Problem
Case Study
Mr. Malcolm Reddy is an 84-year-old man who has had hypertension and hypercholesterolemia for many years. He also has episodic angina. To manage his hypertension and hypercholesterolemia, Malcolm is prescribed atenolol and simvastatin respectively. At home, he also uses Glyceryl Trinitrate Nitrolingual (GTN) spray PRN.
Part I: Hospitalisation Recently, Malcolm had a fall and sustained a lower leg laceration. He was admitted overnight to a hospital medical ward for observation and care of his leg wound. His medications have been written up in the chart (see Appendix). Malcolm is sharing a room with three other patients, Mr. Rama Ali, Mr. Malcolm Relly, and Mr. Sun Nyguen. Malcolm notes that the ward is very busy. The registered nurse (RN) has been rushing in and out of the room and appears tired. The RN comes to Malcolm's bedside to introduce themself. When the RN is at Malcolm's bedside, Malcolm comments on how busy and noisy the ward is, particularly given it is the morning. The RN explains that several nurses have called in sick. "I'm working a double shift", says the RN, "It's my sixth day in a row working". The RN tells Malcolm that, due to budget constraints, the health service now has a policy that minimises the recruitment of agency nurses. As a result, nurses from other wards are trying to 'fill the gaps' whenever they can. "Even this morning, an RN was allocated late to work on our ward and missed handover", says the RN. After planning their day, the RN comes to assist Malcolm with a shower and gathers his toiletries. The RN notices a nitrolingual spray labelled with Malcolm Reddy's name. The RN asks Malcolm if this is his. "Yes", says Malcolm, "I take it for angina, but I haven't used it for months. I told the doctor about it when I came into hospital yesterday. I didn't think they were listening to me". The RN responds, "Ah, I see. That information about your angina and GTN wasn't handed over to me when I started my shift". It is 08:00 and Malcolm's medication is now due. The RN provides Malcolm with his medication in a cup. He looks at the tablets and states, "this is not my tablet. When I take my Noten at home, it is a different shape - it's usually oblong. This one is round". The tablet provided to Malcolm by the RN is shown below (front and back).
Part II: Discharge Planning A few days later, Malcolm is due to be discharged to home from the ward. His discharge medications include atenolol, simvastatin, paracetamol (PRN), and GTN (PRN). As part of his discharge planning, the RN plans a short education session with Malcolm about the medications he will be taking at home.
Task
Using your knowledge of the product information and pharmacological properties of GTN, discuss five key considerations related to GTN that the RN will include in their education session with Malcolm.