1. What is your understanding of the above situation?

The client had an MI due to the exertion from walking up the flight of stairs at her
job. She normally would have had NTG to take on the onset of angina. After being
observed was sent home with medications to prevent further damage or another MI.
4. Explain the two predominant types of angina.
Stable Angina: which is relieved by nitroglycerin and rest
Unstable Angina: which is not relieved by nitroglycerin or rest.
5. Discuss common nursing diagnoses for clients with angina pectoris.
Decreased cardiac output related to poor myocardial perfusion
Anxiety related to perceived threat of death
Activity intolerance related to lack of oxygen due to poor blood perfusion to heart
and lungs.
8. What are the purposes for the prescribed medications?
Nitroglycerin relief or prevention of anginal attacks.
Propranolol prevention of MI
Nifedipine management of angina pectoris
Clopidogrel reduction of atherosclerotic
9. What are the most common adverse reactions of the prescribed medications?
Headache, nervousness, bleeding, dizziness, weakness, blurred vision, hypotension.
10. Discuss the drug-to-drug and drug-to-food/herbal interactions for the prescribed
medications.
Nitroglycerin: Concurrent use of sildenafil, tadalafil, or vardenafil may result in
severe hypotension (do not use within 24 hr of isosorbide dinitrate or mononitrate);
concurrent use contraindicated. Concurrent use of riociguat may result in severe
hypotension; concurrent use contraindicated. Additive hypotension with
antihypertensives, acute ingestion of alcohol, beta blockers, calcium channel
blockers, haloperidol, or phenothiazines .
Propranolol: General anesthesia, IV phenytoin, and verapamil may cause additive
myocardial depression. Additive bradycardia may occur with digoxin. Additive
hypotension may occur with other antihypertensives, acute ingestion of alcohol, or
nitrates. Levels may be with chronic alcohol use. Concurrent use with
amphetamines, cocaine, ephedrine, epinephrine, norepinephrine, phenylephrine, or
pseudoephedrine may result in unopposed alpha-adrenergic stimulation (excessive
hypertension, bradycardia).
Nifedipine: Rifampin, rifabutin, phenobarbital, phenytoin, or carbamazepine may
significantly levels and effects; concurrent use is contraindicated. Ketoconazole,

fluconazole, itraconazole, clarithromycin, erythromycin, nefazodone, saquinavir,

indinavir, nelfinavir, or ritonavir may levels and effects; consider initiating
nifedipine at lowest dose. Additive hypotension may occur when used concurrently
with fentanyl, other antihypertensives, nitrates, acute ingestion of alcohol, or
quinidine .
Clopidogrel Bisulfate: Concurrent abciximab, eptifibatide, tirofiban, aspirin,
NSAIDs, heparin, LMWHs, thrombolytic agents, SSRIs, SNRIs, prasugrel, or warfarin
may risk of bleeding. May metabolism and effects of phenytoin, tolbutamide,
tamoxifen, torsemide, fluvastatin, and many NSAIDs .

11. Discuss client education for unstable angina and aortic stenosis.
Proper diet
Monitoring of vital signs
Do not ingest alcohol while taking nitroglycerin
Suggest Tylenol to relieve headaches as a side effect of antianginal medications
Lay in supine position with legs elevated if hypotension results from SL nitroglycerin
Continue use of medication even if feeling well