Transdermal-Pharmacology for Nurses: Practical Applications

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Chapter 23: Anti-anginal drugs Test, Patch, Transdermal, Patient, Severe Chest Pain

The key terms in this Pharmacology course include Anti-Anginal Drugs, Patch, Transdermal, Patient, Drugs, Severe Chest Pain, Nitrates and Nitrite, Assessment, Blood Pressure, Hypotension, Sublingual Nitroglycerin Tablets, Angina, Transdermal Nitroglycerin Therapy, Beta Blocker, Adverse Effect, Transdermal Patch


A patient arrives in the emergency department with severe chest pain. The patient reports that the pain has been occurring off and on for a week now. Which assessment finding would indicate the need for cautious use of nitrates and nitrites?

History of renal disease

Apical pulse rate of 110 beats/min

Blood pressure of 88/62 mm Hg

History of a myocardial infarction 2 years ago

Hypotension is a possible contraindication to the use of nitrates because the medications may cause the blood pressure to decrease. The other options are incorrect.


A 74-year-old professional golfer has chest pain that occurs toward the end of his golfing games. He says the pain usually goes away after one or two sublingual nitroglycerin tablets and rest. What type of angina is he experiencing?

Unstable

Variant

Classic

Prinzmetal

Classic, or chronic stable, angina is triggered by either exertion or stress and usually subsides within 15 minutes with either rest or drug therapy.


What action is often recommended to help reduce tolerance to transdermal nitroglycerin therapy?

Omit a dose once a week.

Cut the patch in half for 1 week until the tolerance subsides.

Remove the patch at bedtime, and then apply a new one in the morning.

Leave the patch on for 2 days at a time.

To prevent tolerance, remove the transdermal patch at night for 8 hours, and apply a new patch in the morning. Transdermal patches must never be cut or left on for 2 days, and doses must not be omitted.


While assessing a patient who is taking a beta blocker for angina, the nurse knows to monitor for which adverse effect?

Dry cough

Hypertension

Bradycardia

Nervousness

Adverse effects of beta blockers include bradycardia, hypotension, dizziness, lethargy, impotence, and several other effects, but not dry cough or nervousness.


A patient with a history of angina will be started on ranolazine (Ranexa). The nurse is reviewing the patient’s history and will note potential contraindications to this drug therapy if which condition is present? (Select all that apply.)

Heart failure

Decreased liver function

Prolonged QT interval on the electrocardiogram

Type 2 diabetes mellitus

Closed-angle glaucoma

Ranolazine is contraindicated in patients with pre-existing QT prolongation or hepatic impairment. The other options are not contraindications.


When applying transdermal nitroglycerin patches, which instruction by the nurse is correct?

“Temporarily remove the patch if you go swimming.”

“Use only the chest area for application sites.”

“Apply the patch to the same site each time.”

“Rotate application sites with each dose.”

Application sites for transdermal nitroglycerin patches need to be rotated. Apply the transdermal patch to any nonhairy area of the body; the old patch should first be removed. The patch may be worn while swimming, but if it does come off, it should be replaced after the old site is cleansed.