NURSsr323srSectionsr7
srQuizsr2srBlueprintsr
Angina
Treatmentsrforsrchestsrpainsrandsrspasm 2srquestions
● 3srtypessrofsrangina/C
P
○ Stablesr angina
■ Triggeredsrbysrincreasesrinsrphysicalsractivity,sremotionalsrexcite
ment,srlargesrmeals,srcoldsrexposure
● Ifsryousrsitsrdownsrandsrrest,srthissrresolves
■ Underlyings r causes r →s r CAD
■ Goal:srreducesrintensitysrandsrfrequencysrofsranginasrattacks
● Increasesroxygensrsupply
● Decreasesrdemand
■ Treatment
● BetasrBlockers
○ Firstsrlinesrforsrstablesrangina
■ Notsreffectivesragainstsrvasospasticsrangina
○ Preventssrstimulationsrofsrthesrbetasrreceptorssrofsrthesrheart
■ SlowssrHR,srdepressessrAVsrconduction,srd
ecreasessrCO,srreducessrBP.
○ Unstablesr angina
■ Chestsrpainsrthatsrdoessrnotsrresolvesrwithsrrest
■ ThissrissrasrMEDICALsrEMERGENCY
● AMBULANCEsrTOsrER
■ ResultsrofsrCADsrcomplicatedsrbysrcoronarysrspasm,srplateletsraggregation
,srthrombi
■ Treatment
● Maintainsroxygensrsupply
● Decreasesr oxygensr demand
● MONAsr→srslowssrdownsrprogressionsrofsrCADsrorsrtr
eatssrcomplicationssrthatsrarisesrw/srunstablesrangina/
MI
○ Morphine
, ○ Oxygen
○ Nitroglycerin
○ Aspirinsr→srchewsrandsrswallow,sranti-
plateletsrtosrpreventsrclots
○ Prinzmetal’ssr(variant)srangina
■ Painsrissrproducedsranytimesrevensratsrrestsrorsrinsrsleep
■ Causedsrbysrcoronarysrarterysrspasmsrthatsrrestrictssrbloodsrflowsrtosrheart
■ Goal:srreducesrincidencesrandsrfrequencysrofsranginasrattacks
● Increasesroxygensrsupply
● Treatsrwithsrcalciumsrchannelsrblockers
○ Thesesrrelaxsrcoronarysrspasm
Teachingsrfor:srNitratesrtherapy,srNitrosrpatch,srNitrosrpaste 4srquestions
● Nitrates
○ Prototypesragent:srnitroglycerin
,○ Relaxessrvascularsrsmoothsrmuscle,srimprovessroxygenation
○ Decreasessr myocardialsr oxygensr consumption
○ Redistributessrbloodsrflowsrinsrthesrheart,srimprovingsrcirculationsrtosrischemicsrarea
s
○ Dilatessrbothsrarterialsrandsrvenoussrvessels:
■ Venoussr dilations r →s r decreasess r peripherals r resistance,s r thuss r decre
asings r BP
■ Arteriolarsrdilationsr→srreducessrsystemicsrvascularsrresista
ncesrandsrarterials r pressure,srthussrdecreasingsrBP
○ Tolerancesrtosrthesrvascularsrandsrantianginalsreffectssrmaysrdevelop
■ Minimizesr by:
● Startingsrwithsrassrsmallsrasrdosesrassrpossible
● RemovingsrNTGsr(pastesrorsrpatches)srfromsrthesrpatie
ntsrforsr8-10srhours,srusuallysratsrnight
○ Wearsrglovessrorsrelsesryou’llsrgetsrasrheadachesrd/tsrthesrvasodi
lation
○ Can’tsrleavesronsrforsr24srhours
○ Uses:
■ Acutesrangina
● Sublingualsrtabletssrorsrpowder
○ ShouldsrNOTsrswallowsrnitroglycerinsrtablets
● Translingualsrspray
■ Chronicsrrecurrentsrangina
● TopicalsrNTGsrpaste
● Transdermalsr NTGs r patch
● Transmucosalsrorsroralsrsustained-release
■ Significantsrhypertension
● AdministersrIVsrcontinuoussrinfusion
● MonitorsrHRsrandsrBPsrcontinuously
○ Nursingsrresponsibilities
■ Assesssrthesrpatient’ssrBPsrandsrpulsesrpriorsr tosradministration
■ Acutesrcaresr→srIVsraccesssrestablished
■ HavesrthesrpatientsrsitsrorsrliesrdownsrbeforesrtakingsrNTGsrforsracutesrpain
■ Repeatsrsublingualsrnitroglycerinsreverysr5srminutessrforsrupsrtosr3srdoses
● Callsr911srifsrnosrreliefsraftersrfirstsrdose,srcouldsrbesrmyocardialsrinfarc
tion
■ Monitorsrforsrhypotensionsrandsrreflexsrtachycardia
■ Commons r adverses r effects r →s r headache
○ Precautions/storage
■ Losessrpotencysrw/srexposuresrtosrlight,srhumiditysrandsrheat
, ● Storesratsrroomsrtemperaturesrinsrasrdrysrplacesrawaysrfromsrthesrsun
■ PlasticsrIVsrbagssrofsrfluid
● Nosrpolyvinylsrchloridesrtubing
■ Goodsrchemicalsrstabilitysruntilsrexpirationsrdatesronsrbottlesrifsrstoredsrappro
priately
■ Sublingualsrnitroglycerinsrrequiressrreplacementsreverysr3srmonthssr(shelfsr
life)
■ Drugsrinteractionssr→srviagrasrwithinsr24srhourssror
srcialissrwithinsr3srdays
● Phosphodiesterasesrtypesr5srinhibitorssr(medssrforsrED)
○ Sildenafilsr(viagra)
○ Tadalafilsr(cialis)
● Causessrasrfatalsrdropsrinsrbloodsrpressuresrd/tsrvasodilation
● AsksrBOTHsrmensrandsrwomensraboutsrthissr→srwom
ensralsosrtakesrthissrforsrsimilarsrusessrassrmen
srQuizsr2srBlueprintsr
Angina
Treatmentsrforsrchestsrpainsrandsrspasm 2srquestions
● 3srtypessrofsrangina/C
P
○ Stablesr angina
■ Triggeredsrbysrincreasesrinsrphysicalsractivity,sremotionalsrexcite
ment,srlargesrmeals,srcoldsrexposure
● Ifsryousrsitsrdownsrandsrrest,srthissrresolves
■ Underlyings r causes r →s r CAD
■ Goal:srreducesrintensitysrandsrfrequencysrofsranginasrattacks
● Increasesroxygensrsupply
● Decreasesrdemand
■ Treatment
● BetasrBlockers
○ Firstsrlinesrforsrstablesrangina
■ Notsreffectivesragainstsrvasospasticsrangina
○ Preventssrstimulationsrofsrthesrbetasrreceptorssrofsrthesrheart
■ SlowssrHR,srdepressessrAVsrconduction,srd
ecreasessrCO,srreducessrBP.
○ Unstablesr angina
■ Chestsrpainsrthatsrdoessrnotsrresolvesrwithsrrest
■ ThissrissrasrMEDICALsrEMERGENCY
● AMBULANCEsrTOsrER
■ ResultsrofsrCADsrcomplicatedsrbysrcoronarysrspasm,srplateletsraggregation
,srthrombi
■ Treatment
● Maintainsroxygensrsupply
● Decreasesr oxygensr demand
● MONAsr→srslowssrdownsrprogressionsrofsrCADsrorsrtr
eatssrcomplicationssrthatsrarisesrw/srunstablesrangina/
MI
○ Morphine
, ○ Oxygen
○ Nitroglycerin
○ Aspirinsr→srchewsrandsrswallow,sranti-
plateletsrtosrpreventsrclots
○ Prinzmetal’ssr(variant)srangina
■ Painsrissrproducedsranytimesrevensratsrrestsrorsrinsrsleep
■ Causedsrbysrcoronarysrarterysrspasmsrthatsrrestrictssrbloodsrflowsrtosrheart
■ Goal:srreducesrincidencesrandsrfrequencysrofsranginasrattacks
● Increasesroxygensrsupply
● Treatsrwithsrcalciumsrchannelsrblockers
○ Thesesrrelaxsrcoronarysrspasm
Teachingsrfor:srNitratesrtherapy,srNitrosrpatch,srNitrosrpaste 4srquestions
● Nitrates
○ Prototypesragent:srnitroglycerin
,○ Relaxessrvascularsrsmoothsrmuscle,srimprovessroxygenation
○ Decreasessr myocardialsr oxygensr consumption
○ Redistributessrbloodsrflowsrinsrthesrheart,srimprovingsrcirculationsrtosrischemicsrarea
s
○ Dilatessrbothsrarterialsrandsrvenoussrvessels:
■ Venoussr dilations r →s r decreasess r peripherals r resistance,s r thuss r decre
asings r BP
■ Arteriolarsrdilationsr→srreducessrsystemicsrvascularsrresista
ncesrandsrarterials r pressure,srthussrdecreasingsrBP
○ Tolerancesrtosrthesrvascularsrandsrantianginalsreffectssrmaysrdevelop
■ Minimizesr by:
● Startingsrwithsrassrsmallsrasrdosesrassrpossible
● RemovingsrNTGsr(pastesrorsrpatches)srfromsrthesrpatie
ntsrforsr8-10srhours,srusuallysratsrnight
○ Wearsrglovessrorsrelsesryou’llsrgetsrasrheadachesrd/tsrthesrvasodi
lation
○ Can’tsrleavesronsrforsr24srhours
○ Uses:
■ Acutesrangina
● Sublingualsrtabletssrorsrpowder
○ ShouldsrNOTsrswallowsrnitroglycerinsrtablets
● Translingualsrspray
■ Chronicsrrecurrentsrangina
● TopicalsrNTGsrpaste
● Transdermalsr NTGs r patch
● Transmucosalsrorsroralsrsustained-release
■ Significantsrhypertension
● AdministersrIVsrcontinuoussrinfusion
● MonitorsrHRsrandsrBPsrcontinuously
○ Nursingsrresponsibilities
■ Assesssrthesrpatient’ssrBPsrandsrpulsesrpriorsr tosradministration
■ Acutesrcaresr→srIVsraccesssrestablished
■ HavesrthesrpatientsrsitsrorsrliesrdownsrbeforesrtakingsrNTGsrforsracutesrpain
■ Repeatsrsublingualsrnitroglycerinsreverysr5srminutessrforsrupsrtosr3srdoses
● Callsr911srifsrnosrreliefsraftersrfirstsrdose,srcouldsrbesrmyocardialsrinfarc
tion
■ Monitorsrforsrhypotensionsrandsrreflexsrtachycardia
■ Commons r adverses r effects r →s r headache
○ Precautions/storage
■ Losessrpotencysrw/srexposuresrtosrlight,srhumiditysrandsrheat
, ● Storesratsrroomsrtemperaturesrinsrasrdrysrplacesrawaysrfromsrthesrsun
■ PlasticsrIVsrbagssrofsrfluid
● Nosrpolyvinylsrchloridesrtubing
■ Goodsrchemicalsrstabilitysruntilsrexpirationsrdatesronsrbottlesrifsrstoredsrappro
priately
■ Sublingualsrnitroglycerinsrrequiressrreplacementsreverysr3srmonthssr(shelfsr
life)
■ Drugsrinteractionssr→srviagrasrwithinsr24srhourssror
srcialissrwithinsr3srdays
● Phosphodiesterasesrtypesr5srinhibitorssr(medssrforsrED)
○ Sildenafilsr(viagra)
○ Tadalafilsr(cialis)
● Causessrasrfatalsrdropsrinsrbloodsrpressuresrd/tsrvasodilation
● AsksrBOTHsrmensrandsrwomensraboutsrthissr→srwom
ensralsosrtakesrthissrforsrsimilarsrusessrassrmen
