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PM2D Spring Amy L > Pharmaceutical Care of CV patients I (Role of Pharmacist in Commmunity) > Flashcards

Pharmaceutical Care of CV patients I (Role of Pharmacist in Commmunity) Flashcards

1
Q

List 5 red flag symptoms for CV conditions

A 
Chest pain
Breathlessness
Oedema
Fast heart rate
Dizziness/collapse
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2
Q

How can you differentiate that pain is cardiac pain?

A

Central or band-like
Radiation to jaws/arms/back
Fast pulse
May be relieved by GTN/rest

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3
Q

How can you differentiate that pain is respiratory?

A

Fast respiratory rate
Persistent localised pain
Pain worsens on breathing deeply or coughing
“Knife-like”

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4
Q

How can you differentiate that pain is gastro-intestinal?

A 
Sub-sternal "burning" pain
Often after food or at night
Relieved by antacid
Difficulty swallowing
Tenderness
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5
Q

How can you differentiate that pain is due to infection?

A

High temperature
Previous viral illness
Fast pulse
Infected sputum

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6
Q

List 5 types of drug to avoid in patients with CV disease?

A 
Drugs that:
Have a high sodium content
Increase BP
Increase risk of falls
Cause fluid retention (e.g. NSAIDs)
Increase heart rate
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7
Q

Why should NSAIDs be avoided in patients with CVD?

A

NSAIDs cause fluid retention, renal impairment and interfere with platelet effect of low dose aspirin

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8
Q

Why should triptans be avoided with patients in CVD?

A

Triptans cause vasoconstriction

Treatment of migraines and cluster headaches

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9
Q

What could be the cause of general pain in patients with CVD?

A

Statins - possible side effect = myopathy

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10
Q

What type of pain should paracetamol be taken for in CVD patients?

A

For more severe pain

Take regularly for best control

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11
Q

What two drugs can CVD patients take for pain

A

Paracetamol

Low dose opioids

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12
Q

Why should low dose opioids be avoided if possible in CVD patients?

A

Can increase the risk of falls in the elderly (can cause drowsiness)

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13
Q

What should CVD patients use to treat a fever in colds/flu?

A

Paracetamol

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14
Q

What should CVD patients use to treat blocked sinuses in colds/flu?

A 
Steam inhalation
Avoid decongestants (increase workload of heart)
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15
Q

What should CVD patients use to treat a cough in colds/flu?

A

Steam inhalation
Simple linctus
Pholcodine linctus - if insistent

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16
Q

What should CVD patients use to treat headaches/migraines?

A

Paracetamol - however often tried already
Codeine - good for headaches, watch with the elderly (increases risk of falls)
Migraleve - contains codeine ^^

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17
Q

What should CVD patients NOT USE to treat headaches/migraines and why?

A

Triptans - cause vasoconstriction
NSAIDs - increase fluid retention
Midrid - contains sympathomimetic = may increase heart rate and BP

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18
Q

Why should some CVD patients restrict their fluid consumption?

A

Help prevent symptoms e.g:
Swelling
Weight gain
Shortness of breath

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19
Q

How should CV patients with no fluid restriction treat constipation?

A

Bulk forming laxatives
Lactulose
Encourage fluid intake
Encourage fresh fruit and vegetables, high fibre

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20
Q

How should CV patients with fluid restriction treat constipation?

A

Use stimulant laxatives short term - e.g. senna, docusate sodium
Encourage fresh fruit and vegetables, high fibre

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21
Q

What treatments should not be recommended for patients on warfarin?

A 
Miconazole gel (antifungal) 
Glucosamine (nutritional supplement)
NSAIDs
St John's Wort
Omeprazole (PPI inhibitor) 
Many cold and flu preparations
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22
Q

Why should antihistamines be avoided in patients with CVD?

A

Prolong QT interval and may lead to arrhythmias

23
Q

Why should miconazole gel be avoided by patients on warfarin?

A

Causes increase in INR

Antifungal, often prescribed for oral candidiasis

24
Q

Why should glucosamine be avoided by patients on warfarin?

A

It delays the breakdown of and repairs damaged cartilage

Nutritional supplement

25
Q

Why should NSAIDs be avoided by patients on warfarin?

A

Enhances warfarin’s effects = prone to excessive bleeding

26
Q

Why should St John’s Wort be avoided by patients on warfarin?

A

SJW reduces anticoagulant effect of warfarin

Increased dose of W may be required

27
Q

Why should omeprazole be avoided by patients on warfarin?

A

Omeprazole can prolong the elimination of warfarin
(Reduction in dose of W may be required)
PPI inhibitor

28
Q

Why may CV patients present with tiredness?

A

Drug related - e.g. beta blockers, verapamil (calcium channel blocker)
Worsening of symptoms e.g. heart failure
Anaemia caused by GI bleed (aspirin)

29
Q

Why may CV patients present with constipation?

A

Drug related - e.g. diuretics, verapamil (arrhythmias, angina)
Dehydration - fluid restriction

30
Q

Why may CV patients present with nausea?

A

Side effects of drugs - e.g. digoxin
General malaise associated with condition e.g. heart failure, atrial fibrillation
REFER

31
Q

What is digoxin used for?

A

To treat congestive heart failure and to slow the heart rate for those with atrial fibrillation

32
Q

Why may CV patients present with a cough?

A

Drug-related e.g. ACE inhibitors

33
Q

What are the symptoms that CV patients may show when presenting with a cough?

A

Pink frothy sputum

Crackles in lungs even after coughing

34
Q

Which 5 (types of) cardiovascular drugs should be used with caution due to interactions?

A 
Digoxin = cardiac stimulant (small doses)
Amiodarone = anti-arrhythmic 
Warfarin = anticoagulant
Drugs that slow the heart rate
Drugs that affect electrolytes
35
Q

What is amiodarone used to treat?

A

Ventricular tachycardia or ventricular fibrillation

36
Q

List 4 ways to support patients with CVD

A

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

37
Q

List 3 ways that medicine adherence can be improved

A

Simplify regime
Multi-compartment aids
Counsel the patient on correct use of drugs e.g. GTN
MURs should be based around compliance

38
Q

List 2 ways that risk of CVD can be reduced

A

Stop smoking

Lose weight - aim for BMI of less than 25, regular exercise, good diet

39
Q

What kind of diet should obese patients be recommended to take up?

A

Unsaturated fats
Low salt
Increased fruit and vegetable consumption
Mediterranean diet = fish, bread, vegetables

40
Q

How many units of alcohol should men and women not go over?

A

14 units per week

41
Q

List 3 environmental factors that can increase the risk of CVD

A

Exposed to smoke/pollution
Availability of fast food
Able to walk/cycle safely in order to exercise?

42
Q

List 3 social factors that can increase the risk of CVD

A

Stress
Cigarettes
Alcohol

43
Q

How can therapy for angina be optimised?

A

Does the patient have good control of their symptoms?

Are they using their GTN spray correctly?

44
Q

How can therapy for myocardial infarction be optimised?

A

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?

45
Q

List 5 ways that symptoms may deteriorate in heart failure

A

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)

46
Q

Define: Orthopnoea

A

SOB when lying down

47
Q

Define: Paroxysmal nocturnal dyspnoea

A

Attacks of SOB or coughing, generally occurring at night

48
Q

What is peripheral oedema?

A

Oedema in the tissues perfused by the peripheral vascular system
Usually lower limbs

49
Q

List 4 common side effects of beta-blockers

A

Tiredness
Fatigue
Impotence
Coldness of extremities

50
Q

List 2 common side effects of statins

A

Myalgia (muscle pain)

Myopathy (muscular weakness)

51
Q

Name a side effect of nitrates

A

Headaches

52
Q

Name 2 side effects of calcium channel blockers

A

Ankle swelling

Headahes

53
Q

Name 2 side effects of ACE inhibitors

A

Cough

Dizziness

PM2D Spring Amy L (9 decks)

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