MODULE 7: COMMON CONDITIONS AND SOME OF THE DRUGS USED TO TREAT THEM

Transcription

1 MODULE 7: COMMON CONDITIONS AND SOME OF THE DRUGS USED TO TREAT THEM 6.1: The Heart & Blood Circulation The heart is a muscular organ about the size of a fist, located just behind and slightly left of the breastbone. The heart pumps blood through the network of arteries and veins called the cardiovascular system. Because it is a muscle, the heart needs its own blood supply (the coronary arteries) too. It is the job of the arteries and veins to transport blood around the body to where it is needed Common Problems that Occur in the Heart or Circulation Angina - not enough blood is getting to the heart muscle - usually temporary - causes a feeling of discomfort or pain in the chest Heart Attack (Myocardial Infarction) - the blood supply to the heart muscle is blocked and often this damages the heart muscle - causes chest pain, shortness of breath, feeling of sickness Stroke - the blood supply to part of the brain is blocked - causes a variety of symptoms e.g. numbeness, loss of vision, inability to communicate, problems with balance & co-ordination Transient Ischaemic Attack (TIA) - the symptoms of a TIA (also called mini-strokes ) are the same as that of a stroke except they completely disappear (this may take a few mins or a few hours) Deep Vein Thrombosis - a blood clot in one of the deep veins (usually thigh or calf) - it causes pain and swelling in the leg - if a small piece of the clot breaks off it can travel to another part of the body and block the blood vessels there (most commonly this happens in the lung; this is known as a Pulmonary Embolus) Hypertension - high blood pressure - increases the risk of a heart attack or a stroke - rarely any symptoms Heart Failure - the heart becomes weak and less able to pump the blood around the body - causes breathlessness, tiredness and water retention (oedema) at the ankles. (Please note that not all ankle oedema is caused by heart failure) 31

2 6.1.2 Common Heart Medicines The following is a summary of the most common drugs used to treat the heart and circulation conditions listed above. The list and information is not exhaustive so if in doubt, please speak to a pharmacist or GP. Purpose of Drug Common Drugs Common side-effects that might be noticed Comments Aspirin and indigestion Small risk of bleeding Bruising Generally given as a dispersible To thin blood and so reduce risk of blood clots Clopidogrel and indigestion Lowest risk of bleeding Bruising Warfarin Higher risk of bleeding than aspirin or clopidogrel Bruising Requires regular blood monitoring (INR) Daily doses will change To reduce cholesterol (cholesterol can block arteries) Simvastatin Artorvastatin Rosouvastatin Muscle pain/cramps Best given at night BUT timing can be changed to morning Lisinopril Ramipril Cough Skin swelling/itchy skin Also helps reduce symptoms of heart failure and can protect kidneys Losartan Candesartan Dizziness Headache To reduce blood pressure Bendroflumethiazide Amlodipine Felodipine Water retention (ankle swelling) Flushing Also helps to reduce water retention Atenolol Bisoprolol Carvedilol Tiredness Dizziness Coldness in hands & feet Breathing problems Bisoprolol and carvedilol also help reduce symptoms of heart failure. All can help regulate the heart beat To treat water retention and/or heart failure Furosemide Bumetanide Increased urination Light-headedness when going from sitting to standing For patients with poor mobility and/or bladder control, the increased urination can be quite stressful 32

3 6.2 Bones and Joints Common Problems that Occur in the Bones and Joints Osteoarthritis - wear and tear to the joints resulting in pain, stiffness and reduced mobility - hip and knees are most commonly affected Rheumatoid Arthritis - autoimmune condition where the body attacks the joint linings causing pain, stiffness, swelling and reduced mobility - hands, wrist and feet most commonly affected Osteoporosis - thinning of the bones causing them to be weak and fragile and therefore more likely to break (fracture) Fractures - Older people commonly experience fractures from falls which would not effect younger people. If they have osteoporosis they are more likely to experience a fracture 33

4 6.2.2 Common Medicines Used to Treat Bone and Joint Problems The following is a summary of the most common drugs used to treat the bone and joint conditions listed on the previous page. The list and informationis not exhaustive so if in doubt, please speak to a pharmacist or GP. Purpose of Drug Common Drugs Common side-effects that might be noticed Comments Painkiller Paracetamol Rarely experience side-effects Important not to exceed the maximum daily dose of 8 tabs. Avoid other medicines containing paracetamol Painkiller (weak opiate) Painkiller (strong opiate) Codeine Dihydrocodeine Tramadol Morphine (MST, Sevredol ) Fentanyl (Durogesic patches) Oxycodone (OxyNorm, OxyContin ) Constipation Dry mouth Drowsiness Confusion Cocodamol = paracetamol & codeine Codydramol = paracetamol & dihydrocodeine Anyone on regular opioids should also have laxatives. All opioids are addictive Anti-inflammatory painkiller Diclofenac Naproxen Ibuprofen Indigeston/heartburn Bleeding Take with or after food to protect stomach Drugs to stop the Rheumatoid Arthritis Methotrexate Must seek medical advice if the person develops breathlessness, cough, sore throat, fever or any other sign of infection. Rash Regular blood monitoring is essential as methotraxate can affect the immune system Methotrexate is only ever given WEEKLY To strengthen bones Risedronate Alendronate Calcium & Vitamin D supplements (Calcichew D3 Forte, Adcal D3 ) If the person develops trouble swallowing, pain on swallowing or heartburn, contact the GP Rarely experience side-effects The drug can irritate the lining of the throat & stomach so must be taken while sitting upright and with plenty of water Most are chewable 34

5 6.3 The Brain Common Problems Affecting the Brain Trouble Sleeping - ageing changes your sleep pattern; older people find it harder to fall asleep, find they wake more easily (and more often) and sleep less Anxiety - feelings of fear, worry, apprehension, or dread that are excessive or disproportional to the problems or situations that are feared. Common feards about aging can lead to anxiety. Many older adults are afraid of falling, making ends meet, being dependent on other, being left alone and dying Depression - symptoms of depression can be complex and vary widely between people. In general, depression can be defined as sustained feelings of sadness and hopelessness that results in an inability to enjoy life. Physical illness increases the likelihood of depression so although it is not part of the ageing process, older people are commonly affected Dementia - Dementia is a word used to describe a group of symptoms including memory loss, confusion, mood changes and difficulty with day-to-day tasks. There are many causes of Dementia, with Alzheimer s the most common. Currently, there is no cure Parkinson s Disease (PD) - People with PD don t have enough of a chemical called dopamine in their brain and this affects their ability to move. Tremor, rigidity and slowness of movement all occur over time. Currently, there is no cure 35

6 6.3.2 Common Problems Used to Treat Problems in the Brain The following is a summary of the most common drugs used to treat the neurological (brain-related) conditions listed on the previous page. The list and information is not exhaustive so if in doubt, please speak to a pharmacist or GP. Purpose of Drug Common Drugs Common side-effects that might be noticed Comments Sedative - to induce sleep Temazepam Zopiclone Confusion (leading to falls and injury) Ironically, some people become more hostile and aggressive when on these drugs. Sedative - to calm anxiety Diazepam Lorazepam Dependence (Physical and Psychological) - these drugs need to be withdrawn SLOWLY Constipation The drugs become less effective over time leading to requests for higher doses Best avoided in older peole To treat depression Citalopram Mirtazapine Weight loss Rash These ongoing need for these drugs should be reviewed To slow the progression of dementia Donepezil Galantamine Rivastigmine Memantime Insomnia/vivid dreams Agitation/aggression Dizziness Tremor Headache These drugs only slow the progression of the dementia. Sometimes they also help to reduce the behavioural problems that dementia can cause To relieve symptoms of Parkinson s Disease L-Dopa - Co-beneldopa (Madopar ) - Co-carledopa (Sinemet ) Pramipexole (Mirapexin ) Ropinirole (Requip ) Taste disturbance Dry mouth Fatigue & sudden onset of sleep Compulsive behaviour/ loss of inhibition Constipation Low blood pressure = dizziness/falls The timing of all L-Dora theraphy is crucial for 24hr control of symptoms Stick to the prescribed times 36

7 Mr Smith is on the following medicines: ACTIVITY 21 Aspirin 75mg disersible tabs - One in the morning Mirtazapine 30mg tabs - One in the evening Methotrexate 5mg tabs - One tablet to be taken weekly Co-codamol 30/500mg tabs - Two to be taken three times a day In the table below, list what each medicine does and one of its common side-effects: Medicine What it does Common side-effect ASPIRIN MIRTAZAPINE METHOTREXATE COCODAMOL 37