A63 years old female patient was brought to the emergency room withpain in the left shoulder and admitted to the telemetry unit. Ananalysis of electrocardiogram and enzyme confirmed a case of acutemyocardial infarction. A catheterization procedure, which included astent on the right coronary artery, was successful. The past medicalhistory that has significance in the current case is hypertension,which has been treated with HCTZ 25 mg daily in the last ten years.Additionally, the patient is overweight and lives a sedentarylifestyle. Her secretarial job is less physical she has no time forregular exercise and prefers fast foods. Further, she has beendiagnosed with type 2 diabetes and, therefore, requires additionalmedication.
Thepatient has several prescribed drugs, which include HTCZ 25mg dailyfor hypertension, Metformin 250 bid daily for diabetes, andatorvastatin (Lipitor) 80 mg daily, ASA 81mg daily, clopidogrel 75 mgdaily, metoprolol 100 mg bid and enalapril (Vasotec) 10 mg daily fortreatment of coronary artery disease. The physician prescribed thedrug to assist in the management of the conditions. However, someside effects and contraindications are likely to emanate from them.
Metforminis used, together with other interventions such as physical exerciseand diet, in the regulation of blood sugar in type 2 diabetespatients. The drug prevents the risks associated with high levels ofblood sugar. The patient is required to swallow the tablet withplenty of fluids. Some of the side effects and contraindications mayinclude stomach upset, metallic taste and general body weakness.Persistent adverse effects must be reported to the nurse, pharmacistor physician (Karch, 2013).
Thedrug is an HMG-CoA reductase inhibitor that is used to reduce thelevel of LDL (‘bad’ cholesterol) and increase HDL (‘good’cholesterol) in the blood. This reduces the risk of severalcardiovascular diseases. The patient should avoid foods rich in fatsto reduce contraindication. The medication should be combined withother interventions, mainly adopting a healthy lifestyle. The tabletsshould be swallowed whole, and she should avoid alcohol or grapefruitproducts. Some of the side effects may include mild musculoskeletaland gastrointestinal problems. Any unexplained problems such askidney problems or sign of stroke should be reported immediately(Jagadeesh, 2015).
ASAis administered to relief pain, inflammation, fever and inhibitclotting. It is essential in reducing the risk of stroke or heartattack. Some of the side effects of ASA include abdominal pain orburning, nausea, buzzing ears, and general body weakness (Karch,2013).
Clopidogrelis used in patients with cardiovascular diseases because it preventsthe aggregation of platelets. It prevents them from sticking to thewalls of blood vessels. This reduces the risk of heart diseases andstroke. It can be used together with ASA to keep the veins andarteries open after catheterization and cardiac stent procedures.Some of the most important side effects associated with the druginclude continuous breeding due to the anticlotting properties andgastrointestinal problems such as mild abdominal pains andconstipation. However, any persistent or worsening symptom should bereported without delay (Jagadeesh, 2015).
Metoprololis a beta blocker which has a direct impact on the heart activitiesand the blood circulation system. Its primary uses include thetreatment of hypertension, angina, and related discomforts, andprevention of acute cardiovascular conditions such as heart attack.The drug should not be used in patient with severe heart blockage,circulation problems or low heart rate. Some of the side effects arebreathing problems, lower heart rate, rash, increased interest insexual activities and gastrointestinal discomfort. The patient mayalso experience mild dizziness and fatigue. These effects can worsenresulting in cold limbs, severe fatigue, and depression. The drug caninteract with other medications such as herbal alternatives orvitamin supplements, which may worsen the contraindications(Jagadeesh, 2015).
Enaloprilis an ACE inhibitor used in the management of various cardiovascularconditions such as hypertension, heart dysfunction, and heart attack.It also plays a significant role in preventing the kidneys from theimpacts of these diseases. For example, patients with persistentlyhigh blood pressure are given this drug to reduce the risk of renalfailure. The main caution associated with the use of enalapril isavoidance of pregnancy. Some of the common side effects are serumcreatinine (which is related to high risk of kidney diseases), drycough, reduced blood pressure and dizziness. Adverse events likeswelling of the face should be reported to the doctor, nurse orphysician (Karch, 2013).
Otherguidance to the patient
Inaddition to the provision of information on how to use the drugs andpossible side effects, it is important for the nurse to providesupplementary training. This may include the risk associated with thecondition and some of the lifestyle changes that can improve thepatient health (Karch, 2013). For example, the client can be advisedon the importance of healthy diet and physical exercise. The need forfrequent checkups should also be emphasized. Additionally, it isimportant to warn the client against the use of over the countermedications and herbal supplements, which are not recommended by thephysician. It will prevent possible contraindications. Due to thecondition of the patient, it is important to inform her about anginaand the risks associated with it. This includes the signs andsymptoms, both chest discomforts and others, as well as possiblecomplications. It will enable her to respond adequately to angina,including cases of emergency.
Jagadeesh,G. (2015). Pathophysiologyand pharmacotherapy of cardiovascular disease.Swetzerland: Adis.
Karch,A. (2013). Focuson nursing pharmacology(6th ed.). Philadelphia: Lippincott Williams & Wilkins.
Karch,A. (2013). Studentresource: Focus on nursing pharmacology(6th ed.). Philadelphia: Lippincott Williams & Wilkins.
LaureateEducation (2009). Pathopharmacology.Baltimore: Laureate Education