Coronary Artery Disease by

alayman71 — 2016-10-01 20:10:20 UTC

alayman71 — 2016-10-01 20:16:04 UTC

Nitrates/Antianginal

alayman71 — 2016-10-03 14:50:43 UTC

Fibrates/Lipid lowering agents

Case Study

alayman71 — 2016-10-03 14:53:04 UTC

alayman71 — 2016-10-03 14:54:02 UTC

NCLEX questions

alayman71 — 2016-10-03 14:54:26 UTC

NCLEX Answers

Patient teaching

alayman71 — 2016-10-03 15:48:03 UTC

nitroglycerin, isosorbide:

ADMINISTRATION

Teach patient how to use for angina attacks:

-Stop activity. Sit or lie down.
-Immediately put one SL tablet or translingual spray under the tongue, let dissolve.
-Rest for 5 minutes.
-If pain not relieved by FIRST tablet, call 911, then take a second tablet.
-Rest for 5 minutes.
-Take a third tablet if pain is still not relieved. DO NOT TAKE MORE THAN 3 TABLETS.

SAFETY

-Will absorb onto skin. Do not spray in direction of another person, do not inhale airborne medication if you are not the intended recipient (headache and/or hypotension may result).
-Contraindicated if PDE5 inhibitors have been taken within the last 48 hours. Can result in life-threatening hypotension (sildenafil, tadalafil, vardenafil). These drugs are vasodilators used to treat erectile dysfunction, and hypertension (tadalafil only).

STORAGE

-Breaks down rapidly with light, heat, oxygen, time and exposure to plastic.
-Store tablets in original bottles, in a cool, dark place.
-SL tablets begin to deteriorate/break down after bottle is opened. Tablets may be ineffective if no relief is provided, OR if no side effects are experienced such as headache, burning sensation under the tongue, or bitter taste in mouth.
-Replace every 6 months, once bottle is opened.

Expected Pharmacological Action

alayman71 — 2016-10-03 17:19:14 UTC

Nitrates

-Increase coronary blood flow dilating coronary arteries and improving collateral flow to ischemic regions
-Vasodilation (venous greater than arterial)
-Reduces myocardial oxygen consumption
-In vasospastic angina, reduces coronary artery spasm

Fibrates

-Decreases triglyceride levels
-increase in HDL levels

Antilipemics

-Decrease manufacture of LDH and VLDL cholesterol
-Increase manufacture of HDL
-Promotion of vasodilation, and decrease in plaque site inflammation, thromboembolism, and risk of atrial fibrillation.

alayman71 — 2016-10-03 20:15:49 UTC

alayman71 — 2016-10-03 22:10:30 UTC

PCSK9 inhibitors

alayman71 — 2016-10-03 22:37:04 UTC

American Heart Association EBP Journal article: Managing Your Angina Symptoms with Nitroglycerin.

Nursing Measures

alayman71 — 2016-10-03 22:39:38 UTC

Nitrates
-Assess vitals - prior to first dose and in between each dose (heart rate and BP important, BP will decrease. Hold nitro if systolic pressure <90-100mm Hg.)
-Assess PQRST, note any changes in between each dose (severity level, 1-10 numeric pain scale).
-Obtain baseline EKG
-Follow appropriate instructions for each administration
-Provide patient education

Fibrates
-Obtain baseline liver function tests
-Obtain baseline PT and INR, and monitor periodically

Antilipemics
-Administer statins via oral route
-Adminsiter lovastatin with evening meal. Other statins can be taken without food, but evening dosage is best.
-Atorvastatin or fluvastatin should be used in clients who have impaired kidney function. For other statins, dosage will be reduced.

alayman71 — 2016-10-04 22:45:37 UTC

Statins, Antilipemic

alayman71 — 2016-10-04 23:10:23 UTC

References

Patient teaching: Nitroglycerin translingual administration

alayman71 — 2016-10-12 00:21:19 UTC