Home' Australian Pharmacist : Australian Pharmacist January 2016 Contents Australian Pharmacist January 2016 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
1. Anon. New Drugs: Riociguat. Aust Prescr 2014;37:139–43.
2. At: www.australianprescriber.com/magazine/37/4/139/43/
3. Ghofrani H-A, Galie N, Grimminger F, et al. Riociguat for
the treatment of pulmonary arterial hypertension. N Engl J
Med 2013;369:330–40. At: www.nejm.org/doi/full/10.1056/
4. Aspen Pharmacare Australia. Product information:
Anginine. 2007. At: www.aspenpharma.com.au/product_
5. Sanofi Australia. Product information: Nitrolingual. 2014. At:
6. Sansom LN, ed. Australian pharmaceutical formulary and
handbook. 23rd edn. Canberra: Pharmaceutical Society of
Australia; 2015. p. 318–19.
7. Cardiovascular Expert Group. Therapeutic guidelines:
Cardiovascular, version 6. Melbourne: Therapeutic
Guidelines Ltd; 2012.
8. Kelly JP, Kaufman DW, Jurgelon JM, et al. Risk of aspirin-
associated major upper-gastrointestinal bleeding
with enteric-coated or buffered product. Lancet
9. García Rodríguez LA, Hernández-Díaz S, de Abajo FJ.
Association between aspirin and upper gastrointestinal
complications: systematic review of epidemiologic studies.
Br J Clin Pharmacol 2001;52(5):563–71 .
10. Cox D, Maree AO, Dooley M, et al. Effect of enteric coating
on antiplatelet activity of low-dose aspirin in healthy
volunteers. Stroke 2006;37(8):2153–8 .
11. Maree AO, Curtin RJ, Dooley M, et al. Platelet response to
low-dose enteric-coated aspirin in patients with stable
cardiovascular disease. J Am Coll Cardiol 2005;46(7):1258–
1. Which ONE of the following most
appropriately describes the MAIN
trigger for an acute attack of
a) Rupture of an atherosclerotic plaque.
b) Increased myocardial demand for
c) Sudden reduction in myocardial oxygen
d) Platelet aggregation in a coronary
2. Which ONE of the following is NOT
generally considered a first-line
preventive therapy for angina?
a) Diltiazem modified-release (MR).
b) Isosorbide mononitrate MR.
c) Metoprolol tartrate.
3. Which ONE of the following
antiplatelet regimens is the LEAST
appropriate for someone with stable
a) Aspirin tablets 100 mg daily.
b) Aspirin EC capsules 100 mg daily.
c) Aspirin/dipyridamole MR capsules
25/200 mg one twice daily.
d) Clopidogrel tablets 75 mg.
4. The persistence of angina pain
after 15 minutes and three doses of
sublingual GTN should prompt which
ONE of the following?
a) A dose of two Panamax (paracetamol)
b) A fourth dose of sublingual GTN.
c) Telephoning the GP.
d) Telephoning 000 (triple zero) or 112.
5. When should a bottle of GTN
sublingual tablets be disposed of?
a) Two weeks after opening.
b) At the manufacturer’s expiry date.
c) Three months after opening.
d) When all the tablets have been used.
A month later, Fred presents in the
pharmacy accompanied by his daughter
Judy after attending the cardiology
clinic, and he has prescriptions for
rosuvastatin 20 mg tablets and aspirin
100 mg tablets. He explains that further
testing has confirmed his GP’s suspicion
that ‘he has a dodgy ticker’ and whilst
he seems relatively unperturbed by his
diagnosis, he expresses some dismay at
needing to have ‘more bloody pills’.
You dispense these with CMIs and spend
some time discussing their rationale and
Judy says she ‘will make sure Dad takes
his tablets’. A week later Fred comes back
to ask your advice. He has noted muscle
pain and having read the CMI he did
not take the rosuvastatin this morning.
You acknowledge that this may be a
side effect of the statin and discuss
the options. With Fred’s consent you
contact his GP and explain the situation,
suggesting a trial of an alternative
statin at a lower than equivalent dose
and he agrees to see Fred later in the
week. You record this as a clinical
intervention. Fred is subsequently
prescribed atorvastatin 10 mg daily and
continues to tolerate this well over the
next month and the dose is uptitrated
to 20 mg with no problems. During this
time, Fred experiences no further
A few months later when dispensing
Fred’s last repeat for atorvastatin, he
again mentions that he hates taking
tablets, but ‘does as he is told’ and
you mention the availability of a
combination product containing both
his atorvastatin and amlodipine. Fred is
delighted to know about this and you
suggest that he may wish to discuss this
option with his GP when he attends for
review the following week.
Fast-acting nitrates such as GTN have
been the cornerstone of acute angina
management for many years and
their role remains largely unchanged.
Pharmacists have an important and
ongoing role to play in helping patients
optimise their angina management,
through advice on appropriate use of
GTN and other treatments and lifestyle
modifications to reduce the morbidity
and mortality associated with CHD.
Links Archive Australian Pharmacist December 2015 Australian Pharmacist February 2016 Navigation Previous Page Next Page