Coronary Heart Disease With Asthma

7/31/2019 Coronary Heart Disease With Asthma

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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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Coronary Heart Disease With Asthma