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Strengths or forms in the product range (naila)

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Strengths or forms in the product range (naila)

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Referred as ischemic heart/ coronary artery/ heart disease

often leading to chest pain or discomfort (angina pectoris)

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Bisoprolol tablets

initial dose : 1.25mg OD

target dose : 10mg OD

Carvedilol tablets

initial dose : 3.125mg BD

target dose : 25-50mg BD

Metoprolol(SR)

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Isosorbide Mononitrate CR

Orally.

Dose : 60mg once daily, up to 120mg once daily.

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 0.4mg Sublingual Spray 200 doses and 0.5mg Sublingual tablet form 

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Glyceryl Trinitrate.

Sublingual tablet form & Sublingual Spray 200 doses.

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Results from imbalance between myocardial blood supply and oxygen demand by heart muscle

as coronary blood supply is inadequate due to plaque build-up (atherosclerosis) -->blocked/ narrowed coronary artery

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Dual Antiplatelet Therapy (DAPT)

Aspirin + Clopidogrel/Ticagrelor

Oral:

Aspirin oral 100mg OM

Clopidogrel 75mg OM

Ticagrelor 90mg BD

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Atorvastatin : 40mg, 80mg

Rosuvastatin: 20mg, 40mg

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Bare Metal Stent

Drug-eluting stent

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male

has higher chance of getting IHD than female before menopause but it becomes the opp after menopause

high stress lifestyle

smoking

hypertension

overweight

physical inactivity

unhealthy diet

diets that contain saturated fats, trans fats, salt and sugar

age

family history of heart disease

high cholesterol diet

diabetes

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caused by a blocked heart blood vessel from atherosclerotic plaque on the walls of coronary artery

Thrombus forms when plaques rupture which obstructs blood flow

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Vegetables

Fruit

Legumes & Nuts

Whole grains

Lean protein

Complex carbohydrates

Dietary fiber

Monosaturated fat

Polyunsaturated fat

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Baked goods

Fired foods with hydrogenated oil/ shortening

Saturated fat

Dietary sodium

Processed Meat

Refined Carbohydrates

Sugar-sweetened beverages

Alcoholic beverages

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Reason: Excessive alcohol intake can contribute to the development of hypertension and a major risk factor for coronary artery disease. Chronic high blood pressure places additional strain on the heart and blood vessels, increasing the risk of atherosclerosis (hardening and narrowing of the arteries).

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Lose weight if current weight is in the unhealthy range.

Reason: Excess weight can place an increase workload on the heart, leading to greater oxygen demand. This can strain the heart and contribute to the progression of coronary artery disease.

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Regulate moderate to high intensity aerobic exercise is recommended.

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Complications, Signs and Symptoms (wxuan)

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Complications, Signs and Symptoms (wxuan)

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Smoking can contribute to the development of atherosclerosis. The chemicals in tobacco smoke can damage the inner lining of blood vessels, leading to the formation of fatty deposits (plaques) on the arterial wall. These plaques can narrow and harden the arteries, reducing blood flow to the heart.

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Carbon monoxide, a toxic component of the cigarette smoke, binds to hemoglobin in the blood more strongly than oxygen, reducing the amount of oxygen that can be carried to the heart and other organs. This can lead to a reduced oxygen supply to the heart muscle

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Chest pain/ discomfort

when some parts of the heart does not receive enough blood due to narrow/clogged arteries

crushing/ heavy/ gripping pain that may also radiate to neck, jaw and arms

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Predictable chest pain

Usually occurs on exertion/ emotional stress

Lasts < 5 minutes

Relieved by rest, Glyceryl trinitrate (GTN) or both

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Heart becomes too weak, stiff

Inability for heart to provide sufficient output to meet demands of body

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Irregular rhythm of heartbeat

Too fast

Too slow

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Unexpected/ unpredictable chest pain

Occurrences are severe, prolonged and possibly at rest

Lasts long <15~20 minutes

Seek immediate medical attention

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Uncomfortable pressure, squeezing, fullness, pain

may radiate to shoulders, arms, back, neck, jaw

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when not enough oxygen is pumping to the heart

Body responds by breathing faster to get more oxygen into body, causing shortness of breath

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Low blood supply to brain, causes tiredness

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Pharm class: ISMN CR

MOA: Causes venous dilation hence reducing preload

Dose: 60 mg once daily; up to 120 mg once daily

Common side effects:

Dizziness, postural hypotension, tachycardia, throbbing headache

Cautions:

Tolerance (reduced therapeutic effects) may develop in patients taking long-acting nitrates.

Reduction of blood-nitrate concentrations to low levels for 4 to 12 hours each day usually maintains effectiveness in such patients.

ISMN CR should be given as OD à to prevent tolerance

Counselling points: Take on empty stomach. Do not chew or crush.

Common side effects are dizziness when getting up quickly from lying or sitting down position, temporary headache, flushing, fast heartbeat and nausea &vomiting. Avoid taking with sildenafil/tadalafil as it may lower blood pressure greatly and could be life-threatening

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Step 1:

Upon the first sign of a heart attack(chest pain, Do not wait until severe pain develops), use one tablet / 1-2 sprays under your tongue. Sit and rest. The medication usually gives relief in less than 5 minutes.

Step 2:

If symptoms persist, continue to sit and rest. Use one tablet / 1-2 sprays under your tongue. Rest for an additional 5 minutes.

Step 3:

If the pain is not relieved after 3 doses, call 995 for an ambulance. You may continue to take 1 tablet / use the spray every 5 minutes to relieve the attack while waiting for the ambulance.

Note:

This medication may cause headache as a side effect. Please take painkillers if necessary. If the headache persists, please consult your doctor.

Rise from a lying to standing position slowly to reduce dizziness (symptoms of postural hypotension.)

Store this medication in a cool dry place, away from sunlight

Always carry this medication with you in the original bottle.

GTN tablet needs to be discarded 2 months after opening. GTN spray needs to prime for first-time use and regularly check if it is working. Store until expiry date after opening.

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Pharm class: Antiplatelets

MOA: Decrease platelet aggregation and reduce thrombus formation in the coronary arteries

Contraindications:

Hypersensitivity to NSAIDs; patients with asthma, rhinitis, and nasal polyps; use in children or teenagers for viral infections, with or without fever.

Dose:

100mg OM

Common side effects:

Generally mild and infrequent but high incidence of GI irritation with slight asymptomatic blood loss, increased bleeding time, bronchospasm and skin reactions in hypersensitive patients.

Counselling points:

Take this medication after food as it may cause gastric irritation/discomfort.

Consult a doctor immediately if blood appears in the urine or stools, black tarry stools occurs or coffee-ground vomitus occurs.

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Pharm class: Antiplatelets- P2Y12 platelet inhibitors

MOA: Decrease platelet aggregation and reduce thrombus formation in the coronary arteries

Contraindications:

Active bleeding, Significant liver impairment or cholestatic jaundice.

Dose:

75mg OM

Common side effects:

Abdominal pain, bleeding disorders (including gastro-intestinal and intracranial, diarrhoea, dyspepsia

Counselling points:

You may take this medication before or after food. If stomach discomfort occurs, please take it after food.

Consult a doctor immediately if blood appears in the urine or stools, black tarry stools occurs or coffee-ground vomitus occurs.

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Pharm class: Antiplatelets - P2Y12 platelet inhibitors

MOA: Same as clopidogrel

Contraindications:

Active bleeding, history of intracranial haemorrhage

Dose:

90mg BD

Common side effects:

Bruising, dyspnoea, haemorrhage

Counselling points:

You may take this medication before or after food. If stomach discomfort occurs, please take it after food.

Consult a doctor immediately if blood appears in the urine or stools, black tarry stools occurs or coffee-ground vomitus occurs.

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Some patients may be prescribed with 2 antiplatelets after they had a recent heart attack OR just had a surgical intervention done (PCI or CABG) to prevent thrombus formation.

Aspirin + Clopidogrel/Ticagrelor

This is NOT therapeutic duplication.

The duration of using two antiplatelets depends on balance between the risk of thrombus formation and bleeding. After completing DAPT,  single antiplatelet therapy should be continued. In most situations, DAPT is indicated for 12 months, and some patients may need to extend the duration of DAPT. Specifically, for percutaneous coronary intervention (PCI) using Drug-Eluting Stents (DES), if patients with low to moderate bleeding/ischemic risk, DAPT is recommended for 6 months.