vasodilator – n. 血管扩张药
antianginal – n. 抗咽峡炎药
cyanide – n. 氰化物
thiocyanate – n. 硫氰酸盐
nitroglycerin – n. 硝酸甘油
isosorbide – n. 异山梨醇
mononitrate – n. 单硝酸酯
dinitrate – n. 二硝基盐
isosorbide mononitrate – 单硝酸异山梨酯
isosorbide dinitrate –硝酸异山梨酯
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Vasodilators and Antianginals
In this video, we are going to talk about some important vasodilators. If you are following along with cards, I am on card number 19 [in the Pharmacology Flashcards], which talks about nitroprusside, which is a vasodilator that is used for a hypertensive crisis.
The mode of action of this medication is that it causes direct vasodilation of arteries and veins, so it brings that blood pressure down very quickly. It reduces both preload and after load. So this medication, like I said, it brings the blood pressure down very rapidly, so hypotension is going to be a very important side effect for you to know.
In fact, this particular medication does carry a black box warning because it causes a dangerous drop in blood pressure. So that's definitely a key side effect.
A couple of other key side effects to keep in mind are cyanide toxicity as well thiocyanate toxicity. So those aren't side effects that you see every day. And in fact, I don't know another medication that has those. So those are unique side effects that I would remember with nitroprusside.
Other side effects can include dizziness as well as GI upset.
So we have one of our level of crew members who provided a great tip for remembering this drug. So nitroprusside may "pruss" you into the ground (or press you into the ground) when your blood pressure rapidly decreases.
So if your patient is getting nitroprusside and gets "prussed" into the ground, then has severe hypotension, then you'll want to take some interventions based on your facility policy. This can include raising the patient's legs, decreasing the dose of nitroprusside, and increasing fluids. But again, you'll need to refer to your facility policy for those interventions.
Now let's talk about medications that are used to treat angina. The important medications that I would be familiar with include nitroglycerin as well as isosorbide mononitrate and isosorbide dinitrate.
So these medications work to treat angina through vasodilation. So they decrease the preload, and they also decrease myocardial oxygen demand.
The side effects of these antianginal medications are very important to know. They include orthostatic hypotension as well as a headache and possible reflex tachycardia.
So the way that I remember these isosorbide medications cause a headache, is I think about eating some icy sorbet, which kind of looks like isosorbide. And when you eat an icy sorbet, it might give you a headache because it's so cold. And that helps me to remember that isosorbide medications also can give you a headache as a side effect.
So, if your patient has sublingual nitroglycerin, then they need to keep this stored in a cool dark place. If they have chest pain, they can take up to three tablets, right? So they would place one under the tongue, wait five minutes. If they are still having chest pain, they need to call 911, and then put a second one under the tongue, wait five minutes, and then if there's still no relief, they can take a third, but no more than three.
And then, if you are giving nitroglycerin topically, you want to make sure you're wearing gloves so that you're not absorbing the medication in your hands.
And just in general, wear your gloves as soon as you walk in the patient's room. It's just best practice.
And then, you want to remove the prior dose. So often, we apply this nitroglycerin on the patient's chest. So you want to make sure you remove the prior dose. You want to make sure you're rotating sites and you want to choose a clean, hairless area to place the new dose. Right? So if the patient has a bunch of hair and you stick it on top of the hair, it's not going to get absorbed. So you want to make sure you choose a hairless area.
In my next video, we will get into antidysrhythmic medications. If our free videos have helped you, be sure to like this video and subscribe to us here at Level Up RN!
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Vasodilators and Antianginals
—————TESTS—————
1. A patient is prescribed Diltiazem for the treatment of a cardiac disorder. Which findings below would require the nurse to hold the ordered dose of Diltiazem and notify the physician for further orders? Select all that apply.
A. Blood pressure 198/102
B. EKG shows 3rd Degree Atrioventricular Block
C. EKG shows Atrial Fibrillation with Rapid Ventricular Response
D. Heart Rate 46 beats per minute
2. Which calcium channel blockers below are known as the dihydropyridines and are known to be more vascular selective? Select all that apply.
A. Verapamil
B. Felodipine
C. Nifedipine
D. Diltiazem
E. Amlodipine
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答案Answers 1. B and D. Rationale: Diltiazem is a calcium channel blocker that helps treat arrhythmias (supraventricular tachycardia and atrial fibrillation), hypertension, and angina. It is contraindicated if bradycardia or 2nd/3rd AV blocks occur. This is because this medication decreases the function of the SA and AV nodes (which is advantageous if a-fib with rapid ventricular response is occurring). However, if a 2nd degree AV block is presenting or bradycardia, the SA and AV nodes are not working properly and this medication could further impede their function. 2. B, C, and E. Rationale: Remember the “dipine” medications are known as the dihydropyridines, and they are more vascular selective. This is why they are great at treating hypertension because they cause vasodilation due to inhibiting the calcium channels in the vascular smooth muscle. This leads to the relaxation of these vessels and in turn decreases arterial blood pressure.
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