stumped

[stewy50]

I am researching a question that an pharm instructor posed to us allowing us to use on line resources. Case study, there is a 58 year old female at the clinic for follow up angina appointment. Last visit she was started on NTG transderm 0.4 mg/hr every 24 and sublingual NTG 0.4 mg PRN. Durign her first week of therapy, her weekly angina episodes decreased from 4 to 1 per week. After three weeks her episodes returned to 4 weekly. All occurred with activity and were relieved by rest and sublingual nitro. Her daily medications include Digoxin 0.125 mg, Furosemide 40 mg, Warfarin 5 mg, Lovastatin 20 mg at HS. Captopril 12.5 mg. KCL 20 mEq  BID, and the nitroglycerine described above.  We are to describe the pharmacological treatments present in this persons treatment plan.

[stewy50]

Thanks for your insight and help will let you know how it comes out

[ed34]

3. The disease has progressed and needs a more aggressive intervention.

[joanincarolina]

I concur with Ed and Flycaster but the issue for this patient is the return of her anginal symptoms after 3 weeks. If we assume she has been supplementing the nitro patch with sl nitro for angina symptoms then address that critical issue for the patient as she needs good O2 supply to heart muscle regardless of underlying etiology.
1. Is she using the patches correctly? Not halving them, having no interference with light/sun on them and sweat coming between the patch and her skin. These both  affect absorption rate.
2. How is she using the sl nitro? This med is very affected by light and unstable the more the little container is opened and moisture let in.It can expire well before its stated expire date depending on usage and greatly diminish effect. Hope this helps. Joan.

[Flycaster305]

I'm not a heart professional, but I've had angina like the patient you described.  I'm a male, 68 years old, eight stents, and now passive CAD, once very active.  My angina was relieved greatly after going back on Plavix and also mixing in Ranexa 1000 mg X 2.  I have known small vessel disease, and these drugs simply almost eliminated angina with exercise. I also take Imdur.  I would tell you the Ranexa helped me immediately.  Apparently it's not a commonly prescribed drug, but as I've read, it maximizes the amount of oxygen the heart muscle can assimulate when combined with beta blockers, such as Coreg.  

[ed34]

Well it seems likely the patient has coronary artery disease by the symptoms you describe. Therefore the Digoxin is not necessary is it? it's for treating atrial flutter/fibrillation. Furosemide is for heart failure/edema, Warfarin is an anticoagulant, Lovastatin is a cholesterol lowering medication (statin group), Captopril ace inhibitor to treat hypertension. KCL20 a potassium supplement?
So the patients cholesterol lipids are being lowered by using the statin drug.
Potassium supplements being given. A normal level of potassium in the blood is important so that your cells, nerves, heart, muscles, and kidneys work properly.
Fluid retention is being controlled so fluid doesn't built up in the sac around the heart or the chest cavity etc. Warfarin is thinning the blood so platelets are less active, preventing a clot forming in the coronary arteries or brain or anywhere else.
Blood pressure medication is also being given to keep the heart from having to pump too hard.
I'm not sure what you need here, but I would say an important medication is missing which is important until some intervention (surgical) has taken place. Beta blockers such as bisoprolol reduce the effects that hormones such as adrenaline have on the heart, it blocks most of the receptors on the heart. This keeps it from overworking and can help keep angina under control.