In order to prevent the development of tolerance, the nurse instructs the patient to:

Chest pain that occurs when the herts supply of blood carrying oxygen and energy rich nutrients
is insufficient to meet the demands of the heart

A common form of arteriosclerosis involving deposits of fatty, cholesterol-containing material
(plaques) within arterial walls

chest pain that has as its primary cause atherosclerosis, which resluts in long-term but relatively
stable level of obstruction in one or more coranary arteries

arteries that deliver oxygen to the heart muscle.

Coronary artery disease CAD

any one of teh abnormal conditions that can affect the arteries of the heart and produce various
pathologic effects, especially a reduced supply of oxygen and nutrients to the myocardium

poor blood supply to an organ

poor blood supply to the heart via the coronary arteries

goss necrosis of the myocardium following interruption of blood supply; it is almost always
caused by atherosclerosis of tehcoronary arteries and is commonly called heart attack.

a rapid heartbeat caused by a variety of autonomic nervoius system effects such as blood
presssure changes, fever, or emotional stress

early stage of progressive coronary artery disease

ichemia induced myocardial chest pain caused by spasms of the coronary arteries

What are the indications of Nitrates/Nitrites ?

Rapid-acting forms
• Used to treat acute anginal attacks.
• Sublingual tablets; intravenous infusion.
• Long-acting forms
• Used to PREVENT anginal episodes.

What are the indications of Isosorbide dinatrate and Isosorbide
mononitrate?

Used for:
• Acute relief of angina.
• Prophylaxis in situations that may provoke angina.
• Long-term prophylaxis of angina.

What are the indications of Nitroglycerin?

• It is a Prototypical nitrate.
• Large first-pass effect with oral forms.
• Used for symptomatic treatment of ischemic heart conditions (angina).
• IV form used for BP control in perioperative hypertension, treatment of HF, ischemic pain,
pulmonary edema associated with acute MI, and hypertensive emergencies.

What are the side effects of Nitrates/Nitrites?

• Headaches.
• Usually diminish in intensity and frequency
with continued use.
• Tachycardia, postural hypotension.
• Tolerance may develop.

How to use Nitrates/Nitrites in ointment and sublingual doses?

Use of Sublingual route: 1 tab under tongue at first sign of chest pain; if pain not relieved after 1 dose, call 911; may repeat up to 3 tablets.
Use of Ointments forms: 1-2 inch every 8 hour, up to 4-5 inch ribbon every 4 hour.

What are the indications of Calcium Channel Blockers?

• First-line drugs for treatment of angina, hypertension, and supraventricular tachycardia.
• Coronary artery spasms (Prinzmetal’s angina).
• Short-term management of atrial fibrillation and flutter.
• Several other uses.

Who most benefit from calcium channel blockers?

Patients with hypertension. Patients with stable coronary artery disease.

What are the side effects of calcium channel blockers?

• Very acceptable adverse effect and safety profile.
• May cause hypotension, palpitations, tachycardia or
bradycardia, constipation, nausea, dyspnea, other adverse
effects.

What is the nursing consideration for calcium channel blockers?

• Constipation is a common problem; instruct patients to take
in adequate fluids and eat high-fiber foods.

a patient has a new prescription for transdermal nitroglycerin patches.
The nurse teaches the patient that these patches are most appropriately used?

to prevent the occurrence of angina.

A nurse with adequate knowledge about the administration of IV
nitroglycerin will recognize that which statement is correct?

IV nitroglycerin must be protected from exposure to light through use of special tubing.

Which statement by the patient reflects the need for additional patient
education about the calcium channel blocker diltiazem (Cardizem)?

I can take this drug to stop acute anginal attacks.

While assessing a patient with angina who is to start beta-blocker
therapy, the nurse is aware that the presence of which condition may be a problem if these drugs are used?

A 68-year-old man has been taking the nitrate isorbide dinitrate for 2 years for angina. He recently has been experiencing erectile dysfunction and wants a Rx for sildenafil (Viagra). Which response would the nurse most likely hear from the prescriber?

Taking sildenafil with the nitrate may result in severe hypotension, so a contraindication exists.

The nurse is reviewing drug interactions with a male patient who has a Rx for isosorbide dinitrate (Isordil) as tx for angina symptoms. Which substances listed below could potentially result in a drug interaction?

a. a glass of wine.
c. Viagra, an erectile dysfunction drug.
e. Coreg, a beta- blocker.

Which instruction should be included in the discharge teaching for a
patient with a transdermal nitroglycerin patch?

Apply the patch to a nonhairy, nonfatty area of the upper torso or arms. A nitroglycerin patch should be
applied to a nonhairy, nonfatty area for the best and most consistent absorption rates. Sites should be rotated to prevent skin irritation, and the drug should be continued if headache occurs because tolerance will develop. Sublingual nitroglycerin should be used to treat chest pain.

Nitrates relieve angina pain by reducing preload, which is?

blood volume within the heart.

Which are common side effects of nitroglycerin?

B) Flushing.
C) Headache.
D) Hypotension.

Which statement by the patient demonstrates a need for further
education regarding nitroglycerin?

I can take up to three tablets at 5-minute intervals for chest pain. Patients are taught to take up to three
tablets 5 minutes apart. If no relief from chest pain is obtained after three tablets, they should seek medical assistance.

Calcium channel blockers reduce myocardial oxygen demand by
reducing afterload, which is?

pressure against which the heart must pump.

Which nitrate preparation or dosage form has the longest duration of
action?

Transdermal nitroglycerin patch. The transdermal patch has a 24-hour duration of action, compared to
2 to 6 hours for the other choices.

In order to prevent the development of tolerance, the nurse instructs
the patient to perform which action?

Apply the nitroglycerin patch for 14 hours each and remove for 10 hours at night.

Before administering isosorbide mononitrate (Imdur), a priority
assessment would include?

blood pressure. Mononitrate is a vasodilator and thus can cause hypotension. It is important to assess blood pressure before administering.

The patient asks how nitroglycerin should be stored while traveling.
What is the nurse’s best response?

It’s best to keep it in its original container away from heat and light. Although nitroglycerin needs to be kept
in a cool, dry place, it should not be placed in an ice chest where it could freeze. It should also not be locked up and needs to be kept away from light, not in a clear plastic bag.

Patient teaching regarding sublingual nitroglycerin should include which
statement?

Sit or lie down after you take a nitroglycerin tablet to prevent dizziness. Nitroglycerin is a vasodilator and
can cause orthostatic hypotension, resulting in dizziness. It should be kept in a readily accessible location for immediate use should chest pain occur. Three tablets may be taken 5 minutes apart. It should be placed under the tongue and allowed to dissolve.

What is the best way to prevent tolerance to nitrates when using
transdermal patches?

Remove the patch at night for 8 hours, and then apply a new patch in the morning. olerance develops when
the body adapts to continued receptor stimulation by a drug. Giving the patient a nitrate-free period on a daily basis helps prevent this development.

Which statement indicates that the patient understands discharge
teaching about nitroglycerin?

I will need to keep the nitroglycerin stored in the bottle it comes in. Nitroglycerin needs to be stored away
from heat, humidity, and light, all of which can decrease its potency. Keeping it in the brown light-resistant bottle helps achieve this. It should be replaced every 3 to 6 months in order to maintain potency. Nitroglycerin is used every 5 minutes for pain relief or just prior to engaging in activity that is known to cause chest pain.

A patient who is taking sublingual nitroglycerin is complaining of flushing
and headaches. What is the nurse’s best response?

These are the most common side effects of nitroglycerin. They should subside with continued use of
nitroglycerin.

When applying nitroglycerin ointment, the nurse should perform which
action?

Apply the ointment to a nonfatty, nonhairy part of the upper torso. Absorption is best over a nonfatty and
nonhairy portion of skin. The upper torso is the preferred site of application. The nurse should wear gloves when applying to prevent transdermal absorption by the applier. The ointment is measured as one straight line on the nitroglycerin patch and is gently spread over paper and applied, but not rubbed, into the skin. Rubbing would increase absorption and risks of side effects.

When titrating intravenous nitroglycerin, what does the nurse monitor?

A) Blood pressure.
B) Heart rate.
C) Chest pain.
Intravenous nitroglycerin can cause hypotension and tachycardia. Relief of chest pain and/or systolic
blood pressure <90 mm Hg are typical parameters used for titrating nitroglycerin.

A patient receiving intravenous nitroglycerin at 20 mcg/min complains of
dizziness. Nursing assessment reveals a blood pressure of 85/40 mm Hg, heart rate of 110 beats/min, and respiratory rate of 16 breaths/min. What is the nurse’s best action?

Decrease the intravenous nitroglycerin by 10 mcg/min. Nitroglycerin, as a vasodilator, causes a decrease in
blood pressure. Because it is short-acting, decreasing the infusion rate will allow the blood pressure to rise. The patient should be monitored every 10 minutes while changing the rate of the intravenous nitroglycerin infusion.

Nitrates relieve angina pain by reducing afterload, which is?

pressure against which the heart must pump. Afterload is defined as the stress or tension in the ventricular
wall during systole (contraction) as is determined by the pressure that the heart must pump against in the aorta. As a vasodilator, nitroglycerin decreases the pressure in the aorta and thus the resistance against which the heart has to pump.

During patient teaching, the nurse explains that nitroglycerin relieves
chest pain primarily by which action?

Decreasing the workload of the heart. Reducing the workload of the heart decreases oxygen demand,
thus bringing the oxygen supply and demand back into equilibrium.

It is most important to instruct a patient prescribed nitroglycerin to
avoid which substance(s)?

Erectile dysfunction medications. Concurrent administration of erectile dysfunction medications such as
sildenafil citrate (Viagra) can cause an acute exacerbation of nitrate-related hypotension.

When caring for a patient with angina, the nurse would question an
order for a noncardioselective beta-blocker in a patient with coexisting?

bronchial asthma. Noncardioselective beta-blockers should be used with caution in patients with
bronchial asthma since any level of blockade of beta2 receptors can promote bronchoconstriction through unopposed parasympathetic (vagal) tone.

What will the nurse instruct the client to do to prevent the development of tolerance to nitroglycerin?

Which instruction does a nurse provide a patient who is prescribed nitroglycerin patches in order to prevent the development of tolerance to nitrates?

What the nurse should instruct when teaching the patient with angina about taking nitroglycerin tablets?

What would the nurse teach a patient about administration of their nitroglycerin transdermal patch?