antianginal – a. 抗心绞痛的
nitroglycerin – n. 硝酸甘油
precipitate – v. 助长，加速
nonpharmacological – a. 非药理学的
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Antianginal Agents For Adults 成人抗心绞痛药
Adults 成人
Adults who receive these drugs should be instructed in their proper administration, particularly if varying forms of nitroglycerin are used. Patients should also be encouraged to determine what activities or situations tend to precipitate an angina attack so that they can take measures to avoid those circumstances or take an antianginal agent before the event occurs.
With nitroglycerin use, it is important that the patient knows how to use the drug, how to store the drug, how to determine whether it is still effective, and how much to take before seeking emergency medical care.
Patients should know that regular medical follow-up is important and should be instructed in nonpharmacological measures—weight loss, smoking cessation, activity changes, diet changes—that could decrease their risk of CAD and improve the effectiveness of the antianginal therapy.
The safety for the use of these drugs during pregnancy has not been established. There is a significant potential for adverse effects on the fetus related to blood flow changes and direct drug effects when the drugs cross the placenta. The drugs do enter breast milk, and it is advised that another method of feeding the baby be used if one of these drugs is prescribed during lactation.
Older adults frequently are prescribed one of these drugs. Older adults are more likely to develop adverse effects associated with the use of these drugs—arrhythmias, hypotension, and heart disease. Safety measures may be needed if these effects occur and interfere with the patient’s mobility and balance.
Older adults are also more likely to have renal and/or hepatic impairment related to underlying medical conditions, which could interfere with the metabolism and excretion of these drugs. The dose for older adults should be started at a lower level than that recommended for younger adults. The patient should be monitored very closely and dose adjusted based on patient response.
If other drugs are added to or removed from the drug regimen, appropriate dose adjustments may need to be made. If the patient is using a different form of nitroglycerin, special care should be taken to make sure that the proper administration, storage, and timing of use are understood.
1. A patient reports having crushing chest pain that radiates to the jaw. You administer sublingual nitroglycerin and obtain a 12 lead EKG. Which of the following EKG findings confirms your suspicion of a possible myocardial infraction?
A. absent Q wave
B. QRS widening
C. absent P-wave
D. ST segment elevation 2. A patient is receiving treatment for stable coronary artery disease. The doctor prescribes the patient Plavix. What important information will you include in the patient's teaching? Select-all-that-apply.
A. If you are scheduled for any planned surgical procedures, let your doctor know you are taking Plavix because this medication will need to be discontinued 5-7 days prior to the procedure.
B. A normal side effect of this medication is a dry cough.
C. Avoid green leafy vegetables while taking Plavix.
D. Notify the doctor, immediately, if you develop bruising, problems urinating, or fever.
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答案 Answer
1. D. Rationale: This is a common finding on an EKG when a patient is having a myocardial infraction due to muscle damage. 2. A and D. Rationale: Patients on Plavix should let their doctor know that they are taking Plavix because it should be discontinued 5 to 7 days before a surgical procedure due to increased risk of bleeding. Also, option D represents signs and symptoms of Thrombotic Thrombocytopenic Purpura a clotting disorder where clots form in the vessels of the body which is a complication of Plavix.
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