Pharmaceutical Care of CV patients I (Role of Pharmacist in Commmunity) Flashcards
List 5 red flag symptoms for CV conditions
Chest pain Breathlessness Oedema Fast heart rate Dizziness/collapse
How can you differentiate that pain is cardiac pain?
Central or band-like
Radiation to jaws/arms/back
Fast pulse
May be relieved by GTN/rest
How can you differentiate that pain is respiratory?
Fast respiratory rate
Persistent localised pain
Pain worsens on breathing deeply or coughing
“Knife-like”
How can you differentiate that pain is gastro-intestinal?
Sub-sternal "burning" pain Often after food or at night Relieved by antacid Difficulty swallowing Tenderness
How can you differentiate that pain is due to infection?
High temperature
Previous viral illness
Fast pulse
Infected sputum
List 5 types of drug to avoid in patients with CV disease?
Drugs that: Have a high sodium content Increase BP Increase risk of falls Cause fluid retention (e.g. NSAIDs) Increase heart rate
Why should NSAIDs be avoided in patients with CVD?
NSAIDs cause fluid retention, renal impairment and interfere with platelet effect of low dose aspirin
Why should triptans be avoided with patients in CVD?
Triptans cause vasoconstriction
Treatment of migraines and cluster headaches
What could be the cause of general pain in patients with CVD?
Statins - possible side effect = myopathy
What type of pain should paracetamol be taken for in CVD patients?
For more severe pain
Take regularly for best control
What two drugs can CVD patients take for pain
Paracetamol
Low dose opioids
Why should low dose opioids be avoided if possible in CVD patients?
Can increase the risk of falls in the elderly (can cause drowsiness)
What should CVD patients use to treat a fever in colds/flu?
Paracetamol
What should CVD patients use to treat blocked sinuses in colds/flu?
Steam inhalation Avoid decongestants (increase workload of heart)
What should CVD patients use to treat a cough in colds/flu?
Steam inhalation
Simple linctus
Pholcodine linctus - if insistent
What should CVD patients use to treat headaches/migraines?
Paracetamol - however often tried already
Codeine - good for headaches, watch with the elderly (increases risk of falls)
Migraleve - contains codeine ^^
What should CVD patients NOT USE to treat headaches/migraines and why?
Triptans - cause vasoconstriction
NSAIDs - increase fluid retention
Midrid - contains sympathomimetic = may increase heart rate and BP
Why should some CVD patients restrict their fluid consumption?
Help prevent symptoms e.g:
Swelling
Weight gain
Shortness of breath
How should CV patients with no fluid restriction treat constipation?
Bulk forming laxatives
Lactulose
Encourage fluid intake
Encourage fresh fruit and vegetables, high fibre
How should CV patients with fluid restriction treat constipation?
Use stimulant laxatives short term - e.g. senna, docusate sodium
Encourage fresh fruit and vegetables, high fibre
What treatments should not be recommended for patients on warfarin?
Miconazole gel (antifungal) Glucosamine (nutritional supplement) NSAIDs St John's Wort Omeprazole (PPI inhibitor) Many cold and flu preparations
Why should antihistamines be avoided in patients with CVD?
Prolong QT interval and may lead to arrhythmias
Why should miconazole gel be avoided by patients on warfarin?
Causes increase in INR
Antifungal, often prescribed for oral candidiasis
Why should glucosamine be avoided by patients on warfarin?
It delays the breakdown of and repairs damaged cartilage
Nutritional supplement
Why should NSAIDs be avoided by patients on warfarin?
Enhances warfarin’s effects = prone to excessive bleeding
Why should St John’s Wort be avoided by patients on warfarin?
SJW reduces anticoagulant effect of warfarin
Increased dose of W may be required
Why should omeprazole be avoided by patients on warfarin?
Omeprazole can prolong the elimination of warfarin
(Reduction in dose of W may be required)
PPI inhibitor
Why may CV patients present with tiredness?
Drug related - e.g. beta blockers, verapamil (calcium channel blocker)
Worsening of symptoms e.g. heart failure
Anaemia caused by GI bleed (aspirin)
Why may CV patients present with constipation?
Drug related - e.g. diuretics, verapamil (arrhythmias, angina)
Dehydration - fluid restriction
Why may CV patients present with nausea?
Side effects of drugs - e.g. digoxin
General malaise associated with condition e.g. heart failure, atrial fibrillation
REFER
What is digoxin used for?
To treat congestive heart failure and to slow the heart rate for those with atrial fibrillation
Why may CV patients present with a cough?
Drug-related e.g. ACE inhibitors
What are the symptoms that CV patients may show when presenting with a cough?
Pink frothy sputum
Crackles in lungs even after coughing
Which 5 (types of) cardiovascular drugs should be used with caution due to interactions?
Digoxin = cardiac stimulant (small doses) Amiodarone = anti-arrhythmic Warfarin = anticoagulant Drugs that slow the heart rate Drugs that affect electrolytes
What is amiodarone used to treat?
Ventricular tachycardia or ventricular fibrillation
List 4 ways to support patients with CVD
Support medication adherence
Offer lifestyle advice
Provide advice on recognising and responding to symptom deterioration/medicines optimisation
Providing self-management advice on side effects
Can be achieved by MURs and NMS
List 3 ways that medicine adherence can be improved
Simplify regime
Multi-compartment aids
Counsel the patient on correct use of drugs e.g. GTN
MURs should be based around compliance
List 2 ways that risk of CVD can be reduced
Stop smoking
Lose weight - aim for BMI of less than 25, regular exercise, good diet
What kind of diet should obese patients be recommended to take up?
Unsaturated fats
Low salt
Increased fruit and vegetable consumption
Mediterranean diet = fish, bread, vegetables
How many units of alcohol should men and women not go over?
14 units per week
List 3 environmental factors that can increase the risk of CVD
Exposed to smoke/pollution
Availability of fast food
Able to walk/cycle safely in order to exercise?
List 3 social factors that can increase the risk of CVD
Stress
Cigarettes
Alcohol
How can therapy for angina be optimised?
Does the patient have good control of their symptoms?
Are they using their GTN spray correctly?
How can therapy for myocardial infarction be optimised?
Is the patient experiencing symptoms e.g. angina,heart failure
Have their doses been up titrated?
Can they discontinue their clopidogrel/ticagrelor (antiplatelets)
Is their cholesterol within normal range?
List 5 ways that symptoms may deteriorate in heart failure
Increased SOB with decrease in exercise tolerance
Weight gain of more than 2kg in 2 days
New orthopnoea
Paroxysmal nocturnal dyspnoea
Development or worsening of peripheral oedema (lower limbs) or ascites (accumulation of fluid in the abdomen)
Define: Orthopnoea
SOB when lying down
Define: Paroxysmal nocturnal dyspnoea
Attacks of SOB or coughing, generally occurring at night
What is peripheral oedema?
Oedema in the tissues perfused by the peripheral vascular system
Usually lower limbs
List 4 common side effects of beta-blockers
Tiredness
Fatigue
Impotence
Coldness of extremities
List 2 common side effects of statins
Myalgia (muscle pain)
Myopathy (muscular weakness)
Name a side effect of nitrates
Headaches
Name 2 side effects of calcium channel blockers
Ankle swelling
Headahes
Name 2 side effects of ACE inhibitors
Cough
Dizziness
