophylactic use in chronic chest pain Signup and view all the answers

In which situation is IV nitroglycerin useful according to the text?

Controlling blood pressure in perioperative or emergency situations Signup and view all the answers

What is the most common adverse effect of nitroglycerin?

Severe headache Signup and view all the answers

What are the contraindications to nitroglycerin according to the text?

Hypersensitivity reactions and hypotension Signup and view all the answers

What should the nurse do if a patient has hypotension and tachycardia prior to administering nitroglycerin?

Withhold the medication Signup and view all the answers

What is the recommended action if chest pain is not relieved within 5 minutes of taking sublingual nitroglycerin tablets?

Dissolve a second tablet under the tongue Signup and view all the answers

What should be done if withdrawal of a beta-adrenergic blocker is planned?

Gradually decrease the dose under prescriber's guidance Signup and view all the answers

How should transmucosal tablets of nitroglycerin be administered?

Place them under the upper lip or between the cheek and gum and allow them to dissolve slowly Signup and view all the answers

What is important to remember about applying nitroglycerin patches and ointment?

Rotate application sites to promote effective and consistent drug absorption Signup and view all the answers

What should be avoided when taking nitroglycerin and other nitrate preparations?

Taking medications for erectile dysfunction Signup and view all the answers

How should oral nitrates be taken?

On an empty stomach with a glass of water Signup and view all the answers

What should be done if heart rate falls below 55 beats/min while taking beta-adrenergic blockers?

Report to the health care provider Signup and view all the answers

How should atenolol be taken?

At the same time each day Signup and view all the answers

What should be done if withdrawal of a beta-adrenergic blocker is planned by the prescriber?

Gradually decrease the dose under prescriber's guidance Signup and view all the answers

What should be done when taking drugs for heart disease on a regular schedule?

Take them at evenly spaced intervals to increase drug effectiveness in preventing acute attacks of angina Signup and view all the answers

What should patients avoid while using nitrate drugs?

Alcohol consumption Signup and view all the answers

How should nitroglycerin ointment be applied to the skin?

By spreading in a thin, even layer on a nonhairy area of the skin Signup and view all the answers

What is the recommended administration route for IV nitroglycerin?

Infusion pump Signup and view all the answers

When should extended-release oral nitrate preparations be used post-MI?

If angina persists after revascularization Signup and view all the answers

What happens if sublingual nitroglycerin tablets are exposed to body heat for a prolonged period?

They become ineffective Signup and view all the answers

What effect may occur with nitrate antianginal drugs, especially sublingual nitroglycerin?

Headache and dizziness Signup and view all the answers

Which of the following is the primary effect of nitroglycerin?

Dilating veins and arteries Signup and view all the answers

What is the primary influence on the demand for oxygen by the heart muscle?

Heart rate Signup and view all the answers

What is the main mechanism by which beta-adrenergic blockers reduce myocardial oxygen consumption?

Decreasing the work of the heart Signup and view all the answers

What is the purpose of observing a 10- to 12-hour nitrate-free interval?

To avoid tolerance to nitrates Signup and view all the answers

Which drug is commonly prescribed in addition to aspirin in patients at high risk for MI?

Calcium channel blockers Signup and view all the answers

How do antianginal drugs primarily work to improve blood delivery to the heart muscle?

By dilating blood vessels or decreasing the work of the heart Signup and view all the answers

Which effect do beta-blockers have on the heart?

Decrease heart rate and myocardial contractility Signup and view all the answers

What is the primary purpose of calcium channel blockers in the treatment of angina?

Decrease workload of the heart and decrease myocardial oxygen demand Signup and view all the answers

What is the recommended dose of aspirin for a patient with a new diagnosis of angina?

162 mg daily Signup and view all the answers

What is a common adverse effect of nitroglycerin?

Headache Signup and view all the answers

What should patients taking beta-blockers do if the prescriber plans to discontinue the medication?

Gradually decrease the dose over several days Signup and view all the answers

Which patient condition is a contraindication for IV administration of nitroglycerin?

Systolic blood pressure less than 90 mm Hg Signup and view all the answers

What is the primary purpose of administering IV administration of glycoprotein IIb/IIIa agents, such as abciximab or eptifibatide?

To block the GP IIb/IIIa receptors on platelets and prevent adhesion of fibrinogen Signup and view all the answers

What is the main risk associated with both clopidogrel and newer oral agents such as prasugrel and ticagrelor?

Bleeding from the gastrointestinal tract or other sites Signup and view all the answers

What is the primary effect of calcium channel blockers on the ischemic myocardium?

Vasodilation and reduction in peripheral vascular resistance Signup and view all the answers

How is heparin therapy considered therapeutic?

When the activated partial thromboplastin time (aPTT) is 2 to 2.5 times the normal value Signup and view all the answers

What is the main mechanism by which nitroglycerin relieves angina?

By reducing venous pressure and decreasing venous return to the heart Signup and view all the answers

What should be done if a patient has received heparin within the past 3 months or has been receiving unfractionated heparin for 4 to 14 days?

Switch to low-molecular-weight heparin (LMWH) Signup and view all the answers

What is the purpose of observing a 10- to 12-hour nitrate-free interval?

To prevent the development of tolerance to nitroglycerin Signup and view all the answers

In which situation is IV nitroglycerin useful according to the text?

To manage pain associated with an MI when unresponsive to other forms of nitrates Signup and view all the answers

What is the most common adverse effect of nitroglycerin?

Severe headache Signup and view all the answers

What should be done if a patient has hypotension and tachycardia prior to administering nitroglycerin?

Withhold the medication and monitor the patient closely Signup and view all the answers

What is important to remember about administering SL nitroglycerin or translingual spray?

It should be used as soon as chest pain develops Signup and view all the answers

What drugs interact with nitroglycerin, increasing or decreasing its effects?

Calcium channel blockers and alcohol Signup and view all the answers

Why should nitroglycerin ointment not be massaged into the patient's skin?

It increases the absorption of the ointment Signup and view all the answers

Why do patients take PO nitrates in the morning after a nitrate-free interval?

To prevent tolerance development Signup and view all the answers

Why should extended-release oral nitrate preparations be used post-MI if angina persists after revascularization?

To maintain long-term control of angina Signup and view all the answers

Why is it important to avoid PVC tubing when administering IV nitroglycerin?

PVC tubing absorbs a significant amount of the drug Signup and view all the answers

What should patients do if rest and three sublingual tablets or oral sprays do not relieve chest pain?

Seek emergency care immediately Signup and view all the answers

What is a potential side effect that may occur with nitrate antianginal drugs, especially sublingual nitroglycerin?

Temporary headache Signup and view all the answers

What should be done if chest pain is not relieved within 5 minutes of taking sublingual nitroglycerin tablets?

Dissolve a second tablet under the tongue Signup and view all the answers

What should patients avoid while using nitrate drugs?

Erectile dysfunction medications Signup and view all the answers

How should transmucosal tablets of nitroglycerin be administered?

Place them under the tongue until they dissolve Signup and view all the answers

Why should beta-blocker therapy not be stopped abruptly?

To avoid rebound tachycardia Signup and view all the answers

What is the primary influence on the demand for oxygen by the heart muscle?

Myocardial oxygen consumption Signup and view all the answers

How are organic nitrates like nitroglycerin converted in the body?

They are converted to nitric oxide Signup and view all the answers

What is the main mechanism by which nitroglycerin relieves angina?

Dilating blood vessels Signup and view all the answers

What is the primary purpose of nitrates in angina treatment?

To reduce myocardial oxygen demand Signup and view all the answers

Which drug is commonly prescribed in addition to aspirin in patients at high risk for MI?

Clopidogrel Signup and view all the answers

What are the contraindications to nitroglycerin according to the text?

Use of erectile dysfunction medications Signup and view all the answers

QSEN Alert: Nitroglycerin Tolerance and Safety

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Questions and Answers

What is the effect of dilation of the veins on blood flow?

How do nitrates affect the systemic arteriolar bed?

What is the purpose of applying topical nitroglycerin patches in the morning and removing them at bedtime?

How do beta-blockers reduce myocardial oxygen consumption?

Why should beta-blocker therapy not be stopped abruptly?

What is the primary effect of calcium channel blockers on the ischemic myocardium?

Which drug is commonly prescribed in addition to aspirin in patients at high risk for MI?

What is the main mechanism by which nitroglycerin relieves angina?

What is the risk associated with both clopidogrel and newer oral agents such as prasugrel and ticagrelor?

What is the indication for IV administration of glycoprotein IIb/IIIa agents, such as abciximab or eptifibatide?

How is heparin therapy considered therapeutic?

How are organic nitrates like nitroglycerin converted in the body?

Which of the following best describes the action of antianginal drugs?

What influences the demand for oxygen by the heart muscle?

Which drug is described as a potent vasodilator that improves blood flow to the heart muscle?

What type of vessels does nitroglycerin primarily dilate?

Which of the following is NOT an influence on the demand for oxygen by the heart muscle?

What is the primary purpose of nitrates in angina treatment?

What is the purpose of observing a 10- to 12-hour nitrate-free interval?

When is the oral form of nitroglycerin useful?

In which situation is IV nitroglycerin useful according to the text?

What is the most common adverse effect of nitroglycerin?

What are the contraindications to nitroglycerin according to the text?

What should the nurse do if a patient has hypotension and tachycardia prior to administering nitroglycerin?

What is the recommended action if chest pain is not relieved within 5 minutes of taking sublingual nitroglycerin tablets?

What should be done if withdrawal of a beta-adrenergic blocker is planned?

How should transmucosal tablets of nitroglycerin be administered?

What is important to remember about applying nitroglycerin patches and ointment?

What should be avoided when taking nitroglycerin and other nitrate preparations?

How should oral nitrates be taken?

What should be done if heart rate falls below 55 beats/min while taking beta-adrenergic blockers?

How should atenolol be taken?

What should be done if withdrawal of a beta-adrenergic blocker is planned by the prescriber?

What should be done when taking drugs for heart disease on a regular schedule?

What should patients avoid while using nitrate drugs?

How should nitroglycerin ointment be applied to the skin?

What is the recommended administration route for IV nitroglycerin?

When should extended-release oral nitrate preparations be used post-MI?

What happens if sublingual nitroglycerin tablets are exposed to body heat for a prolonged period?

What effect may occur with nitrate antianginal drugs, especially sublingual nitroglycerin?

Which of the following is the primary effect of nitroglycerin?

What is the primary influence on the demand for oxygen by the heart muscle?

What is the main mechanism by which beta-adrenergic blockers reduce myocardial oxygen consumption?

What is the purpose of observing a 10- to 12-hour nitrate-free interval?

Which drug is commonly prescribed in addition to aspirin in patients at high risk for MI?

How do antianginal drugs primarily work to improve blood delivery to the heart muscle?

Which effect do beta-blockers have on the heart?

What is the primary purpose of calcium channel blockers in the treatment of angina?

What is the recommended dose of aspirin for a patient with a new diagnosis of angina?

What is a common adverse effect of nitroglycerin?

What should patients taking beta-blockers do if the prescriber plans to discontinue the medication?

Which patient condition is a contraindication for IV administration of nitroglycerin?

What is the primary purpose of administering IV administration of glycoprotein IIb/IIIa agents, such as abciximab or eptifibatide?

What is the main risk associated with both clopidogrel and newer oral agents such as prasugrel and ticagrelor?

What is the primary effect of calcium channel blockers on the ischemic myocardium?

How is heparin therapy considered therapeutic?

What is the main mechanism by which nitroglycerin relieves angina?

What should be done if a patient has received heparin within the past 3 months or has been receiving unfractionated heparin for 4 to 14 days?

What is the purpose of observing a 10- to 12-hour nitrate-free interval?

In which situation is IV nitroglycerin useful according to the text?

What is the most common adverse effect of nitroglycerin?

What should be done if a patient has hypotension and tachycardia prior to administering nitroglycerin?

What is important to remember about administering SL nitroglycerin or translingual spray?

What drugs interact with nitroglycerin, increasing or decreasing its effects?

Why should nitroglycerin ointment not be massaged into the patient's skin?

Why do patients take PO nitrates in the morning after a nitrate-free interval?

Why should extended-release oral nitrate preparations be used post-MI if angina persists after revascularization?

Why is it important to avoid PVC tubing when administering IV nitroglycerin?

What should patients do if rest and three sublingual tablets or oral sprays do not relieve chest pain?

What is a potential side effect that may occur with nitrate antianginal drugs, especially sublingual nitroglycerin?

What should be done if chest pain is not relieved within 5 minutes of taking sublingual nitroglycerin tablets?

What should patients avoid while using nitrate drugs?

How should transmucosal tablets of nitroglycerin be administered?

Why should beta-blocker therapy not be stopped abruptly?

What is the primary influence on the demand for oxygen by the heart muscle?

How are organic nitrates like nitroglycerin converted in the body?