ANTI-ANGINAL THERAPY Flashcards
▪Nitrates
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
▪Calcium Channel Blockers
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
c. ▪Non-DHPs- verapamil and diltiazem
▪Anti-anginal agent-
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
d. ▪ranolazine
Secondary Add On Medication)
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
e. Sodium Nitroprusside
d. ▪ranolazine
◦ ACUTE emergencies and chronic therapy (FAST acting)
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
e. Sodium Nitroprusside
a. ▪ nitroglycerin
◦ CHRONIC Therapy (SLOW acting)
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
e. Sodium Nitroprusside
b. ▪ isosorbide mononitrate
◦ Hypertensive Crisis (FAST acting) REMEMBER THIS?
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
e. Sodium Nitroprusside
e. Sodium Nitroprusside
• Acute AND Chronic Angina
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
a. ▪ nitroglycerin
SL Tablets-> ? IV drip -> ? Ointment-> ? Spray-> ? Patch-> ? Acute Angina or Chronic prevention of Angina
SL Tablets-> Acute Angina IV drip -> Acute Angina Ointment-> Acute Angina Spray-> Acute Angina Patch-> Chronic prevention of Angina
◦ PREVENTION (for CHRONIC angina)
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
b. ▪ isosorbide mononitrate
◦ Slow to work, take once or twice a day to prevent chest pain
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
b. ▪ isosorbide mononitrate
NOTABLE DRUG INTERACTIONS ◦ PDE-5 Inhibitors! Viagra® (sildenafil), Cialis® (tadalafil) a. ▪ nitroglycerin b. ▪ isosorbide mononitrate c. ▪Non-DHPs- verapamil and diltiazem d. ▪ranolazine
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
◦ Severe head trauma- Can increase intracranial pressure
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
◦ Nitroglycerin SL Tablets/Spray PRN
◦ Tablets are kept in dark/amber vial to protect from ?
LIGHT
Order for Nitroglycerin SL Tablets/Spray PRN
?) Stop activity, sit/lie down
?) If pain continues after 5 minutes, take THIRD dose
?) If pain unrelieved after 5 minutes, CALL 911, and take
second dose
?) Take first dose of Nitroglycerin
1) Stop activity, sit/lie down
2) Take first dose of Nitroglycerin
3) If pain unrelieved after 5 minutes, CALL 911, and take
second dose
4) If pain continues after 5 minutes, take THIRD dose
Nitroglycerin SL Tablets/Spray PRN what the dose limit
3
◦Nitroglycerin Patches order
?) Place the patch on a hairless area of skin (chest, back, or abdomen)
and rotate sites to prevent skin irritation.
?) Remove the patch at night to reduce the risk of developing tolerance to
nitroglycerin. Be medication-free 10 to 14 hr/day
?) Remove old patch, wash skin with soap and water (NOT ALCOHOL), and
dry thoroughly before applying new patch.
1) Place the patch on a hairless area of skin (chest, back, or abdomen)
and rotate sites to prevent skin irritation.
2) Remove old patch, wash skin with soap and water (NOT ALCOHOL), and
dry thoroughly before applying new patch.
3) Remove the patch at night to reduce the risk of developing tolerance to
nitroglycerin. Be medication-free 10 to 14 hr/day
Is the Nitroglycerin Patches applied once daily?
Yes
Nitroglycerin Patches
1) Place the patch on a hairless area of skin (chest, back, or abdomen)
and ? to prevent skin irritation.
2) Remove old patch, wash skin with soap and water (NOT ALCOHOL), and
dry thoroughly before applying new patch.
3) Remove the patch at night to reduce the risk of developing tolerance to
nitroglycerin. Be ? 10 to 14 hr/day
rotate sites
medication-free
◦Nitroglycerin Ointment order
?) Avoid touching ointment with the hand
?) Remove the prior dose before a new dose is applied
?) Measure specific dose with applicator paper and spread over 2.5 to 3.5
inches of the paper
?) Apply to a clean, hairless area of the body, and cover with clear plastic
1) Remove the prior dose before a new dose is applied
2) Measure specific dose with applicator paper and spread over 2.5 to 3.5
inches of the paper
3) Apply to a clean, hairless area of the body, and cover with clear plastic
4) Avoid touching ointment with the hand
For the Nitroglycerin Ointment you should Remove the prior dose before a new dose is applied?
Yes
◦IV Nitroglycerin (EMERGENCIES) Which is true
◦ Never stop IV nitroglycerin abruptly (wean off)- rebound hypertension/ischemia can occur
◦ When giving a dose, check blood pressure before administration!
(SBP<90!)
◦ GENERAL REMINDER: Educate patients to change positions
slowly with all nitroglycerins
◦ Never stop IV nitroglycerin abruptly (wean off)- rebound hypertension/ischemia can occur
◦ When giving a dose, check blood pressure before administration!
(SBP<90!)
◦ GENERAL REMINDER: Educate patients to change positions
slowly with all nitroglycerins
◦Daily, slow release medication
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
b. ▪ isosorbide mononitrate
◦ Meant for prevention of chest pain
◦ “Prophylaxis
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
b. ▪ isosorbide mononitrate
Which is true about b. ▪ isosorbide mononitrate
◦If there is a concern for reflex tachycardia, can add a beta
blocker!
◦Patients can take acetaminophen to help with the induced
headache
◦Patients on chronic therapy require an “off-period” to avoid
developing a tolerance
◦ This means usually a daily “off” time
◦If there is a concern for reflex tachycardia, can add a beta
blocker!
◦Patients can take acetaminophen to help with the induced
headache
◦Patients on chronic therapy require an “off-period” to avoid
developing a tolerance
◦ This means usually a daily “off” time
◦ Dysrhythmias (primary use!)
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
c. ▪Non-DHPs- verapamil and diltiazem
MECHANISM OF ACTION: • Block calcium channels in • Vascular smooth muscle • Myocardial tissue • Nodes (SA/AV) a. ▪ nitroglycerin b. ▪ isosorbide mononitrate c. ▪Non-DHPs- verapamil and diltiazem d. ▪ranolazine
c. ▪Non-DHPs- verapamil and diltiazem
- Contraction (Heart Muscle)
Inotropic
Chronotropic
Dromotropic
Inotropic-
Heart Rate (SA Node)
Inotropic
Chronotropic
Dromotropic
Chronotropic
- Velocity (AV Node)
Inotropic
Chronotropic
Dromotropic
Dromotropic
Constipation
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
c. ▪Non-DHPs- verapamil
DRUG INTERACTIONS NO GRAPEFRUIT JUICE a. ▪ nitroglycerin b. ▪ isosorbide mononitrate c. ▪Non-DHPs- verapamil and diltiazem d. ▪ranolazine
c. ▪Non-DHPs- verapamil and diltiazem
USED TO TREAT ◦ Chronic stable Angina, ADD ON THERAPY a. ▪ nitroglycerin b. ▪ isosorbide mononitrate c. ▪Non-DHPs- verapamil and diltiazem d. ▪ranolazine
d. ▪ranolazine
ADVERSE EFFECTS ◦ Can cause QT prolongation a. ▪ nitroglycerin b. ▪ isosorbide mononitrate c. ▪Non-DHPs- verapamil and diltiazem d. ▪ranolazine
d. ▪ranolazine
Contra-indicated in anyone who has prolonged QT syndrome
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
d. ▪ranolazine
Metabolized via CYP450 (inducers and inhibitors easily influence this drug)
a. ▪ nitroglycerin
b. ▪ isosorbide mononitrate
c. ▪Non-DHPs- verapamil and diltiazem
d. ▪ranolazine
d. ▪ranolazine
