Cardiac: Pharmaceutical care in cardiovascular patients two Flashcards
What are the four things that are managed in cardiovascular patients in hospital?
- Improve symptoms
- Prevent deterioration
- Review medicines and lifestyle with patient
- Communicate changes to GP
What is the role of the pharmacist in managing hypertension?
- Monitor Blood Pressure to aim for a blood pressure 140/90 mmHG or below
- Compliance
- Health promotion
- Monitor side effects (especially elderly)
- Watch for drug to drug interaction
- Watch for disease to drug interaction
What are the common side effects of calcium channel blockers?
- Headache
2. Ankle oedema
What are the common side effects of ACE inhibitors and how do you solve them?
- First dose hypotension: Reduce diuretic and use longer acting drugs (Ramipril)
- Hyperkalemia: monitor and watch for other drug that raise potassium
- Reduction in GFR: 20% reduction in GFR
- Cough- excess bradycardia
What are the common side effects of thiazide diuretics?
- Hypokalaemia: monitor 4 weeks after starting therapy then periodically
- Fluid loss: watch for dehydration
- Ineffective if GFR is
Give an example of a drug to drug interaction in relation to cardiovascular disease?
Drugs may enhance or decrease the anti-hypertensive effect of drugs such as metoprolol with citalopram
Give an example of a disease to disease interaction in relation to cardiovascular disease?
- Stress may elevate blood pressure
2. Infection may increase or decrease blood pressure
If there is an interaction but it’s not a significant one in drug to drug interactions, what should you do?
Monitor the patient
If there is an interaction but it’s a significant one in drug to drug interactions, what should you do?
- Look for an alternative medication
2. Review the patients blood pressure and review anti-hypertensive if necessary
How do you deal with compliance and adherence in antihypertensive patients?
- Hypertension is asymptomatic
- Warn patients of the adverse reactions that anti-hypertensive drugs have
- Patient should be aware of consequences of hypertension
- Identify any beliefs or concerns
- Consider alternative drug regimens
What is the role of a pharmacist in hospital for ischemic heart disease and heart failure?
- Monitoring for side effects/effect
- Health care promotion
- Drug to Drug interactions and drug to disease interactions
- Counselling
- Control and prevention of side effects
How do you control symptoms and secondary prevention?
- GTN- sublingual and intravenous infusion
- Morphine and diamorphine- Analgesic and vasodilating effect
- Aspirin, Ticagrelor, Clopidogrel: Anti-platelet and check contra-indication
- Statin, Beta blocker, ACE inhibitor: Patient has a normal cholesterol and normal pressure
What are the main things you should monitor in cardiovascular patients?
- Blood pressure
- Pulse
- G.I effects
- Signs of bruising and bleeding
- Platelets
- Hypersensitivity reaction
- Cholesterol
- U and E’s
- Pain
- Liver transferase enzymes
What are the side effects of beta blockers?
- Hypotension
- Fatigue
- Cold fingers and toes
- Impotence
- Bradycardia
- Broncho constriction
- Hypoglycaemia
- Sleep disturbances
What are the side effects of Ticagrelor?
- Gastro-intestinal disturbances- can prescribe PPI
- Aspirin hypersensitivity- change to clopidogrel
- Bleeding- especially with other drugs affecting clotting
What are the side effects of clopidogrel or Ticagrelor?
- Increased bleeding risk when used with aspirin- Monitor for bleeding
- Thrombocytopenia- Monitor platelets after 7 days
What are the side effects of statins?
- Abdominal pain
- Constipation
- Asthenia
- Headache
- Myopathy
- Liver dysfunction
What are the drug and disease interactions in ischemic heart disease?
- Respiratory diseases: monitor for symptoms, beta blocker cause (broncho-constriction), Aspirin sensitivity
- Renal disease: Monitor ACE
- Diabetes: watch for hypoglycaemia with beta blockers
- Peripheral vascular disease: discontinue beta blockers
How do you counsel patients with myocardial infarction?
- Information is often overwhelming
- Communicate plans: titrating beta blockers and ACE inhibitor
- Clopidogrel and ticagrelor: 1 month or 1 year
- Continue a beta blocker for 12 months
- Treatment and care should be taken into account
- Fit in daily life
Describe what the stable angina role of pharmacist in hospital?
- Avoid exacerbation
- Avoid discontinuing drugs abruptly: beta blockers can cause rebound tachycardia
- Avoid extra strain on heart: hypovolaemia, tachycardia and pain
Describe what aims of reducing heart failure?
- Reduce mortality
- Delay disease progression
- Control symptoms and improve quality of life
What are the primary drugs used in heart failure?
- Diuretics: remove fluid from longs
- ACE inhibitors: lower blood pressure and vascular resistance
- Beta blockers: Lower cardiac load on heart by reducing force of contraction
- Aldosterone antagonists: reduces mortality
How do you control the symptoms of heart failure?
- Start at low dose
- Build up slowly: takes months
- Monitor fluid balance
- Weight loss
- Exercise intolerance
What should you monitor in diuretics?
- Electrolytes and renal function: potassium for hypokalaemia
- Fluid balance
- Weight loss
- Symptoms improvements
What should you monitor in ACE inhibitors?
- Electrolytes and renal function: potassium for hyperkalaemia
- Blood pressure
What should you monitor in beta blockers?
- Pulse
- Blood pressure
- Lung function if asthmatic
What should you monitor in Aldosterone antagonists?
- Potassium
- Renal function
- Pulse- can arrhythmias
What are the medicines optimisations?
- Ensure patients on best regime: evidence based
- Monitor side effects
- Manage their medicines
- Adapt to daily routine
- Compliance aids
- Flexible dosing - Perform accurate drugs histories
- Communicate changes
