Week 12: Angina drugs (13 questions)

Question 1

Nitrates/Nitrites:

Nitroglycerin used for?
Isosorbide Nitrate used for?
cannot take nitroglycerin with?

Answer 1

Nitroglycerin:
ACUTE emergencies and chronic therapy

Isosorbide Mononitrate/Dinitrate:
CHRONIC Therapy (SLOW acting)
used for PREVENTION

PDE5 Inhibitors:
sildenafil and tadalafil

Question 2

Nitrates/Nitrites:

GENERAL ADVERSE EFFECTS 3

Answer 2

Headache!

Hypotension
**Can lead to a dangerous reflex tachycardia

Tolerance with Chronic Therapy

Must have nitrate free period

Patients remove patches at night (need 10-14 hours “offtime”)

Question 3

Nitroglycerin SL Tablets/Spray PRN

How are tablets kept?
If having chest pain? four steps
Whats the dose limit?

Answer 3

Tablets are kept in dark/amber vial to protect from LIGHT

If having chest pain
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

3 dose limit

Question 4

When and How to use Nitroglycerin SL tablets?

Answer 4

WHEN to use?
Use if sudden chest pain develops

Use if going to do something that provokes chest pain (exertional angina)

HOW to use?
SL spray/tab goes under the tongue
No food/drinks x 10-15 minute after

Question 5

Nitroglycerin Patches

How to use?

Answer 5

Once daily patches

1) Place the patch on a hairless area of skin (chest, back, or abdomen) and ROTATE SITES

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 developing tolerance

Be medication-free 10 to 14 hr/day

Question 6

Nitroglycerin Ointment

How to use?

Answer 6

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

Avoid touching ointment with the hand (wear gloves)

Question 7

IV Nitroglycerin (EMERGENCIES)
what occurs if stopped suddenly?

dose is adjused every….? based on?

reminder for all nitrogycerin?

Answer 7

Never stop IV nitroglycerin abruptly (wean off)- rebound hypertension/ischemia can occur

This is a titratable drip, we adjust the dose every 5 minutes based on patients chest pain and blood pressure

check blood pressure before administration! (SBP<90!)

GENERAL REMINDER: Educate patients to change positions slowly with all nitroglycerin due to fall risk