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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?