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PM2C: Therapeutics and Patient Care: Summer > Cardiac: Pharmaceutical Care in Cardiovascular Patients One > Flashcards

Cardiac: Pharmaceutical Care in Cardiovascular Patients One Flashcards

1
Q

What are the red flag symptoms for cardiovascular conditions?

A
  1. Chest pain
  2. Breathlessness
  3. Oedema
  4. Fast heart rate
  5. Dizziness and collapsing
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2
Q

How do you know when a pain is cardiac pain?

A
  1. Pain branches from chest to other regions like jaw, arms and legs
  2. Fast pulse
  3. May be relieved by GTN or rest
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3
Q

How do you know when a pain is respiratory pain?

A
  1. Fast respiratory rate
  2. Pain worsens on breathing deeply or coughing
  3. Knife like pain
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4
Q

How do you know when a pain is gastro intestinal pain?

A
  1. Sub-sternal burning pain
  2. Often after food or at night
  3. Can be relieved by antacid (gaviscon)
  4. Difficulty swallowing
  5. Tenderness
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5
Q

How do you know when a pain is a viral infection?

A
  1. Flu like symptoms
  2. Fever
  3. Colour of sputum
  4. Signs of chest infection
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6
Q

When should refer to the GP for cardiovascular diseases?

A
  1. Any of the red flag symptoms
  2. They contact any disease which could cause worsening of symptoms
  3. Drug to disease interaction for responding to symptoms condition
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7
Q

What are the drugs that you should avoid in cardiovascular patients?

A
  1. Drugs that contain high amounts of sodium: draw in more water, higher blood volume, increases blood pressure (antacids)
  2. Drugs that increase blood pressure: pseudoepherdrine
  3. Drugs that increase heart rate
  4. Drugs that cause increase in falls: Opioids and anti-histamines
  5. Drugs that retain fluid
  6. Anti-histamines as they can increase the QT intervals
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8
Q

How do you treat indigestion in patients with cardiovascular disease?

A
  1. Check if it’s indigestion first
  2. Low sodium antacids: Mucogel
  3. H2 antagonists
  4. Proton pump inhibitors: omeprazole, interactions with other drugs such as warfarin and clopidogrel
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9
Q

Why do you recommend not to use NSAIDs on patients with cardiovascular disease?

A
  1. Increase in blood pressure
  2. Can cause a 10% reduction in GFR
  3. Kidneys are one of the first organs to fail in heart failure
  4. Cause fluid retention, renal impairment and interfere with anti-platelet therapy of aspirin

5.

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10
Q

How do you treat pain in cardiovascular patients?

A
  1. Paracetamol: for more severe pain, take regularly

2. low dose opioids: avoid if you can as increase rate of falls in elderly

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11
Q

How do you treat cold and flu in cardiovascular patients?

A
  1. Paracetamol: fever
  2. Blocked sinuses: use steam inhalation and avoid decongestants like sedated
  3. Cough:
    Simple linctus
    Steam inhalation
    Pholcodine linctus if insistent
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12
Q

How do you treat a patient with a migraine?

A
  1. First option: paracetamol (often already tried)
  2. Second option: Codeine: good for headache but can increase risk of fall in elderly
  3. Third option: Migraleve (same as above)
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13
Q

How do you treat patients with constipation in cardio vascular disease that have their fluid restricted?

A
  1. Stimulant laxatives such as senna

2. Encourage fresh fruit, vegetables and high fibre

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14
Q

How do you treat patients with constipation in cardio vascular disease that don’t have their fluid restricted?

A
  1. Bulk forming laxatives
  2. Lactulose
  3. Encourage fluid intake
  4. Encourage fresh fruit and vegetables (natural water) and high fibre
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15
Q

If a patient is on warfarin, what can you recommend for pain if they have cardiovascular issues or not?

A

Best to stick with steam inhalation and pain relief

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16
Q

When a cardiovascular patient presents they are tired, what might be the reason for this?

A
  1. Drug related to beta blocker or verapamil
  2. Worsening of condition: heart disease
  3. Anaemia caused by GI bleeding from aspirin
17
Q

When a cardiovascular patient presents they are constipated, what might be the reason for this?

A
  1. Drug related: verapamil or diuretics

2. Dehydration caused by fluid restriction

18
Q

When a cardiovascular patient presents they are nausea, what might be the reason for this?

A
  1. Drug related: Digoxin

2. General malaise associated with condition (heart failure, atrial fibrillation)

19
Q

When a cardiovascular patient presents they are coughing, what might be the reason for this?

A
  1. Drug related: Ramipril (ACE) may cause coughing
  2. Crackle in lungs
  3. Pink frothy sputum (oedema)
20
Q

Give examples of the cardiovascular drugs that you should watch out for?

A
  1. Digoxin: many drug interactions and a NTI (narrow therapeutic index)
  2. Warfarin
  3. Amiodarone
  4. Drugs that slow heart rate: drugs that treat arrhythmias can cause arrhythmias
  5. Drugs that affect electrolytes: ACE inhibitors can affect potassium levels
21
Q

How do you support patients with cardiovascular disease to adhere to their medication?

A
  1. NMS and MURs
  2. Support medicine adherence: simplify the regime, dosette boxes, counsel patients on correct use of the drug
  3. Life style advice
  4. Self management on side effects of medicines
22
Q

What are the different health promotion schemes that available?

A
  1. Main aim for pharmacists is to try prevent cardiovascular disease as much as possible
  2. Stop smoking schemes
  3. Obesity: losing weight
  4. Regular exercising routine
  5. Diet: unsaturated fats, low salt and veg
  6. Reduction in amount of alcohol
23
Q

What other environmental and social factors can affect cardiovascular disease?

A
  1. Environmental:
    - Pollution
    - Weather
    - Cultures
    - Expensive healthy food, cheap fast food
  2. Social
    - Stress: plaques increase under stress: increases CVD
    - Social smoking and drinking
24
Q

How do you optimise therapy for a patient with angina?

A
  1. Does the patient have good control of their symptoms?

2. Are they using their GTN spray correctly?

25
Q

How do you optimise therapy for patients with myocardial infarction?

A
  1. Does patient experience symptoms of angina or heart failure?
  2. Have their doses been titrated up? Ramipril start at lose dose and increase
  3. Can they discontinue clopidogrel or ticagerol?
  4. Is cholesterol within normal range?
26
Q

How do you optimise therapy for patients with heart failure?

A
  1. Doses may been increased if patient is feeling well

2. Pharmacist involvement can increase the number of patient receiving ACE inhibitors

27
Q

What are the symptoms that are shown when a patient has deterioration in heart failure?

A
  1. Increased SOB and decrease in exercise tolerance
  2. Weight gain of more than 2kg in 2 days
  3. Orthopnoea: difficulty in breathing
  4. Paroxysmal (short burst of dyspnoea (breathlessness))
  5. Development or worsening of peripheral oedema
28
Q

What are the common side effects of beta blockers?

A

Tiredness, fatigue, impotence and coldness of extremities

29
Q

What are the common side effects of statins?

A

Myalgia and myopathy

30
Q

What are the common side effects of nitrates?

A

Headache

31
Q

What are the common side effects of Calcium channel blockers?

A
  1. Ankle swelling

2. Headache

32
Q

What are the common side effects of ACE inhibitors?

A
  1. Cough

2. Dizziness

PM2C: Therapeutics and Patient Care: Summer (25 decks)

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