module 10 year 1 npa course

[dispenser321]

i have very far behind and really stuck with the case studies i feel like giving up i need to no the advantages and disadvantages of different formulations of gtn and the prescription for warfarin furosomide ramipril and gtn i need any interactions and advice and information to give to the customer any advice would be great i just so fed up of looking in bnf and getting no where x

[johnep]

That is why we are here, never fear.
GTN. Original tablet formulation was in a chocolate base but unstable and changed I believe to mannitol
Those formulations currently available and probably in your dispensary are:
Tablet, spray, patches and ointment. You can look them up in the BNF.
Warfarin seems to interact with virtually anything, details of each would be in Stockley.

Generally advice to customer is to report bruises which could indicate warfarin dose needs adjusting.
Others will have more for you.
johnep

[dispenser321]

thanxs so much for ur help its a litlle clearer now still unsure of the disadvanges and advanges of the above products though i thought the interaction would be fursomide and gtn as it lowers blood pressure is this correct and not sure

[Nik]

Ramipril and furosemide together will have the effect of quickly dropping blood pressure - nitrates can cause hypotension because they act as vasodilators, i.e they dilate blood vessels. Patients may find they will feel faint or dizzy when they first start taking nitrates - taking them while sitting down may help to counteract this. They could also spit out the tablet once the angina pain is relieved or swallow the tablet as this inactivates it. Cannot see any particular interaction with warfarin and these meds and normal warfarin counselling would apply. A bit of a long shot but it's important to make sure patients can produce enough saliva if they have been prescribed gtn tabs and aren't on any drugs which could cause a dry mouth or make them too dehydrated.
Johnep has mentioned the available formulations of gtn above - pros and cons really depend on the indication. Sublingual tabs and spray formulations are more appropriate for treating acute angina attacks as they work very quickly. The patches and ointment are more suitable for prophylaxis - they don't offer as flexible dosing compared to tabs and sprays and may not offer a "nitrate free" period to avoid developing tolerance. The ointment prep is also pretty messy to apply and surgical tape is needed to keep the ointment on.

[dispenser321]

thanxs so much for that it help me so much i can get on abit more now