NAPLEX Question of the Week: Angina

This week's question will determine how well you know a well known agent used in the management of angina.

Like Comment

A 56 year old female with PMH significant for HTN, DM, and hyperlipidemia presents to the ED with chest pain and tightness. While workup is pending, the ordering provider wishes to administer nitroglycerin and asks which dosage forms are available at your critical access hospital. 

Which of the following dosage forms would be appropriate for nitroglycerin to be administered in our patient? Select all that apply.

A. Intravenous admixture

B. Sublingual tablet

C. Sublingual spray

D. Transdermal patch

E. Extended release capsules

Answer with rationale: 

The correct answers are A, B, and C. All 5 answers are dosage forms for which nitroglycerin can be administered. Additionally there is an ointment that exists. A key counseling point with the ointment (sometimes referred to as paste) it that it should be applied with a glove to limit vasodilation to the person administrating the nitro.

However all 5 answers are not correct...Read the question carefully. My hunch is that a number of folks would potentially miss this question as they read it purely thinking it was a dosage form question. While that is an important piece, the question also asks which should be used for our patient with acute angina? This makes answer D (the patch)  and E (extended release capsules) incorrect as this is used chronically to prevent angina symptoms.

One word in a question can change the whole question. Remember to read every word to not miss an important piece of the puzzle!

Expertise in dosage forms are an important part of a pharmacist's practice, no matter where you are serving. While many pharmaceuticals come in one dosage form (statins for example) many come in multiple dosage forms such as anti epileptic drugs (i.e. phenytoin), aspirin (tablets and rectal suppositories), acetaminophen (intravenous, multiple oral, rectal suppositories). This becomes important in situations such as when patients are NPO, require faster onset therapies, or have a gastric tube where a medication may not be able to be crushed. 

Have a great weekend!

Dr. B

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.