Author Question: A patient who takes nitroglycerin for stable angina pectoris develops hypertension. The primary care ... (Read 34 times)

panfilo · **on:** Jul 24, 2018

A patient who takes nitroglycerin for stable angina pectoris develops hypertension. The primary care NP should contact the patient's cardiologist to discuss adding:

a. amlodipine (Norvasc).
b. diltiazem (Cardizem).
c. verapamil HCl (Calan).
d. nifedipine (Procardia XL).

Question 2

A patient who has stable angina pectoris and a history of previous myocardial infarction takes nitroglycerin and verapamil. The patient asks the primary care nurse practitioner (NP) why it is necessary to take verapamil.

The NP should tell the patient that verapamil: a. improves blood flow and oxygen delivery to the heart.
b. increases the rate of contraction of the cardiac muscle.
c. increases the force of contraction of the cardiac muscle.
d. has a positive inotropic effect to increase cardiac output.

mceravolo · **Reply #1 on:** Jul 24, 2018

Answer to Question 1

D
Nifedipine and related drugs are potent vasodilators, which makes them more effective for hypertension than verapamil and diltiazem. Amlodipine is not a first-line drug.

Answer to Question 2

A
Verapamil decreases the force of smooth muscle contraction in the smooth muscle of the coronary and peripheral vessels; this results in coronary artery dilation, which lowers coronary resistance and improves blood flow through collateral vessels as well as oxygen delivery to ischemic areas of the heart. Calcium channel blockers do not increase the rate or force of contraction of the heart.