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PM2C: Therapeutics and Patient Care: Summer > Cardiac: Pharmaceutical care in cardiovascular patients two > Flashcards

Cardiac: Pharmaceutical care in cardiovascular patients two Flashcards

1
Q

What are the four things that are managed in cardiovascular patients in hospital?

A
  1. Improve symptoms
  2. Prevent deterioration
  3. Review medicines and lifestyle with patient
  4. Communicate changes to GP
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2
Q

What is the role of the pharmacist in managing hypertension?

A
  1. Monitor Blood Pressure to aim for a blood pressure 140/90 mmHG or below
  2. Compliance
  3. Health promotion
  4. Monitor side effects (especially elderly)
  5. Watch for drug to drug interaction
  6. Watch for disease to drug interaction
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3
Q

What are the common side effects of calcium channel blockers?

A
  1. Headache

2. Ankle oedema

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4
Q

What are the common side effects of ACE inhibitors and how do you solve them?

A
  1. First dose hypotension: Reduce diuretic and use longer acting drugs (Ramipril)
  2. Hyperkalemia: monitor and watch for other drug that raise potassium
  3. Reduction in GFR: 20% reduction in GFR
  4. Cough- excess bradycardia
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5
Q

What are the common side effects of thiazide diuretics?

A
  1. Hypokalaemia: monitor 4 weeks after starting therapy then periodically
  2. Fluid loss: watch for dehydration
  3. Ineffective if GFR is
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6
Q

Give an example of a drug to drug interaction in relation to cardiovascular disease?

A

Drugs may enhance or decrease the anti-hypertensive effect of drugs such as metoprolol with citalopram

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7
Q

Give an example of a disease to disease interaction in relation to cardiovascular disease?

A
  1. Stress may elevate blood pressure

2. Infection may increase or decrease blood pressure

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8
Q

If there is an interaction but it’s not a significant one in drug to drug interactions, what should you do?

A

Monitor the patient

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9
Q

If there is an interaction but it’s a significant one in drug to drug interactions, what should you do?

A
  1. Look for an alternative medication

2. Review the patients blood pressure and review anti-hypertensive if necessary

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10
Q

How do you deal with compliance and adherence in antihypertensive patients?

A
  1. Hypertension is asymptomatic
  2. Warn patients of the adverse reactions that anti-hypertensive drugs have
  3. Patient should be aware of consequences of hypertension
  4. Identify any beliefs or concerns
  5. Consider alternative drug regimens
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11
Q

What is the role of a pharmacist in hospital for ischemic heart disease and heart failure?

A
  1. Monitoring for side effects/effect
  2. Health care promotion
  3. Drug to Drug interactions and drug to disease interactions
  4. Counselling
  5. Control and prevention of side effects
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12
Q

How do you control symptoms and secondary prevention?

A
  1. GTN- sublingual and intravenous infusion
  2. Morphine and diamorphine- Analgesic and vasodilating effect
  3. Aspirin, Ticagrelor, Clopidogrel: Anti-platelet and check contra-indication
  4. Statin, Beta blocker, ACE inhibitor: Patient has a normal cholesterol and normal pressure
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13
Q

What are the main things you should monitor in cardiovascular patients?

A
  1. Blood pressure
  2. Pulse
  3. G.I effects
  4. Signs of bruising and bleeding
  5. Platelets
  6. Hypersensitivity reaction
  7. Cholesterol
  8. U and E’s
  9. Pain
  10. Liver transferase enzymes
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14
Q

What are the side effects of beta blockers?

A
  1. Hypotension
  2. Fatigue
  3. Cold fingers and toes
  4. Impotence
  5. Bradycardia
  6. Broncho constriction
  7. Hypoglycaemia
  8. Sleep disturbances
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15
Q

What are the side effects of Ticagrelor?

A
  1. Gastro-intestinal disturbances- can prescribe PPI
  2. Aspirin hypersensitivity- change to clopidogrel
  3. Bleeding- especially with other drugs affecting clotting
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16
Q

What are the side effects of clopidogrel or Ticagrelor?

A
  1. Increased bleeding risk when used with aspirin- Monitor for bleeding
  2. Thrombocytopenia- Monitor platelets after 7 days
17
Q

What are the side effects of statins?

A
  1. Abdominal pain
  2. Constipation
  3. Asthenia
  4. Headache
  5. Myopathy
  6. Liver dysfunction
18
Q

What are the drug and disease interactions in ischemic heart disease?

A
  1. Respiratory diseases: monitor for symptoms, beta blocker cause (broncho-constriction), Aspirin sensitivity
  2. Renal disease: Monitor ACE
  3. Diabetes: watch for hypoglycaemia with beta blockers
  4. Peripheral vascular disease: discontinue beta blockers
19
Q

How do you counsel patients with myocardial infarction?

A
  1. Information is often overwhelming
  2. Communicate plans: titrating beta blockers and ACE inhibitor
  3. Clopidogrel and ticagrelor: 1 month or 1 year
  4. Continue a beta blocker for 12 months
  5. Treatment and care should be taken into account
  6. Fit in daily life
20
Q

Describe what the stable angina role of pharmacist in hospital?

A
  1. Avoid exacerbation
  2. Avoid discontinuing drugs abruptly: beta blockers can cause rebound tachycardia
  3. Avoid extra strain on heart: hypovolaemia, tachycardia and pain
21
Q

Describe what aims of reducing heart failure?

A
  1. Reduce mortality
  2. Delay disease progression
  3. Control symptoms and improve quality of life
22
Q

What are the primary drugs used in heart failure?

A
  1. Diuretics: remove fluid from longs
  2. ACE inhibitors: lower blood pressure and vascular resistance
  3. Beta blockers: Lower cardiac load on heart by reducing force of contraction
  4. Aldosterone antagonists: reduces mortality
23
Q

How do you control the symptoms of heart failure?

A
  1. Start at low dose
  2. Build up slowly: takes months
  3. Monitor fluid balance
  4. Weight loss
  5. Exercise intolerance
24
Q

What should you monitor in diuretics?

A
  1. Electrolytes and renal function: potassium for hypokalaemia
  2. Fluid balance
  3. Weight loss
  4. Symptoms improvements
25
Q

What should you monitor in ACE inhibitors?

A
  1. Electrolytes and renal function: potassium for hyperkalaemia
  2. Blood pressure
26
Q

What should you monitor in beta blockers?

A
  1. Pulse
  2. Blood pressure
  3. Lung function if asthmatic
27
Q

What should you monitor in Aldosterone antagonists?

A
  1. Potassium
  2. Renal function
  3. Pulse- can arrhythmias
28
Q

What are the medicines optimisations?

A
  1. Ensure patients on best regime: evidence based
  2. Monitor side effects
  3. Manage their medicines
    - Adapt to daily routine
    - Compliance aids
    - Flexible dosing
  4. Perform accurate drugs histories
  5. Communicate changes

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

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