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20 Cards in this Set
- Front
- Back
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organic nitrates
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proto: nitroglycerin
oral extended release capsules: Nitro-time sublingual tablet- Nitrostat translingual spray- nitrolingual topical ointment- Nitrobid transderm patch- Nitro-Dur intravenous- Nitro-Bid IV other meds: sublingual: Isosorbide dinitrate ( Isordil) oral: Isosorbide mononitrate (Imdur) |
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organic nitrate MOA
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in chronic stable exertional angina, nitroglycerin (NTG) dilates veins and decreases venous return (preload), which decreases cardiac oxygen demand
in variant angina- nitroglycerin prevents or reduces cornoary artery spasm, thus increasing oxygen supply |
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organic nitrate use
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treatment of acute angina attack
prophylaxis of chronic stable angina or variant angina |
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organic nitrate adverse
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headache
orthostatic hypotension reflex tachycardia- administer a beta-blocker such as metroprolol (Lopressor) if symptoms occur tolerance |
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organic nitrate contraindications
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pregnancy risk C
hypersensitivity to nitrates nitroglycerin is contraindicated in clients with traumatic head injury because the med can increase intracranial pressure use cautiously in clients taking antihypertensive meds and clients who have renal or liver dysfunction |
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organic nitrate interactions
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use of alcohol can contribute to hypotensive effect of nitroglycerin
antihypertensive meds such as beta-blockers, calcium channel blockers, and diuretics can contribute to hypotensive effect use of PDES inhibtors (sildenafil, Viagra) tadalafil (Cialis), vardenafil (Levitra) and nitroglycerin can result in life-threatening hypotension |
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sublingual tablet and translingual spray
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types: rapid onset, short duration
Use: treat acute attack, prophylaxis of acute attack interventions: rapid acting nitrate at the first sign of chest pain- do not wait until pain is severe use prior to activity that is known to cause chest pain for sublingual tablet- place tablet under tongue and allow it to dissolve tablets should be stored in a cool dark place translingual spray should be sprayed against oral mucosa and not inhaled |
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sustained release oral capsules
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types: slow onset, long duration
use: long-term prophylaxis against anginal attacks interventions: swallow capsules without crushing or chewing take capsules on an empty stomach with at least 8 oz of water |
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transdermal
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slow onset
long duration use: long term prophylaxis against anginal attacks interventions: patches should not be cut to ensure appropriate dose patch should be placed on hairless area of skin and roate sites to prevent skin irritation remove patch at night to reduce risk of developing tolerance to nitroglycerin |
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topical ointments
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slow onset, long duration
use: long term prophylaxis against anginal attacks interventions: avoid touching ointment with hands |
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intravenous
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control of angina not responding to other meds
control of BP or induced hypotension during surgery heart failure resulting from MI administer with IV tubing supplied by manufacturer using a glass IV bottle administer continuously due to short duration of action start at slow rate, usually 5 mcg/min and titrate gradually until desired response is achieved |
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med effectiveness
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prevention of acute anginal attacks
long-term management of stable angina control of perioperative BP control of heart failure following acute MI |
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antianginal agents
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proto: ranolazine (Ranexa)
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antianginal MOA
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lowers cardiac oxygen demand and thereby improves exercise tolerance and decreases pain
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antianginal USe
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chronic stable angina in combination with amlodipine (Norvasc) a beta adrenergic blocker or an organic nitrate
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antianginal adverse
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QT prolongation
elevated BP |
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antianginal contraindications
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pregnancy risk category C
ranolazine is contraindicated in clients who have prolonged QT liver dysfunction older adult clients |
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antianginal interactions
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inibitors of CYP3A4 can increase levels of ranolazine that lead to torsades de pointes
agents include grapefruit juice, HIV protease inhibitors, macrolide antibiotics, azole fungals, and verapamil quinidine and sotalol (Betapace) can further prolong QT interval concurrent use of digoxin ( Lanoxin) and simvastin (Zocor) increases serum levels of digoxin and simvastin |
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antianginal admin
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may be taken concurrently with other antianginal meds such as nitroglycerin
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antianginal med effectiveness
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prevention of acute anginal attacks
long-term management of stable angina |
