Post on 05-Apr-2018
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Mr. JV, a 67 year old retired plumber, has
recently moved to you area and has come
to the pharmacy to collect his first
prescription. He has a PMH of coronary
heart disease (CHD) and has recently hada coronary stent inserted. The patient is
also suffering from asthma and dyspepsia.
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For Coronary Heart Disease:Coronary artery disease decreases blood supply to the
heart from the blocked coronary artery. The lower bloodflow may fail to meet the heart's demand for oxygen.
Treatment aims to balance blood supply to the heart w/
heart oxygen demand, & prevent worsening of coronary
heart disease. Treatment of coronary artery disease ishighly individual, and must be based on a patient's
symptoms and diagnostic test results.
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For Asthma:
Treatment of asthma has 2 aims: (a) relief of
symptoms, (b) reduction of airways inflammation.
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ASPIRIN
Alcohol may increase risk of GI ulceration and prolong
bleeding time. Corticosteroids may decrease aspirin level. Decreased antihypertensive effect of beta-blockers.
Unexpected hypotension may occur with nitroglycerin.
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BETA-BLOCKER
Calcium channel blockers can lower of blood pressure& heart rate to dangerous levels when administered
together with metoprolol. Verapamil will cause increase of blood plasma level of
either drug. It is important to monitor cardiacfunction due to additive effects.
May cause shortness of breath in asthmatic.
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NITROGLYCERIN (NITRATES)
Possible additive hypotensive effect when used
concomitantly w/ -blockers, antihypertensives. Aspirin may enhance vasodilatory and hemodynamic
effects of nitroglycerin. Calcium Channel blocker: Symptomatic orthostatic
hypotension may occur. Since alcohol also may intensify the blood pressure
lowering effect of nitroglycerin, patients receiving
nitroglycerin should be advised to drink alcoholic
beverages with caution.
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CALCIUM CHANNEL BLOCKERS
Beta-blockers: May result in increased hypotension
resulting to bradycardia, peripheral edema, CHF, AV
block and asystole because of additive depressant
effects on myocardial contractility or AV contraction.
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STATINS
Consumption of grapefruit or grapefruit juice inhibits
the metabolism of statinsfuranocoumarins in
grapefruit juice inhibit the cytochrome P450 enzyme
CYP3A4, which is involved in the metabolism of most
statins.
Elevate function test (ALT, EST) Headache and dyspepsia frequently occur. Virapamil (Ca channel blocker) may increase risk of
myopathy and rhabdomyolysis. Dont exceed 20 mg
of statin
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BETA 2-AGONIST
-blockers:Pulmonary effects of salmeterol may be
blocked and may produce severe bronchospasm in
patient with COPD. -blockers precipitate
bronchospasm and increase the dose of B-agonist
necessary to achieve bronchodilation.
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CORTICOSTEROID
May increase risk of GI distress and bleeding.
Use together cautiously.
May decrease salicylate level. Monitor patientfor lack of salicylate effectiveness.
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PROTON PUMP INHIBITORS
No known interaction with other medication taken
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Aspirin:
Take 75-325 mg once daily.
Beta-Blockers (Metoprolol):
Maintenance: 100-200 mg daily. Can be combined
w/ other antihypertensive.
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Nitroglycerin (Gen-Nitro (Sublingual tablet)):
(Oral) 0.3 to 0.6 mg dissolved under the tongue or
in buccal pouch at first sign of acute angina attack;
repeat q 5 min (do not exceed 3 tabs in 15 min). Also
may be used as a single dose 5 10 min beforeactivity that might precipitate an angina attack.
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Calcium channel blocker (Verapamil):
(Oral) 40 160 mg tid. Do not exceed 480 mg/day.
Statins (Simvastatin):
Initial dose: 20 mg & may be adjusted at intervals of
not
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Beta 2-agonist (Salmeterol):
(Inhalationtn) 1 inhalation (50mcg) bid, approx 12 hr
apart.
Corticosteroid (Prednisolone):
5 60 mg/day
Esomeprazole:
The dose for preventing NSAID-induced ulcers is
20 to 40 mg daily up to 6 months.
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ASPIRIN:
Avoid drinking alcohol. Alcohol may increase your risk
of stomach bleeding.
Instruct patient to take drug with food or after meals &w/ full glass of water to reduce unpleasant GI reaction. Instruct patient to report ringing in ears or unusual
bleeding, bruising, or persistent GI pain.
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-BLOCKERS:
toprolol may worsen the symptoms of heart failure inme patients. Check with your doctor right away if you
having chest pain or discomfort; dilated neck veins;
treme fatigue; irregular breathing; an irregular heartbeatortness of breath; swelling of the face, fingers, feet, orer legs; weight gain; or wheezing.
e this drug with meals.not stop abruptly.
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-BLOCKERS:
medicine may cause changes in your blood sugar levelsmedicine may cause some people to become less alertn they are normally.
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NITROGLYCERIN:
Advise patient that headaches are a common sideeffect of therapy and are also a marker of antianginal
effectiveness. Caution patient not to crush, chew, or swallow
sublingual tablets. Advise patient to discontinue nitroglycerin and notify
healthcare provider if vision blurring and dry mouth
occurs. Advise patient that stopping drug abruptly causes
spasm of the coronary arteries.
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CALCIUM CHANNEL BLOCKER:
Tell patient if dose is missed to take as soon as
possible. If several hours have passed or if nearing
time for next dose, tell patient not to double dose to
catch up unless advised by healthcare provider. Advise patient that drug may cause dizziness and to
use caution while driving or performing other tasks
requiring mental alertness until effect of drug have
stabilized.
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CALCIUM CHANNEL BLOCKER:
Tell patient to swallow whole, do not cut, crush or
chew. May cause nausea, headache, vomiting, dizziness,
depression, constipation, irregular heartbeat,swelling of hands and feet.
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STATINS:
Advise patient to control weight and to adhere to
prescribed dietary regimen. Instruct patient to report the following symptoms to
healthcare provider: any unexplained muscle pain,tenderness, or weakness, especially if accompanied
by fever or malaise; yellowing of skin or eyes. Take drug in the evening. Have periodic blood test.
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BETA 2-AGONIST (INHALATION):
If rash and urticaria, appears which signal a
hypersensitivity reaction, patient should inform
prescriber. Instruct patient not to stop the medication once
symptoms have been controlled. Continued daily
use is necessary to continue control of symptoms. Use only twice a day or as instructed. May occur headache, tremors, fast heart and
palpitations.
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CORTICISTEROID:
Instruct patient to take medication with meals or snack
to avoid GI irritation.
Caution patient not to take with aspirin unless directedwith health care provider.
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PPI:
Instruct patient to take each dose on an empty
stomach at least 1 hr before eating. Tell your doctor immediately if you have: heartburn
combined with lightheadedness/ sweating/dizziness,chest pain or shoulder/jaw pain (especially with trouble
breathing), pain spreading to arms/neck/shoulders,
unexplained weight loss.
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