Assignment Problem: M.S., a 68-year-old accountant, has been diagnosed with coronary artery disease after experiencing chest pain sometimes when he jogs. After undergoing a thorough physical examination, including cardiac catheterization, he is given a prescription for extended-release nitroglycerin capsules, 6.5 mg, three times a day. He also has a prescription for 0.4-mg sublingual nitroglycerin tablets to take as needed for chest pain.
1) What type of angina is M.S. experiencing, and what are the therapeutic goals of the drug therapy he has received?
2) M.S. asks you, "Why do I have two prescriptions for the same drug? It doesn't make sense to me!"
What is the best answer to the patient's question?
3) Two days after he begins the nitroglycerin, M.S. calls the office and says, "I'm having awful headaches. What is wrong?" What is the best explanation, and what can he do about the headaches?
4) After one month, M.S. is switched from the extended-release capsules to a transdermal nitroglycerin patch. He says that he is glad he does not have to remember to "take those pills" three times a day. However, 3 months later, he calls and says, "I don't think this patch is working. I'm having more episodes of chest pain now when I jog."
What could be the explanation for this, and what can be done?