Cardiac: Pharmaceutical Care in Cardiovascular Patients One Flashcards
(32 cards)
What are the red flag symptoms for cardiovascular conditions?
- Chest pain
- Breathlessness
- Oedema
- Fast heart rate
- Dizziness and collapsing
How do you know when a pain is cardiac pain?
- Pain branches from chest to other regions like jaw, arms and legs
- Fast pulse
- May be relieved by GTN or rest
How do you know when a pain is respiratory pain?
- Fast respiratory rate
- Pain worsens on breathing deeply or coughing
- Knife like pain
How do you know when a pain is gastro intestinal pain?
- Sub-sternal burning pain
- Often after food or at night
- Can be relieved by antacid (gaviscon)
- Difficulty swallowing
- Tenderness
How do you know when a pain is a viral infection?
- Flu like symptoms
- Fever
- Colour of sputum
- Signs of chest infection
When should refer to the GP for cardiovascular diseases?
- Any of the red flag symptoms
- They contact any disease which could cause worsening of symptoms
- Drug to disease interaction for responding to symptoms condition
What are the drugs that you should avoid in cardiovascular patients?
- Drugs that contain high amounts of sodium: draw in more water, higher blood volume, increases blood pressure (antacids)
- Drugs that increase blood pressure: pseudoepherdrine
- Drugs that increase heart rate
- Drugs that cause increase in falls: Opioids and anti-histamines
- Drugs that retain fluid
- Anti-histamines as they can increase the QT intervals
How do you treat indigestion in patients with cardiovascular disease?
- Check if it’s indigestion first
- Low sodium antacids: Mucogel
- H2 antagonists
- Proton pump inhibitors: omeprazole, interactions with other drugs such as warfarin and clopidogrel
Why do you recommend not to use NSAIDs on patients with cardiovascular disease?
- Increase in blood pressure
- Can cause a 10% reduction in GFR
- Kidneys are one of the first organs to fail in heart failure
- Cause fluid retention, renal impairment and interfere with anti-platelet therapy of aspirin
5.
How do you treat pain in cardiovascular patients?
- Paracetamol: for more severe pain, take regularly
2. low dose opioids: avoid if you can as increase rate of falls in elderly
How do you treat cold and flu in cardiovascular patients?
- Paracetamol: fever
- Blocked sinuses: use steam inhalation and avoid decongestants like sedated
- Cough:
Simple linctus
Steam inhalation
Pholcodine linctus if insistent
How do you treat a patient with a migraine?
- First option: paracetamol (often already tried)
- Second option: Codeine: good for headache but can increase risk of fall in elderly
- Third option: Migraleve (same as above)
How do you treat patients with constipation in cardio vascular disease that have their fluid restricted?
- Stimulant laxatives such as senna
2. Encourage fresh fruit, vegetables and high fibre
How do you treat patients with constipation in cardio vascular disease that don’t have their fluid restricted?
- Bulk forming laxatives
- Lactulose
- Encourage fluid intake
- Encourage fresh fruit and vegetables (natural water) and high fibre
If a patient is on warfarin, what can you recommend for pain if they have cardiovascular issues or not?
Best to stick with steam inhalation and pain relief
When a cardiovascular patient presents they are tired, what might be the reason for this?
- Drug related to beta blocker or verapamil
- Worsening of condition: heart disease
- Anaemia caused by GI bleeding from aspirin
When a cardiovascular patient presents they are constipated, what might be the reason for this?
- Drug related: verapamil or diuretics
2. Dehydration caused by fluid restriction
When a cardiovascular patient presents they are nausea, what might be the reason for this?
- Drug related: Digoxin
2. General malaise associated with condition (heart failure, atrial fibrillation)
When a cardiovascular patient presents they are coughing, what might be the reason for this?
- Drug related: Ramipril (ACE) may cause coughing
- Crackle in lungs
- Pink frothy sputum (oedema)
Give examples of the cardiovascular drugs that you should watch out for?
- Digoxin: many drug interactions and a NTI (narrow therapeutic index)
- Warfarin
- Amiodarone
- Drugs that slow heart rate: drugs that treat arrhythmias can cause arrhythmias
- Drugs that affect electrolytes: ACE inhibitors can affect potassium levels
How do you support patients with cardiovascular disease to adhere to their medication?
- NMS and MURs
- Support medicine adherence: simplify the regime, dosette boxes, counsel patients on correct use of the drug
- Life style advice
- Self management on side effects of medicines
What are the different health promotion schemes that available?
- Main aim for pharmacists is to try prevent cardiovascular disease as much as possible
- Stop smoking schemes
- Obesity: losing weight
- Regular exercising routine
- Diet: unsaturated fats, low salt and veg
- Reduction in amount of alcohol
What other environmental and social factors can affect cardiovascular disease?
- Environmental:
- Pollution
- Weather
- Cultures
- Expensive healthy food, cheap fast food - Social
- Stress: plaques increase under stress: increases CVD
- Social smoking and drinking
How do you optimise therapy for a patient with angina?
- Does the patient have good control of their symptoms?
2. Are they using their GTN spray correctly?
