Question

Case Study, Chapter 28, Drug Therapy for Coronary Heart Disease

Gene Cooper is a 56-year-old accountant who is being evaluated at the cardiology clinic for angina. He is 6 feet tall and weighs 260 lb, with a waist measurement of 40 inches. He has a history of hypertension, for which he has been prescribed a thiazide diuretic. He admits that he has not been taking the medication lately. His blood pressure upon this visit is 156/94 mm Hg. He smokes one pack per day. His LDL cholesterol level is 187 mg/dL. He has no history of diabetes, and his fasting glucose level is within normal limits. He states that he “works out at the gym” 3 days per week. He admits to episodes of midsternal chest pain accompanied by dyspnea and diaphoresis and associated with activity that is usually relieved with rest. He states that these episodes have been increasing in frequency, occurring once or twice weekly. (Learning Objectives 1, 2, and 7)

1. The nurse is teaching Mr. Cooper about nonpharmacologic management of his angina. What measures can he take to reduce his risk?
2. Mr. Cooper is given a prescription for sublingual nitroglycerin tablets to use as needed for chest pain and isosorbide mononitrate to take daily. He asks why he needs two prescriptions. How should the nurse respond?
3. Mr. Cooper continues to experience episodes of angina despite treatment with the nitrate. He is given a prescription for ranolazine. He asks whether he can stop taking the nitrate now. How should the nurse answer this question?

Answer 1

Measures to be taken by Mr.Cooper to reduce the Risk of Angina are-

- Increase in amount of polyunsaturated fatty acid Consumption, mainly 2-3 servings of oily fish per week may help in prevention of Cardiovascular diseases.

-Saturated Fatty acids must Comprise less then 10% of total energy intake.

- Limit salt intake to less then 5grams/day.

-Consume 30-45 grams of fiber/day

-Consume 200 grams Vegetables + 200 grand of fruits/day

- Limit consumption of Alcoholic beverages.

Mr. Cooper is given a prescription for sublingual nitroglycerin tablets to use as needed for chest pain and isosorbide mononitrate to take daily. As he asks to the need of two prescriptions. The nurse should Respond that the Two Tablets works in diferent manner

Sublingual Nitroglycerin - Starts it's Action 1- 3 months Post Administration and remains in blood for a shorter period of time. Whereas

Isosorbide Mononitrate- Starts It's Action after 60 minutes of oral dosing and stays in Blood for a longer period of time

So Nitroglycerin helps to Prevent Conversion of Angina To Myocardial infarction actuely. Whereas Isosorbide Mononitrate helps it to prevent in chronic/long Run.

Now the patient is given Ranolazine, i.e partial fatty acid oxidation inhibitor. As Heart uses Fatty acid as Furl(not very efficient so it hampers its use) Now Heart uses Glucose which is Better Fuel and Reduce the Generation of free radicals And Hence protect the Myocardium from Ischaemia. This Drug is Considered as 2nd line Treatment for Angina.

No, the Patient can't stop Isosorbide-mononitrate therapy as it can still induce anginal attack if medicine is stopped untill Physician's advice.