Self Care in pts. w/CVD +CV risks -Krinsky

What are some OTC products to avoid/ use caution with in HTN or HF?

(just an overview, will get into more detail about each)

What are some OTC products to avoid/ use caution with in HTN or HF?

(just an overview, will get into more detail about each)

Avoid:

• NSAIDs

• Cold/allergy products w/ phenylephrine or pseudoephedrine

• Pepto-Bismal

• meds w/ high sodium content

Caution:

• PPIs

• Loperamide

• Nicotine

• antihistamines

For at home blood pressure monitors, what are the 2 most popular? What is the most accurate and reliable?

(learning objective)

1. Aneroid- 1st choice—> most accurate, most reliable

2. Digital

Describe Aneroid blood pressure monitors:

(learning objective)

• what we most commonly think of!!!!

• involves auscultation w/ the use of a stethoscope to detect Korotkoff’s sounds

Describe digital blood pressure monitors:

(learning objective)

• uses Oscillometric sensors (to detect blood surges under the cuff)

• second best

• can be semiautomatic or fully automatic

Are finger monitors recommended to accurately measure blood pressure?

no

What is a major drawback w/ blood pressure monitors?

you can’t tell if the device is out of calibration

• should be checked yearly

What are some things that should be done in order for an accurate blood pressure reading?

(Ex: no caffeine ___ min before, etc.)

• no caffeine or tobacco 30 min before

• do not eat 30 min before

• keep a log

• allow time to relax

What are the usage guidelines for taking an accurate blood pressure reading?

(like how should the patient be sitting, etc.)

• room should be room temp

• sit in chair, supported, feet flat on the floor

• make sure arm is at heart level

  • if using arm cuff- place on table

  • if using wrist cuff- supported with pillows

• rest for 5 min in this position

• measure bp as directed

If using a stethoscope, to read bp, what are the 5 phases to taking an accurate reading?

Phase 1- sound begins, record systolic BP when two taps are heard

Phase 2- louder tapping, swishing, murmuring

Phase 3- tapping persists, no more swish/murmur

Phase 4- tapping sounds muffled/softer

Phase 5- tapping stops, record Diastolic bp when sound stops

If a patient has a common cold and HTN/HF what symptoms/things what would be excluded?

(this question is really hard to word, I apologize)

• Chest pain

• Underlying cardiopulmonary diseases

What caution should be taken in pts. with HF/HTN and Antihistamines?

antihistamines can cause:

• cardiovascular- tachy/bradycardia and palpitations

• in the elderly- can cause hypotension

What caution should be taken in pts. with HF/HTN and Decongestants?

(learning objective)

decongestants can cause:

• systemic side effects

  • CV stimulation- increased BP, increased HR, arrhythmias

• caution in HTN, IHD

What caution should be taken in pts. with HF/HTN and PPIs?

DO NOT USE together if:

• chest pain

• frequent chest pain

Studys found that OTC NSAIDs can exacerbate what conditions?

HF and osteoarthritis

Loperamide is an antidiarrheal. What are the symptoms of loperamide overdose?

• slowed HR

• heart arrhythmia

• heart attack

What is an FDA warning with Loperamide?

warns about serious heart problems w/ high doses of Loperamide from abuse/misuse

What are the effects of nicotine?

• arousal

• increase in HR and BP

Nicotine should be used in caution w/ pts. that….

have serious underlying CV disease

What OTC product may offer benefit in patients with dyslipidemia and HTN by decreasing BP and LDLs?

(learning objective)

Orlistat

(FYI: Orlistat is an obesity drug)

With Orlistat the change in Blood pressure is ______________ on weight loss and the change in LDL is ___________________ of weight loss. (independent/dependent)

With Orlistat the change in Blood pressure is DEPENDENT on weight loss and the change in LDL is INDEPENDENT of weight loss.

List the 5 forces driving the growth in home diagnostics.

(learning objective)

1. increased public interest in health/ preventative medicine

2. reduced health care costs (pts. can avoid unnecessary visits to providers and can seek earlier tx)

3. reduced access and availability of health care resources

4. increase # of available tests

5. important advances in tech that have led to simple, accurate home tests

What are the major variables to consider when deciding on a home-test?

• test complexity

• ease of reading results

• presence of a control

• cost

When deciding on an at-home cholesterol test what should be considered?

what type of cholesterol the test measures

• some only measure total cholesterol

• some measure LDLs, TGs, etc.

List the criteria for selecting a home INR device.

(learning objective)

• insurance coverage

• ease of use

• process for use (# of steps)

• time to result

• connectivity to providers

Why should NSAIDs not be used in patients on anticoagulant therapy?

(learning objective)

• INCREASES bleeding risk

  • affects platelet aggregation

Describe the FDA requirement for OTC NSAID labeling regarding CV risks.

(learning objective)

OTC labels MUST include heart attack and stroke risk information

A study done with warfarin and NSAIDs found what?

Warfarin+ NSAIDs= high bleeding risk than just warfarin alone

• especially GI bleeding risk

If you are at risk of bleeding, you should be careful with antacids that contain ______________.

aspirin