CVD

Question 1

isosorbide dinitrate (Isordil) dosing

Answer 1

Nitrate
IR: 5-80mg 2-3x/day
SR: 40mg 1-2x/day

Question 2

isosorbid mononitrate (Imdur)
dosing

Answer 2

Nitrate
ISMO: 20mg PO BID
Imdur: 30-240mg PO QD

Question 3

nitroglycerin (Nitrostat) dosing

Answer 3

Nitrate

0.3-0.6mg SL Q 5 mins PRN x 3

Question 4

transdermal nitro dosing

Answer 4

Nitrate

0.2-0.4mg/hr Q 24 hrs

Question 5

Nitrate MOA

Answer 5

produces cyclic GMP

Decreases cardiac oxygen demand by decreasing preload thereby reducing wall tension

Vasodilation = increase O2 supply

Question 6

Nitrates are ideal for pts w/ concomitant _____

Answer 6

Heart failure

Question 7

True or false: Nitrates should be used as monotherapy in pts w/ tachycardia?

Answer 7

False: should NOT be used as monotherapy

Question 8

What is special about dosing nitrates? When should once daily products be taken?

Answer 8

They should be dosed asymmetricly, w/ a 8-12 hr nitrate free period. Once daily should be taken in the morning

Question 9

What forms of nitro can be used as prophylaxis for stress or effort induced ischemic attacks?

Answer 9

Spray & sublingual. Use 2-5 minutes before activity

Question 10

Why should transdermal patch application sites be rotated?

Answer 10

To prevent tolerance. Rotate b/t chest & upper extremities

Question 11

What is likely the cause of nitro tolerance?

Answer 11

A reduction in tissue cyclic GMP, a substrate needed for vasodilaiton

Question 12

What nitro dosing regimens are susceptible to tolerance?

When does tolerance develop?

Answer 12

• Frequent dosing of long acting (>3x/day)
• Continuous delivery systems (IV/transdermal)
• Long acting
• W/i the first 24hrs

Question 13

What form of nitro does NOT cause tolerance?

Answer 13

Sublingual

Question 14

What are the adverse effects of nitrates? (6)

Answer 14

• HA
• Flushing
• Postural hypotension
• Syncope
• Reflex tachycardia
• Contact dermatitis w/ NTG patch

Question 15

What are the cautions/contraindicaitons of nitrates?

Answer 15

• Severe anemia
• Hypotension (SBC <90mmHg)
• Right ventricular infarction
• Bradycardia
• Aortic valve stenosis
• Use of phosphodiesterase inhibitors

Question 16

ranolazine MOA

Answer 16

Decreases oxygen demand by blocking late sodium channels - reduces Ca overload in myocyte. Prevents/reduces ischemia, improves diastolic function & decrease HbA1c by 1%

Question 17

Does ranolazine have an effect on blood pressure? Heart rate?

Answer 17

NO effect on blood pressure or heart rate

Question 18

Which heart failure medication can prolong QTc?

Answer 18

ranolazine

Question 19

What are the adverse effects of ranolazine?

Answer 19

• Dizziness
• Nausea
• Palpitations
• QTc prolongation (~10msecs)

Question 20

What should be monitored when taking ranolazine?

Answer 20

LFTs: AST & ALT @ baseline

EKG: QTc @ baseline

Question 21

What are drugs that are contraindicated w/ ranolazine?

Answer 21

CYP3A inhibitors (verapamil, diltiazem, erythromycin) = limit ranolazine to 500mg BID

CYP3A substrates (simvastatin) = limit SIMVASTATIN to 20 mg daily

Question 22

What should you educate pts about when taking ranolazine?

Answer 22

• Avoid grapefruit juice
• NOT for acute cessation of chest pain
• Do not crush tabs
• Tell doc about palpitations or syncope