Term
| What is the rationale for drug treatment of angina? |
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Definition
- symptom relief
- reduce risk of death or MI |
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Term
| What is the rationale for for the use of low dose in the treatment of cholesterol and hypertension? |
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Definition
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Term
| When are short acting nitrates used? |
|
Definition
treat acute attacks of angina OR;
immediately before strenuous activity that may precipitate an attack |
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Term
| What are short acting nitrates? |
|
Definition
glyceryl trinitrate: 600mcg sublingual tablet (Anginine); spray 400mc (Nitrolingual)
isosorbide dinitrate - sublingual tablet 5mg or tablet 10mg (Isordil) |
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Term
| How is anginine (glyceryl trinitrate sublingual tablets) used in the case of acute angina attack |
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Definition
Sit or lie down before use as the drug may cause drowsiness
1 tablet every 5 min. If pain persist after 15mg over 15min, treat as heart attack ->ambulance/hospitalisation
Spit or swallow what is left of tablet after pain has been relieved |
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Term
| When are long acting nitrates indicated |
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Definition
| prevention of angina in patients with more frequent symptoms |
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Term
| What long acting nitrate preparations are available |
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Definition
| Transdermal GTN 5/10/15 mg/24hr (Transiderm, Minitran, Nitro-Dur) |
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Term
| What are the counselling points for using GTN patches? |
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Definition
-apply to clean, dry chest or upper arm
-ensure a nitrate-free period of 10-12 hours each day to avoid tolerance |
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Term
| What are the counselling points on anginine tablets (other than how to use)? |
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Definition
-discard any left over tablets 3 months after opening bottle (helpful to write down on bottle opening date)
-store in cool dry dark place |
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Term
| Why might the nitrolingual spray be more suited for patients with infrequent angina than anginine tablets? |
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Definition
| longer shelf-life; till expiry date (not 3 months after opening). |
|
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Term
|
Definition
Isosorbide dinitrate
sublingual tab (5 mg), or tab (5-10 mg) |
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Term
| What is the onset of action and duration of GTN spray and sublingual tablet |
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Definition
onset: <5 min
duration: <1 h |
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Term
| What is the onset of action of a GTN patch |
|
Definition
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Term
| what is the onset of action and duration of isosorbide mononitrate tablet (Imtrate, Monodur, Imdur) |
|
Definition
| 1-2 hours; prolonged (they are controlled release products. |
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Term
|
Definition
| isosorbide dinitrate tablet 10mg |
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Term
| How is the sublingual spray used? |
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Definition
Prime with 5 sprays before first use, or not used for 4 months.
Prime with 1 spray if not used for 7 days.
Aim spray under tongue and press nozzle once - do not inhale spray. |
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Term
| For patients in whom there is a contraindication to a beta blocker, what may be substituted to maintain stable angina. |
|
Definition
diltiazem or verapamil
AND/OR
GTN transdermal or isosorbide mononitrate |
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Term
| What is the dose of nondihydropyridine CCBs in management of stable angina |
|
Definition
diltiazem 30-120mg tds
diltiazem controlled release 180-360mg d
verapamil 40-120mg bd or tds
verapamil sustained release 160-480mg d |
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Term
| What is Cardizem and Cardizem CD |
|
Definition
diltiazem 60mg tab
diltiazem controlled delivery 180/240/360 |
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Term
| What is Isoptin and Isoptin SR |
|
Definition
verapamil tab 40,80,120,160mg
verapamil sustained release 180,240mg |
|
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Term
|
Definition
| verapamil sustained release 180,240mg |
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|
Term
|
Definition
nicorandil - k channel opener with nitrate moeity
*added or substituted when BB does not prevent angina |
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Term
| What may be added when BB alone does not prevent angina |
|
Definition
dihydropyridine CCB (amlodipine NORVASC, nifedipine ADALAT); AND/OR
GTN transderm OR isorbide mononitrate SR
AND/OR
nicorandil IKOREL |
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