OB-GYN 101
Pharmacy

Category:

• Miscellaneous

Description:

• Antianginal (venous (predominantly) and arterial dilator)

Indications:

• Acute angina, angina prophylaxis, perioperative hypertension, CHF associated with MI

• Unresponsive angina pectoris

Contraindications:

• Severe anemia, closed-angle glaucoma, postural hypotension, early MI, head trauma

• Cerebral hemorrhage, hypotension, uncorrected hypovolemia, inadequate cerebral circulation, increased intracrainial pressure, constrictive pericarditis, pericardial tamponade (IV)

Precautions:

• Pregnancy category C; may use SL for angina

• Early days of MI, hypertrophic cardiomyopathy, severe hepatic/renal disease

• Children, glaucoma, abrupt withdrawal, continuous delivery

Adverse Reactions (Side Effects):

• CNS: agitation, anxiety, apprehension, confusion, dizziness, dyscoordination, headache, hypoesthesia, hypokinesia, insomnia, nervousness, nightmares, vertigo, restlessness

• CV: atrial fibrillation, collapse, crescendo angina, dysrhythmias, palpitations, postural hypotension, PVC’s, rebound hypertension, retrosternal discomfort, syncope, tachycardia

• GI: abdominal pain, diarrhea, dyspepsia, fecal incontinence, nausea, tenesmus

• GU: dysuria, impotence, urinary frequency

• HEME: hemolytic anemia, methemoglobinemia

• SKIN: allergic reactions (ointment), contact dermatitis (transdermal), crusty skin lesions, cutaneous vasodilation with flushing, exfloiative dermatitis, rash, sweating

Administered orally (spray, capsule, SL tablet, EC tablet, buccal tablet), topically (transdermal, ointment), and intravenously

• Adult: 

  • BUCCAL 1mg every 3-5 hours while awake initially, titrate dosage upward if angina occurs with tablet in place

  • PO 2.5-9mg 2-4 times daily, up to 26mg 4 times daily;

  • IV 5 mcg/min via continuous infusion, increase by 5 mcg/min every 3-5 minutes to 20 mcg/min; if no response, increase by 10 mcg/min every 3-5 minutes up to 200 mcg min;

  • TOP 1-2 inches every 8 hours, up to 4-5 inches every 4 hours

  • TRANSDERMAL 0.2-0.4 mg/hr initially, titrate to 0.4-0.8 mg/hr; apply new patch daily; tolerance is minimized by removing patch for 10-12 hours daily

  • SL 0.2-0.6mg every 5 minutes for a max of 3 doses in 15 minutes; may also use prophylactically 5-10 minutes prior to activities that provoke angina attack

• Child: 

  • IV 0.25-0.5 mcg/kg/min, titrate by 0.5-1 mcg/kg/min every 3-5 minutes as needed; usual dose 1-3 mcg/kg/min; max 20 mcg/kg/min

Special Considerations:

• 10-12 hour drug-free intervals prevent development of tolerance