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8
PHARMACY PREP

ISCHEMIC HEART DISEASES


1. A 57-year-old male patient with shortness of breath, swollen ankle, high blood
pressure and exercise-induced angina comes to the pharmacy with an Rx of digoxin
0.20 mg/day. He is already taking HCTZ, Verapamil and Nitro lingual spray PRN.
What do you tell his doctor?
I Fill the prescription the way it is
II Change HCTZ to Furosemide
III Decrease the dosage of digoxin
a. I only
b. III only
c. I and II
d. II and III
e. All of the above
Ans-D

Next 1 Questions refer to the following scenario
2-A 36-year female receptionist medical history includes migraine and angina. Which of
the following can she use?
I. Nifedipine
II. Nitrate
III. Verapamil
a. I only
b. III only
c. I and II only
d. II and III only
e. All of the above
Ans-B

Next 2 Questions refer to the following scenario
3. Which medication CAN NOT BE used for Prinzmetal angina (vasospastic angina)?
A. Amlodipine
B. Metoprolol
C. ASA
D. Verapamil
E. Diltiazem
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Ans-B
Tips:
TC page 275, avoid beta blockers in Prinzmetal angina, beta blockers cause
vasoconstriction (vasospasm)

Next 3 Questions refer to the following scenario
AA. is a 62 year-old male, presents with the following prescriptions after being
discharged from hospital: nitroglycerin patch (Nitro-Dur) 0.4mg daily, ASA (Aspirin)
81 mg daily and metoprolol (Lopressor) 25mg twice daily.
Past Medical History indicates Stable angina x 2 years, no known allergies, current
medication Nitroglycerin (Nitrostat) sublingual tablets 0.6 mg prn.

4-What is the recommended length of time that AA. Should go without wearing the
nitroglycerine patch daily to avoid tolerance?
A-2-4 hours
B-10-12 hours
C-6-8 hours
D-14-16 hours
Comments: Drug free period (nitrate free)
Ans-B

5 - What is an important point to discuss with AA, regarding nitroglycerin patch use?
I-Rotate application site regularly
II-Redness at application site requires drug discontinuation
III-Remove patch while bathing or showering and occlusive dressings may increase
absorption.
A-I only
B-III only
C-I and II only
D-II and III only
E-All of the above
Ans-A
Comments: Keep patch on while bathing or showering.

36-Which side effects is AA. The most at risk of experiencing?
A-Hyperkalemia
B-Hypotension
C-Cough
D-Dry mouth
E-Irritation
Ans-B

7 . Which of the following counselling tips regarding nitroglycerin sublingual tablet use
is NOT appropriate to provide AA.?
A-Tablets should be stored tightly capped glass bottle
B-Discard cotton plug from bottle.
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C- Persistent chest pain after using 3 doses in a 15-minute interval should prompt G.M. to
seek immediate medical attention
D- A tingling or burning sensation when dissolved under the tongue is a reliable test for
potency.
E- Tablets should not be chewed or crushed.
Ans-D

8. Patient with prosthetic valve replacement in his heart was discharged after having a
cerebral ischemic attack. The patient is intolerant to ASA. Best prophylactic treatment
to be prescribed for the patient is/are:
(A) Ticlid (Ticlopidine)
(B) Clopidogrel (Plavix 75mg)
(C) Dipyridamole 400mg/day
(D) Dipyridamole plus Warfarin
(E) None of the above
Answer: (D)
Reference: Therapeutic Choices 5
th
edition Page 510