Non-pharmacological management for any patient with Cardiovascular Disease
- Stop smoking
- Physical activity
- Aerobic 30min 3d per week
- Resistance 2d per week - Healthy diet
- Low sodium and saturated fat
- Increase vegetables and whole grains - Limit alcohol intake
- Cardiac rehabilitation
NITRATES
Medication, dose, max, frequency and route
Isosorbide dinitrate
10mg - 40mg PO
TID
(max 480mg)
NITRATES
Side effects
HYPOTENSION -
- Orthostatic Hypotension
- Headache
- Reflex tachycardia
- Flushing
- Tolerance
NITRATES
Advices to patient regarding taking treatment
- Warn regarding orthostatic hypotension and to stay well hydrated
- Tolerence - only take treatment every 8 - 12 hours
- Hypotension - avoid taking it with Sildenafil
NITRATES
Contraindications
- Recent head trauma
- Cerebral haemorrhage
- Mitral valve stenosis
- Aortic stenosis
- Hypertrophic Obstructive Cardiomyopathy
- Restrictive Pericarditis
- With Phosphodiesterase 5 Inhibitors - Sildenafil (within 24h)
- Severe Hypotension
NITRATES
Drug interactions
- Phosphodiesterase 5 Inhibitors (sildenafil)
- Alpha Blockers (Prazosin)
- DHP CCB (Amlodipine)
= HYPOTENSION
B-Blockers
Side effects
BBBBBBBBBBBBBBBB
Bradycardia
BP - Hypotension
Breathe - Bronchospasm | Acute pulmonary oedema
Block - Heart Block
BG - Decreased hypoglycemic awareness in DM
Brain - Fatigue | Depression | Impotence
Beweeg - Exercise intolerance | Worsening PVD
Beat - Sotalol = QT prolongation
B-Blockers
Contraindications
BBBBBBBBB
Bradycardia
BP - Cardiogenic shock
Block - Heart block
Beat - Sick Sinus Syndrome | Vasospastic angina
Brain - Cocaine use
Beweeg - Severe PVD
B-Blocker
Overdose - drugs used to treat
- Glucagon
- Calcium gluconate
- Epinephrine
- Insulin euglycemic therapy
DHP CCB
Side effects
- Hypotension
- Headache
- Flushing
- Oedema
- Reflex tachycardia
DHP CCB
Medication, dose, frequency, route
Amlodipine 5 - 10mg PO daily
max 10mg
DHP CCB
CI
- Severe aortic stenosis
2. Obstructive cardiomyopathy
DHP CCB
DI
Increased CCB effect - Macrolides, Grapefruit
CCB increases effects of:
- Amiodarone
- Digoxin
- Statin
- Carbamazepine
Non-DHP CCB
Medication, dose, route, frequency
Verapamil 80mg PO q8h
max 480
Non-DHP CCB
Side effects
- Hypotension
- Bradicardia
- AV Block
- Constipation (Verapamil)
Non-DHP CCB
CI
Bradicardia
AV Block
Heart failure
Cardiogenic shock
Important question to ask a patient before initiating an ACE-I
History of Angioedema
ACE-I
Side effects
- Hyperkalaemia
- Angioedema
- Renal failure
- Dry cough
- Hypotension (fatigue | dizziness | headache)
- Hepatotoxic
- Loss of taste
ACE-I
CI
- Pregnancy
- Renal artery stenosis
- Angioedema
ACE-I
DI
HYPERKALAEMIA - Spironolactone
Increase Lithium LEVELS
NSAIDS - inc BP + Renal failure
NEUTROPENIA - Allopurinol and corticosteroids
HYPOTENSION - Diuretics
ACE-I
Monitoring
- Side effects
- Serum Creatinine
- Potassium
@ baseline + 2 weeks
Stop ACEI if
- K > 5.6
- Increase >30% in serum CREATININE
ACE-I
Risk factors for hyperkalaemia
- K-sparing diuretics | K-supplements | BB | Heparin
- Renal failure
- DM
- Volume depletion
- Advanced age
ACE-I
Management of a patient on Enalapril with dry cough
- Exclude heart failure
- Stop Enalapril
- Change to ARB - Losartan 50mg PO dly
- Advise: cough may take up to 3 weeks to resolve
60 yo smoker in emergency department with
chest pain for 3 hours
cold and sweaty
ECG shows ST segment changes
- No Cath lab available. What class and medication can be considered in this patient immediately
- Contraindications, list 4
- What other classes of medication can be considered for this patient?
- Non pharma advises on follow up
- Thrombolytics - Alteplase
- Active bleeding
- Pericarditis
- Closed head or facial trauma within the prev 3 months
- Ischemic stroke within previous 3 months
- Antiplatelets
- Thienopyradines
- Beta Blockers
- ACEI
- Stop smoking
- Cardiac rehab
- Physical exercise
- Healthy diet
