Angina

Question 1

Glyceryl Trinitrate

Answer 1

A) Nitrate

B)

1. Stable ANGINA (prev. and tx.)
2. Heart FAILURE (assoc. acute MI)
3. Unstable ANGINA (IV)
4. Acute Pulmonary Oedema (IV)

C)
TAB:
300-600 mcg (0.5-1 tab) every 3-4mins until max
Max 2 or 3 tablets

SPRAY:
400-800 mcg (1-2 sprays); repeat after 5 mins once
Max 3 sprays

PATCH:
5 - 15 mg / 24 hrs ONCE daily (for 14hrs)

D)
1. NITRATE-FREE period (10-12hrs)
2. Blood PRESSURE (hypotension)
3. Compliance
4. EXPIRY date
No renal or hepatic

E)
Labels: 16
*PATCH:
#Apply to clean, dry skin on the CHEST AREA or UPPER ARM
#DISPOSE safely

*TABS:
#SIT or LIE down (may cause dizziness)
#Call AMBULANCE if symptoms get severe or worse quickly or last 10 mins
#UNDER TONGUE; do not swallow
#STORAGE; write date on bottle

*SPRAY:
#SIT or LIE down (may cause dizziness)
#Call AMBULANCE if symptoms get severe or worse quickly or last 10 mins
#PRIME spray before use: 1st time (5x), 7day unused (1x), >4months (5x)
#Spray UNDER TONGUE; do not inhale

S/E
Headache, Flushing, Palpitations, Fainting

Question 2

Isosorbide Dinitrate
(sublin. 5mg - Isosordil)
(tablet 10 mg - Sorbidin)

Answer 2

A) Nitrate

B)

1. ANGINA (prev. and tx.)
2. HEART FAILURE

C)

sublin: 5-10 mg every 2hrs PRN
tablet: 10-40 mg TDS or QID (max160)

D)
1. NITRATE-FREE interval (10-12 hrs)
2. Blood PRESSURE (orthostatic hypotension)
3. Clinical effect
no renal or hepatic

E)
Labels: 16
ISOSORDIL:
#Use during episodes of ANGINA or BEFORE an activity expected to bring on angina
#SIT or LIE down before use as the drug may cause DIZZINESS
#Place tablet UNDER TONGUE; spit pit out what is left to avoid headaches
#Call an AMBULANCE is symptoms get worse or last for 10 mins
S/E:
*Headache, Flushing, Palpitations, Fainting

Question 3

Isosorbide Mononitrate

Monodur OR IMDUR or DURIDE

Answer 3

A) Nitrate

B)
1. PREVENTION of ANGINA

C)
30 - 120 mg ONCE daily

D)
1. NITRATE-FREE Interval (10-12 hrs)
2. Blood PRESSURE (orthostatic hypotension)
No renal or hepatic

E)
Labels: 16, A* (swallow whole)
#Take ONCE daily at the time when angina is MOST FREQUENT
#Initially causes HEADACHES; these generally stop with continued use
#Takes TIME to work. Don’t take it to relieve angina attacks.
S/E:
*Headaches, Flushing, Palpitations

Question 4

Ivabradine (Coralan)

Answer 4

A) Anti-Anginal
(cardiac pacemaker current inhibitor)

B)

1. Stable ANGINA (hr>70bpm)
2. Stable HEART FAILURE (>77bpm)

C)
2.5 - 7.5 mg TWICE daily (max15)

D)
1. LUMINOUS effects*** (enhanced brightness)
2. Heart RATE*** (bradycardia***)
3. Blood PRESSURE (contraindicated if BP<90/50)
4. Development of AF*** (increase risk)
5. Other DRUGS** (CYP3A4)
6. HEPATIC (start low)
no renal

E)
Labels: 5, 12, 18, A, B
#Best absorbed when taken WITH FOOD
#Avoid GRAPEFRUIT
#Your VISION may be BLURRED and you may see BRIGHT AREAS, especially when there are sudden changes in light intensity. These effects are most likely in the first 2 months and generally do not persist throughout treatment
**DR - slow PULSE rate (feel SOB, tired or dizzy) as your dose may need adjusting

Question 5

Nicorandil (Ikorel)

Answer 5

A) Anti-Anginal agent

B)
1. Stable ANGINA (prev. and tx.)

C)
5 - 20 mg TWICE daily (max40)

D)
1. ULCERS and FISTULAS*** (oral and perianal - healing occurs after stopping)
2. Blood PRESSURE (contraindicated in hypotension)
3. HEPATIC
no renal

E)
Labels: 9, 12
#This initially causes HEADACHES; should decrease or disappear with continued use
**DR - ULCERS, WOUNDS or SKIN problems that are SLOW to heal
S/E
*Venous and Arterial DILATION (headaches, dizziness, lethargy, nausea, palpitations, flushing)

Question 6

Perhexiline (Pexsig)

Answer 6

A) Anti-Anginal

B)
1. ANGINA (refractory)

C)
50 - 600 mg ONCE daily

D)

1. CONCENTRATION monitoring (TDM)**
2. WEIGHT** (weight loss)
3. HEPATIC** (hepatotoxicity)
4. PERIPHERAL NEUROPATHY**
5. Blood GLUCOSE levels (low bsl)
6. Other DRUGS (CYP 2D6)

E)
Labels: 5, 12+
#You will need regular BLOOD tests while taking this
#Initially cause NAUSEA and DIZZINESS; disappear with cont. use
**DR - (hepatotoxicity) Weakness and Weight Loss
**DR - (peripheral neuropathy) Feel PINS and NEEDLES or NUMBNESS in fingers or toes
S/E:
*Dizziness, Headache, Weight LOSS, nausea and vomiting