By Alicia, Adam, Gail, Kerrie

1. Elaine's Medication By Alicia, Adam, Gail, Kerrie

2. Nifedipine • What is Nifedipine? - Help to prevent angina attacks. - Help to reduce blood pressure. - Help to improve circulation.

3. Nifedipine (cont) • How does it Nifedipine work? • Calcium Channel Blocker • Interfere with the displacement of calcium ions into myocardial and smooth muscle cells. • Stops the constriction of blood vessels and myocardium. • Smooth muscle is relaxed  Dilation.

4. Nifedipine (cont) • Indications of Nifedipine in the case Elaine. • Prevent the onset of Angina • Prevent the occurrence of Hypertension.

5. Nifedipine (cont) • Main Cautions • Withdraw if ischemic pain occurs or increases. • Withdraw in Heart failure. • Withdraw in Severe Hypertension • Reduce the dose in Hepatic Impairment. • Caution if the patient suffers with Diabetes Mellitus. • Avoid grapefruit juice due to its effects on call metabolism.

6. Nifedipine (cont) • Contra-Indications • Cardiogenic Shock • Not to be used within 1 month of a myocardial Infarction. • Unstable or acute attacks of angina.

7. Nifedipine (cont) • Side Effects Specific to Nifedipine. • Flushing of the skin • Exaggerated fall in blood pressure. • Gravitational Oedema

8. Nifedipine (cont) • Common Dose • 20mg twice a day increasing to 40mg twice a day depending on severity of disease.

9. Atorvastatin • What is Atorvastatin? • Atorvastatin is a member of the statin group of lipid-lowering drugs.

10. Atorvastatin (cont) • How does it Atorvastatin work? • Reduce the amount of cholesterol made in the liver. • Blocks the action of the enzyme needed for cholesterol production. • Cholesterol contributes to the build up of atheroma, which are like 'fatty lumps' that build up on the inside lining of blood vessels. • The build up of atheroma can lead to heart disease, strokes and other blood vessel problems. • In general, the lower the cholesterol level, the better. Most people who have an MI are advised to take a statin.

11. Atorvastatin (cont) • Indications - Primary hypercholesterolaemia - Heterozygous (het-ero-zygus)

12. Atorvastatin (cont) • Main Cautions • Statins should be used with caution in patients who have a history of liver disease or with a high alcohol intake

13. Atorvastatin (cont) • Interactions • Anticoagulant drugs • Antifungal drugs • Ciclosporin and other immunosuppressant drugs • Other lipid lowering drugs

14. Atorvastatin (cont) • Contra-Indications • Active liver disease • Pregnancy / Breastfeeding • Anticoagulant drugs

15. Atorvastatin (cont) • Side Effects Specific to Atorvastatin • Commonly: • nausea and headache • Rarely: • muscle pain • inflammation • muscle damage

16. Atorvastatin (cont) • Common Dose • Primary hypercholesterolaemia and combined hyperlipidaemia usually 10mg once daily. • Familial hypercholesterolaemia initially 10mg daily increased at intervals of 4 weeks to 40mg once daily if necessary can be further increased to maximum dose of 80mg once daily.

17. Atorvastatin (cont) • Age related issues • Not usually recommended for children.

18. Atorvastatin (cont) • Nurses role • Patients should be advised to follow a low fat diet, and to avoid alcohol to prevent liver damage. • Advise that it is best to take your statin at bedtime as more cholesterol tends to be made by the liver at night rather than during the day. • They should not stop taking the drug without consulting their doctor, as stopping the drug may lead to a recurrence of the original condition. • If a patient occasionally unintentionally takes an extra dose this is unlikely to cause problems however a large overdose may cause liver damage and their doctor should be informed. • Long-term use of Atorvastatin can affect liver function, therefore liver function tests should be carried out before commencing treatment and within 1-3 months of starting treatment and thereafter at intervals of 6 months for 1 year.

19. Streptokinase (Streph-toe-kye-nayz) • What is Streptokinase? • Streptokinase belongs to a group of medicines known as fibrinolytics

20. Streptokinase (cont) • How does it Streptokinase work? • It works by stimulating extra production of a substance produced naturally by the body called plasmin. • Plasmin is produced in the blood to break down the major constituent of blood clots (fibrin), therefore dissolving clots once they have full filled their purpose in stopping bleeding. • Extra production of plasmin caused by streptokinase breaks down unwanted blood clots, for example, in the lungs (pulmonary embolism). It is given intravenously as soon as possible after the onset of a heart attack to dissolve clots in the arteries of the heart wall. This reduces the amount of damage to the heart muscle.

21. Streptokinase (cont) • Indications • Deep vein thrombosis • Acute evolving myocardial infarction • Arterial thrombosis and embolism

22. Streptokinase (cont) • Main Cautions - Risk of bleeding including that from invasive procedures, pregnancy, and external chest compression.

23. Streptokinase (cont) • Interactions - Anti-platelet drug and anticoagulant drugs. There is an increased risk of bleeding if these drugs are given with streptokinase

24. Streptokinase (cont) • Contra-Indications - Current anticoagulation treatment • Disease of the blood vessels in and around the brain (cerebrovascular disease) • Lung disease • Recent bleeding • Recent minor trauma, including biopsies, intramuscular injections, cardiac massage, puncture of major vessels. • Severe liver disease • Recent surgery

25. Streptokinase (cont) • Side Effects • Bleeding or oozing from cuts, gums or wounds. • Fever • Low Blood Pressure • Abnormal heart beats (arrhythmias)

26. Streptokinase (cont) • Common Dose • Deep vein thrombosis, pulmonary embolism, by intravenous, 250000 units over 30 minutes, then 100000 units every hour for up to 12-72 hours. • Myocardial infraction, 1500 000 units over 60 minutes. • May be followed by continuous IV heparin infusion to prevent recurrent thrombosis.

27. Streptokinase (cont) • Age related issues - The need for treatment with a thrombolytic agent may be increased in elderly patients with blood clots. However, the chance of bleeding may also be increased.

28. Streptokinase (cont) • Nurses role • Have emergency drugs and equipment available, in the event of bleeding. • Check access sites for evidence of bleeding. • Continuous monitoring of heart rate and rhythm throughout thrombolytic administration. • Vital observations: record 15 minutely for at least 1 hour from onset of infusion until stable. Hourly for a further hour then hourly for 24 hours.

29. Atenolol (Ah-ten-oh-lohl) • What is Atenolol? • Beta blockers • How does it Atenolol work? - Blocks Beta-2 receptors in the artries causing vasodilation. They ease the work load of the heart. Beta-2 receptors are stimulated by adrenaline and noradrenalin. When the beta-2 receptors are stimulated they make the muscle cells work harder which increases the heart rate and blood pressure. Beta Blockers inhibit this action.

30. Atenolol (cont) • Indications • Angina • Coronary arthrosclerosis • Acute M.I • Hypertension

31. Atenolol (cont) • Main Cautions • Pregnancy • Breast feeding • Avoid abrupt withdrawal • First degree arterial fibrillation

32. Atenolol (cont) • Contra-Indications • Asthma • Obstructive Airways disease • Heart failure.

33. Atenolol (cont) • Side Effects • Baradycardia • Heart failure • Hypotension • Bronchospasms

34. Atenolol (cont) • Common Dose • Hypertension 50mg daily • Angina 100 mg daily in 1 or 2 doses • Arrythmyias 50 – 100mg daily

35. Atenolol (cont) • Nurses role - Closely for hypotension and bradycardia

36. References • British Medical Association (2004) New Guide to Medicines and Drugs, London, Dorling Kindersley • British National Formula (2005) British National Formula, British Medical Association, London • Opie, LH (1997) Drugs for the heart 4th Ed, London, W.B Saunders Company

37. References • Patient UK (2006) Medication after Myocardial Infarction [online] Available http://www.patient.co.uk accessed on 31/10/06. • BMA (2004) New Guide to Medicines and Drugs 6th ed. London: Dorling Kindersley Limited.