RxPrep: Ch. 32 - Chronic Angina
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RxPrep: Ch. 32 - Chronic Angina
RxPrep angina NAPLEX pharmacist pharmacy
Chapter 32 in RxPrep
What is the acronym for non-pharmacological and pharmacological therapies of angina?
A - ASA, ACEI, Antianginal drugs
B - Beta blockers, blood pressure
C - Cholesterol, cigarettes
D - Diet, diabetes
E - Exercise, education
What are the antianginal drugs?
ASA (Plavix if ASA is CI)
Bayer, Bufferin, Ascriptin
75-162 mg daily
75 mg daily
When do you d/c ASA before surgery?
Which CYP enzyme is responsible for metabolizing Plavix to its active form? Which allele is associated with good metabolizers, and which ones cause poor metabolism?
2C19*1 is the good one
2C19*2 and *3 are the bad ones
What are some major side effects of Plavix?
What is thrombotic thrombocytopenic purpura (TTP)?
Fever, weakness, extreme skin paleness, purple skin patches, yellowing of the skin and eyes, neurological changes
When do you d/c Plavix before surgery? And, do you start if pt is going to undergo CABG?
What is the intxt between NSAIDs, like ASA, and Li+?
Cause Li+ toxicity
Explain the interaction between Prilosec and Plavix. How do you deal?
Prilosec is a moderate 2C19 inhibitor - blocks Plavix activation --> strokes
Use another PPI (remember
: Nexium is esomeprazole)
Beta blockers cannot be used in which type of angina?
What place do beta blockers have in angina tx?
1st-line: monotx or in combo w/NTGs and/or CCBs
What is the preferred agent for Prinzmetal angina?
What place do CCBs have in angina tx? Which ones should you use?
Use when BB are contraindicated or as add-on
Long-acting > short-acting
NDHP > DHP
What place in tx does NTGs have?
SL and spray
: immediate relief
In combo with BBs and CCBs (never monotx)
What happends if no relief from NTG after one dose of SL/spray?
While waiting for ambulance, you make take up to 3 doses at 5-min intervals
What is the MOA of ranolazine (Ranexa)?
Selectively inhibits the late Na+ current
Decreases intracellular Na+ and Ca2+
May decrease myocardial O2 demand
500 mg BID (max
: 1000 mg BID)
What are the side effects of Ranexa?
Dizziness, constipation, QT prolongation
What are the CIs of Ranexa?
Liver cirrhosis, concurrent use of strong CYP3A4 ind/inh (i.e., grapefruit juice)
In which sex is Ranexa more effective?
Males > females
: Nitrostat 0.3, 0.4, 0.6 mg
: Nitromist, Nitrolingual Pump Spray 0.4 mg/spray
Isosorbide mononitrate tabs/caps (Ismo, Monoket)
Isosorbide mononitrate ER tabs/caps (Imdur)
What are the side effects of NTG?
HA, flushing, hypotension, tachycardia
What are CIs of NTG?
PDE-5 inh use
Increased intracranial pressure
How long do NTG patches stay on/off?
12 hrs on, 12 hrs off
How do you dose NTG ung?
Dosed BID, 6 hrs apart with 10-12 hr nitrate-free interval
How do you dose isosorbide mononitrate?
Daily or BID if IR (at least 7 hrs apart)
How do you dose isosorbide dinitrate?
: daily or BID
How do you store NTG SL?
In its orginal, amber, glass bottle
Do not need to replace every 6 mon anymore
When they use their NTG spray for the first time, or if they have not used it for 6 or more wks, what should they do? Can they shake the bottle?
Prime it - spray 5 times in the air
Prime once if haven't been used for 6+ wks
No, do not shake
If you are putting the NTG patch on the legs, where should you put it?
Above the knees
Can you bathe, swim, and shower while wearing the patch?