| NEC | not elsewhere classified necrotizing enterocolitis |
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ED (Emergency Department)
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ED (Emergency Department)
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HTN hypertension
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cardiac
ˈkɑːdɪak/
adjective
- 1.relating to the heart.
- 2.relating to the part of the stomach nearest the oesophagus.
noun
informal
- 1.a heart attack.
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| Cardiac stress test cost, performance, advantages and disadvantages shared http://www.racgp.org.au/afp/2012/march/cardiac-stress-testing/ | |||||
| Stress test | MBS rebate $ | Sensitivity % | Specificity % | Advantages | Disadvantages |
| Electrocardiography (EST) | 149 | 68 | 70-77 |
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| Echocardiography (exercise) | 310 | 80-85 | 84-86 |
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| Nuclear perfusion study | 449-834 | 85-90 | 70-75 |
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| CT coronary angiogram | 700 (Requires referral from specialist or consultant physician) | 85-90 | 64-90 |
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| Coronary angiogram | 522-900 | -100 | -100 |
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| MBS = Medicare Benefits Schedule | |||||
GTN sublingual tablets (glyceryl trinitrate)
shared http://www.netdoctor.co.uk/heart-and-blood/medicines/gtn-sublingual-tablets.html
GTN sublingual tablets contain the active ingredient glyceryl trinitrate, which is a type of medicine called a nitrate. It is used to help the heart work more easily. Glyceryl trinitrate is also available without a brand name, ie as the generic medicine.
Glyceryl trinitrate works by being converted in the body to a chemical called nitric oxide. This chemical is made naturally by the body and has the effect of making the veins and arteries relax and widen (dilate). When the blood vessels dilate in this way there is more space inside them and hence less resistance. This makes it easier for the heart to pump blood around the body.
Widening the veins also decreases the volume of blood that returns to the heart with each heartbeat. This makes it easier for the heart to pump that blood out again.
As a result of both these actions, the heart does not need as much energy to pump the blood around the body and therefore needs less oxygen.
Glyceryl trinitrate also widens the arteries within the heart itself, which increases the blood and oxygen supply to the heart muscle.
The pain of angina is caused by too little oxygen reaching the heart when its workload increases, such as during exercise. Glyceryl trinitrate improves the oxygen supply to the heart, as well as decreasing the amount of oxygen that the heart needs by making it easier for the heart to pump blood around the body. It can therefore be used to treat angina.
GTN sublingual tablets are designed to dissolve quickly under the tongue. This area of the mouth has a large supply of blood vessels that allows the medicine to be rapidly absorbed. Glyceryl trinitrate taken in this way is used to give rapid relief from the pain of an angina attack. The tablets can also be used to prevent an anticipated attack, for example before exercise or physical effort, emotional stress or exposure to cold.
Glyceryl trinitrate is also available as skin patches and ointment that can be applied regularly each day to help prevent angina attacks. See the factsheets linked at the end of this article for more information.
What is it used for?
- Prevention and relief of angina attacks.
How do I take it?
- Always use this medicine exactly as your doctor has told you and follow the instructions in the information leaflet provided with the tablets. If you are unclear about anything you can ask your pharmacist or doctor for advice.
- Do not swallow the tablets like normal tablets. Glyceryl trinitrate sublingual tablets should be placed under the tongue and allowed to dissolve slowly. Do not suck or chew the tablets.
- It is best to sit down and rest when you take a tablet as otherwise it can make you feel dizzy.
- To relieve an angina attack you should place one tablet under your tongue and let it dissolve. If your chest pain doesn't improve you can take repeat this dose. However, if your chest pain doesn't improve after 15 minutes you should get medical attention straight away.
- To prevent an angina attack place one tablet under your tongue immediately before you do the activity that is likely to bring on an angina attack, for example before doing exercise or going out in the cold.
- Make sure you keep the bottle of tablets with you at all times in case you need to take one.
Warning!
- Follow the instructions you receive with this medicine. Glyceryl trinitrate sublingual tablets should be allowed to dissolve under the tongue - they should not be swallowed like normal tablets.
- This medicine may cause dizziness and so may affect your ability to drive or operate machinery safely. Do not drive or operate machinery until you know how this medicine affects you and you are sure it won't affect your performance. If you do feel dizzy after taking a dose, sit or lie down until the symptoms pass.
- Drinking alcohol may enhance some of the side effects of this medicine, such as feeling faint or dizzy.
- It is important that your glyceryl trinitrate tablets are kept in the container they are dispensed in. They should not be moved to a different container because the active ingredient can evaporate from the tablets. Always close the lid tightly after you have taken a tablet. Do not put any packing material into the bottle with the tablets.
- The tablets may lose their effectiveness if the container has been open for longer than eight weeks, or if the tablets are transferred to a different container. If there are any tablets left in the bottle eight weeks after you first open it, you should get a new supply and return the unused tablets to your pharmacist.
Use with caution in
- Severely decreased kidney function.
- Severely decreased liver function.
- People who have recently had a heart attack.
- People with low levels of oxygen in their blood, eg due to lung disease or right-sided heart failure.
- People with an underactive thyroid gland (hypothyroidism).
- People who are malnourished.
- People with dangerously low body temperature (hypothermia).
- People with raised pressure in the eyeball or glaucoma.
Not to be used in
- People who are allergic to nitrates.
- People with very low blood pressure (hypotension).
- People with a low volume of circulating blood (hypovolaemia), for example due to severe bleeding.
- People with heart disease involving thickening of the heart muscle (hypertrophic obstructive cardiomyopathy).
- People with inflammation of the sac surrounding the heart that stops the heart from beating properly (constrictive pericarditis).
- People with fluid in the sac surrounding the heart that prevents the heart beating properly (cardiac tamponade).
- People with narrowing of the main artery leaving the heart (aortic stenosis).
- People with narrowing of one of the valves in the heart (mitral valve stenosis).
- People with raised pressure inside the skull, for instance due to a head injury or bleeding in the brain (cerebral haemorrhage).
- People with severe anaemia.
- This medicine is not recommended for use in children.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
- This medicine is not known to be harmful if used during pregnancy. However, it should only be used during pregnancy if the benefits to the mother outweigh any possible risks to the developing baby. Seek further medical advice from your doctor.
- It is not known if this medicine passes into breast milk. It should be used with caution in breastfeeding mothers and only if the benefits to the mother outweigh any risks to the nursing infant. Seek further medical advice from your doctor.
Side effects
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
- Headache.
- Dizziness.
- Feeling weak.
- A drop in blood pressure that occurs when moving from a lying down or sitting position to sitting or standing, which results in dizziness and lightheadedness (postural hypotension).
- Nausea.
- Flushing of the face.
- Increased heart rate (tachycardia).
- Decreased heart rate (bradycardia).
- Fainting.
- Burning or stinging sensation in the mouth.
- Blistering or ulceration of the tongue.
- Allergic skin reactions.
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer. For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
If you think you have experienced a side effect from a medicine or vaccine you should check the patient information leaflet. This lists the known side effects and what to do if you get them. You can also get advice from your doctor, nurse or pharmacist. If they think it’s necessary they'll report it for you.
You can also report side effects yourself using the yellow card website: www.mhra.gov.uk/yellowcard.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while taking this one, to make sure that the combination is safe.
The medicines for erectile dysfunction (impotence) listed below must not be used by people who take glyceryl trinitrate, because the combination can produce a severe drop in blood pressure resulting in dizziness, fainting, or even a heart attack:
- avanafil (Spedra)
- sildenafil (Viagra)
- tadalafil (Cialis)
- vardenafil (Levitra).
If this medicine is taken in combination with other medicines that reduce blood pressure, either as a treatment for high blood pressure (antihypertensives), or as a side effect, there may be an enhanced blood pressure lowering effect. This might make some people feel dizzy. If you do feel dizzy, you should lie down until the symptoms pass. Other medicines that can reduce blood pressure include the following:
- ACE inhibitors, eg enalapril, captopril
- aldesleukin
- alpha blockers, eg alfuzosin, doxazosin
- alprostadil
- anaesthetics
- angiotensin II receptor antagonists, eg losartan
- certain antipsychotic medicines, eg chlorpromazine
- baclofen
- benzodiazepines, eg temazepam
- beta-blockers, eg propranolol
- calcium-channel blockers, eg diltiazem, verapamil, nifedipine
- clonidine
- diazoxide
- diuretics, eg furosemide
- hydralazine
- levodopa
- MAOI antidepressants, eg phenelzine
- methyldopa
- minoxidil
- moxisylyte
- moxonidine
- other nitrates, eg isosorbide mononitrate, amyl nitrate (poppers)
- riociguat
- tizanidine
- tricyclic antidepressants, eg amitriptyline.
Your glyceryl trinitrate sublingual tablets may be less effective if you are taking medicines that can cause a dry mouth. This is because they are not able to dissolve properly under your tongue. Medicines that can cause a dry mouth include the following:
- anticholinergic medicines for Parkinson's disease, eg procyclidine, trihexyphenidyl, orphenadrine
- anticholinergic medicines for urinary incontinence, eg oxybutynin, flavoxate, tolterodine, propiverine, trospium
- antihistamines, eg brompheniramine, chlorphenamine
- antispasmodic medicines, eg hyoscine
- disopyramide
- MAOI or tricyclic antidepressants, eg phenelzine, amitriptyline
- antipsychotic medicines, eg chlorpromazine, clozapine.
If you experience a dry mouth, you can help the GTN tablet dissolve by drinking a mouthful of water before putting the tablet under your tongue.
Other medicines containing the same active ingredient
- Coro-Nitro pump spray.
- Deponit patches.
- Glytrin spray.
- Minitran patches.
- Nitrocine injection.
- Nitro-Dur patches.
- Nitrolingual pump spray.
- Nitromin spray.
- Nitronal injection.
- Percutol ointment.
- Transiderm-nitro patches.
Glyceryl trinitrate sublingual tablets, sprays and injection are also available without a brand name, ie as the generic medicine.
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An electrocardiogram (ECG) is a medical test that detects cardiac (heart) abnormalities by measuring the electrical activity generated by the heart as it contracts. The machine that records the patient's ECG is called an electrocardiograph.
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UEC: normal
Urea Electrolytes and Creatinine
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CXR: normal
Abbreviation for chest x-ray. The definition information for CXR is provided by Stedman's. You can search our medical dictionary here.Medical Searches Navigation.
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Wells score: 0
The Wells score or Wells criteria can refer to one of two clinical prediction rules in clinical medicine
- DVT probability scoring for diagnosing deep vein thrombosis
- Pulmonary embolism probability scoring for diagnosing pulmonary embolism
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Clinical signs or symptoms: No.
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