NUR 354 EXAM 2 STUDY GUIDE
8 risk factors to prevent heart disease
- Diet
- Exercise
- No smoking
- Managing a healthy weight and BMI
- Good cholesterol
- Good blood sugar
- Good BP
- Getting enough sleep
Angina patho review
- Angina is when oxygen demand exceeds supply in the heart (supply and demand issue)
o Heart cells aren’t getting enough oxygen = overworked and can’t catch up
- Chest pain/discomfort
- Stable angina: chest pain with exertion (predictable)
- Unstable angina: chest pain when resting and exercising (unpredictable)
- #1 intervention for chest pain: rest and relax
Drug class: Nitrate
- Drug example: Nitroglycerin
- MOA: dilates veins, making them bigger, and increasing cardiac circulation and output
o High doses can dilate arteries
- Indications:
o Acute angina
o Heart failure
- SE/AE:
o Headache
o Orthostatic hypotension
o Reflex tachycardia
- Routes:
o Sublingual – acute angina
o Transdermal – for chronic angina/ angina prevention
▪ Wear gloves when giving transdermal patches and cream
▪ Requires vacation due to tolerance build up
o IV – acute angina
- Dosage for acute stable angina (SL); 0.4 mg (400mcg) q5 min PRN, up to 3 doses
o Assess BP before and after
o Educate pt on seeking emergency medical care if there is no relief after 3 doses
- 1st line for stable angina!
, - Contraindications:
o Pts taking sildenafil, vardenafil, tadalafil within 48-72 hrs
o Pts with suspected acute right ventricular myocardial infarction
- Give fluids if pt is experiencing hypotension related to nitroglycerines
Drug class: Beta adrenergic antagonists (beta blockers)
- Drug examples:
o Propranolol – nonselective (B1 and B2)
o Metoprolol
o Labetalol
o Carvedilol – primarily used for heart failure
- MOA: blocks beta receptors, decreases workload of the heart to help angina (blocks beta
1 = lowers inotropic and chronotropic)
- Indications:
o Angina
o HTN
o Heart failure
o AMI
o Dysrhythmias
o Migraine prevention
o Anxiety
- SE/AE:
o Fatigue
o Bradycardia
- Blackbox warning: abrupt discontinuation can cause adverse cardiac effects
- Alternative option for HTN treatment
o Safest option for HTN in pregnancy
- 1st ling agent for angina prevention
- Assess HR and BP prior to administration
Ranolazine
- MOA: unknown – decreases oxygen demand
- Indication: angina prevention
- SE/AE: QT prolongation
Acute coronary syndrome
- An umbrella term: includes MI and angina
8 risk factors to prevent heart disease
- Diet
- Exercise
- No smoking
- Managing a healthy weight and BMI
- Good cholesterol
- Good blood sugar
- Good BP
- Getting enough sleep
Angina patho review
- Angina is when oxygen demand exceeds supply in the heart (supply and demand issue)
o Heart cells aren’t getting enough oxygen = overworked and can’t catch up
- Chest pain/discomfort
- Stable angina: chest pain with exertion (predictable)
- Unstable angina: chest pain when resting and exercising (unpredictable)
- #1 intervention for chest pain: rest and relax
Drug class: Nitrate
- Drug example: Nitroglycerin
- MOA: dilates veins, making them bigger, and increasing cardiac circulation and output
o High doses can dilate arteries
- Indications:
o Acute angina
o Heart failure
- SE/AE:
o Headache
o Orthostatic hypotension
o Reflex tachycardia
- Routes:
o Sublingual – acute angina
o Transdermal – for chronic angina/ angina prevention
▪ Wear gloves when giving transdermal patches and cream
▪ Requires vacation due to tolerance build up
o IV – acute angina
- Dosage for acute stable angina (SL); 0.4 mg (400mcg) q5 min PRN, up to 3 doses
o Assess BP before and after
o Educate pt on seeking emergency medical care if there is no relief after 3 doses
- 1st line for stable angina!
, - Contraindications:
o Pts taking sildenafil, vardenafil, tadalafil within 48-72 hrs
o Pts with suspected acute right ventricular myocardial infarction
- Give fluids if pt is experiencing hypotension related to nitroglycerines
Drug class: Beta adrenergic antagonists (beta blockers)
- Drug examples:
o Propranolol – nonselective (B1 and B2)
o Metoprolol
o Labetalol
o Carvedilol – primarily used for heart failure
- MOA: blocks beta receptors, decreases workload of the heart to help angina (blocks beta
1 = lowers inotropic and chronotropic)
- Indications:
o Angina
o HTN
o Heart failure
o AMI
o Dysrhythmias
o Migraine prevention
o Anxiety
- SE/AE:
o Fatigue
o Bradycardia
- Blackbox warning: abrupt discontinuation can cause adverse cardiac effects
- Alternative option for HTN treatment
o Safest option for HTN in pregnancy
- 1st ling agent for angina prevention
- Assess HR and BP prior to administration
Ranolazine
- MOA: unknown – decreases oxygen demand
- Indication: angina prevention
- SE/AE: QT prolongation
Acute coronary syndrome
- An umbrella term: includes MI and angina
