Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Beta-blockers are very effective in managing angina. They reduce the workload of the heart and decrease overall myocardial oxygen demand and consumption through antagonism of adrenergic receptors.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
If a patient has been receiving nitrate therapy long term, it should not be abruptly discontinued because of the risk of rebound hypertension and angina. If discontinuation is required, it should be done by tapering the doses.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The common side effects of nitrates include headache, flushing, dizziness, weakness, and orthostatic hypotension. Additionally, since all segments of the vascular system relax in response to nitrates, reflex tachycardia often results.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Prevention of nitrate tolerance is based on a treatment plan that provides for rapid changes in blood nitrate levels over a given time, usually 24 hours. To prevent nitrate tolerance, one 10- to 12-hour nitrate-free interval per day is necessary.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
A drawback to the use of nitrates is the potential for nitrate tolerance. Nitrate tolerance refers to the loss of the ability of the smooth muscles to respond. Tolerance develops to both the peripheral and coronary vasodilator effects.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Nitrate patches should be applied to the torso intact, since cutting a patch destroys the drug delivery system. Care should be taken to ensure that a previously applied patch is removed before applying a new patch.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Transdermal NTG patches may also be used as a long-acting nitrate. Therapy is typically initiated with a 5-mg (0.2 mg/h) or 10-mg (0.4 mg/h) patch, which should be left in place for 12 to 14 hours and then removed to prevent nitrate tolerance.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Transdermal NTG is long-acting and effective for treating and preventing anginal pain. 2% NTG ointment may be applied to the skin as an adjunct to isosorbide therapy for nocturnal pain or used alone for anginal treatment.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The main advantage of rapid-acting nitrates is their ability to halt an episode of angina once it has begun. Generally, the adverse effects of short-acting nitrates are related to their vasodilatory effects.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Patients should be instructed to mark the date they open a bottle of NTG tablets or first use an NTG spray canister. Tablets in an opened glass bottle of NTG retain efficacy for only 1 year and should be discarded after that time period.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Sublingual NTG (Nitrol, Isordil, others) remains the first-line therapy for managing acute angina episodes. NTG may be an adequate treatment for patients who experience angina no more frequently than once a week.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
The sublingual forms of NTG are rapid acting. These medications are used for acute attacks of angina. To be effective, NTG must be administered sublingually to avoid hepatic first-pass metabolism, which would inactivate the medication.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Nitrates do not directly influence the chronotropic or inotropic actions of the heart, so their administration does not affect or alter cardiac function but rather decreases the work of the heart and increases myocardial oxygenation.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Nitrates and their analogs are potent agents and have profound effects on vascular smooth muscle. The nitrates cause dilation throughout the vasculature - in the peripheral arteries and veins as well as the coronary arteries.

Nursing Tip of the Day! - Fundamentals

Category: Fundamentals 
Due to the effects on angiotensin II and aldosterone, ACE inhibitors contribute to potassium retention as sodium is preferentially excreted. This raises the possibility of a hyperkalemia state for the patient and must be monitored routinely.