RxPrep: Ch. 32 - Chronic Angina
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. What would you like to do?
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)
- Beta blockers
- Ranexa (sometimes)
- Bayer, Bufferin, Ascriptin
- 75-162 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?
- Call 911!!!
- 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
- SL tabs: Nitrostat 0.3, 0.4, 0.6 mg
- SL spray: 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
- Severe anemia
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?
- IR: BID-TID
- SR: 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?
What would you like to do?
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