Cardiovascular disease patients

Intermediate Has 3 risk factors for cardiovascular disease Patient should undergo complete car-... 

Cardiovascular disease Patients with significant cardiovascular disease may be unable to compensate for transient changes in hemodynamics or rhythm induced by pilocarpine. Pulmonary edema has been reported as a complication of pilocarpine toxicity from high ocular doses given for acute angle-closure glaucoma. Administer... 

The primary goal of therapy is the control of the hypercholesterolemia and prevention of atherosclerotic cardiovascular disease. Patients with heterozygous FH can usually be successfully treated with medications to lower the LDL cholesterol to acceptable levels (Table 14-2). They are generally responsive to treatment with statins, alone or in combination with other drugs, such as bile acid sequestrants (such as cholestyramine) or cholesterol absorption inhibitors (such as ezetimibe) that act additively to upregulate the expression of the functioning LDL receptor as described in the Biochemical Perspectives section. In a few cases, a more aggressive treatment with LDL apheresis (discussed in this section) may have to be considered in order to reach acceptable LDL cholesterol levels. 

Cardiovascular Disease. Patients with systemic hypertension, arteriosclerosis, and other cardiovascular diseases may be at risk when high concentrations of topically administered adrenergic agonists such as phenylephrine are used. Repeated topical doses or soaked cotton pledgets placed in the conjunctival sac have been associated with adverse cardiovascular effects. Likewise, P-blockers should be avoided or used cautiously in patients with congestive heart disease, severe bradycardia, and high-grade atrioventricular block. Topical P-blockers, however, may be used safely in patients with cardiac pacemakers. 

In order for patients and their families to be able to appreciate the silent efficacy from therapies that slow disease progression and increase compliance, a disease biomarker will be important. This is analogous to measuring blood cholesterol for the control of cardiovascular diseases. Patients on cholesterol lowering agents may not be able to perceive any benefits but will continue to comply with taking the medicine knowing that their blood... 

Fenofibrate (propan-2-yl 2-[4-(4-chlorobenzoyl)phenoxy]-2-methylpropanoate), a fibric acid derivative (Fig. 7.6), mainly exerts its effect via the activation of speciflc nuclear receptor called peroxisome proliferator-activated receptor alpha (PPARa). This PPARa agonist is primarily used to decrease the cholesterol levels in cardiovascular diseases patients. Like statins, fenofibrate also reduces triglycerides and low- and very low density protein levels. It also increases high-density lipoprotein levels in the body. Fenofibrate also has nonlipid (i.e., pleiotropic) effects (reduction in fibrinogen, C-reactive protein, and uric acid levels and improvement in the flow-mediated dilatation). 

Although data are limited, the possible small changes in the pharmacokinetics of frovatriptan and naratriptan with smoking are unlikely to be clinically relevant. It should be noted that smoking is a recognised risk factor for cardiovascular disease. Patients with such risk factors should only use the triptans after careful evaluation. 

Other Cardiovascular Agents Effecting Atherosclerosis. A large amount of clinical data is available concerning semm Upid profiles in patients subjected to dmg therapy for other cardiovascular diseases. Atheroma, for example, may be the underlying cause of hypertension and myocardial infarction. There are on the order of 1.5 million heart attacks pet year in the United States (155). 

Hypertension is one of the two principal risk factors of many cardiovascular diseases, such as coronary heart disease (CHD), stroke, and CHF. Individuals are considered hypertensive if their systoHc arterial blood pressure is over 140 mm Hg (18.7 Pa) or their diastoHc arterial blood pressure is over 90 mm Hg (12 Pa). Over 60 million people, or one-third of the adult population in the United States are estimated to be hypertensive (163). About 90% of these patients are classified as primary or essential hypertensive because the etiology of their hypertension is unknown. It is generally agreed that there is a very strong genetic or hereditary component to this disease. 

One study (83) indicated that in mildly hypertensive male patients treated with an antihypertensive dmg, those below the age of 50 or having no clinical evidence of cardiovascular disease had no significant improvement from cardiovascular diseases within 3.3 years those over the age of 50 or having pre-existing cardiovascular disease benefited significantly. 

In a study with 3427 male and female patients having DBP of 95—109 mm Hg (12—15 Pa), and no clinical evidence of cardiovascular diseases, half of the patients were placebo-treated and half were SC antihypertensive dmg-treated, ie, step 1, chlorothiazide step 2, methyldopa, propranolol [525-66-6], or pindolol [13523-86-9], and step 3, hydralazine, or clonidine [4205-90-7] (86). Overall, when the DBP was reduced below 100 mm Hg (13 Pa), there were more deaths in the dmg-treated group than in the placebo group. The data suggest reduction of blood pressure by antihypertensive dmg treatment that includes a diuretic is accompanied by increased cardiovascular risks. 

The Oslo Trial (87) enrolled 785 male patients <50 years of age with DBP <110 mm Hg (15 Pa) and free of clinical evidence of cardiovascular disease. If the initial DBP was <100 mm Hg (13 Pa), there were no differences in mortaUty or cardiovascular events in the placebo- or dmg-treated groups. If the initial DBP was >100 mm Hg, then the incidence of cardiovascular disease was greater in the dmg-treated than in the placebo-treated group. 

When adrninistered long-term for the treatment of hypertension, diuretics fulfill the goals of preventing cardiovascular disease and increasing longevity. However, diuretic therapy may produce both side and toxic effects that are significant in certain patient subgroups, eg, diabetics and cardiac patients. 

Aggravation of cardiovascular disease (i.e., decreased exercise capacity in patients with angina pectoris, intermittent claudication, or peripheral arteriosclerosis)... 

Patient databases with genetic profiles, e.g. for cardiovascular diseases, diabetes, cancer, etc. may play an important role in the future for individual health care, by integrating personal genetic profile into diagnosis, despite obvious ethical problems. The goal is to analyse a patient s individual genetic profile and compare it with a collection of reference profiles and other related information. This may improve individual diagnosis, prophylaxis, and therapy. 

KC706 stabilizes the inactive conformation of the mitogen-activated protein kinase p38a, a protein kinase involved in inflammatory reactions and cardiovascular functions. KC706 therefore holds the potential to treat conditions such as rheumatoid arthritis, psoriasis, inflammatory bowel disease and cardiovascular disease. This compound is currently being tested in phase II clinical trials with patients suffering from rheumatoid arthritis. 

Naltrexone is contraindicated in those with a hypersensitivity to the narcotic antagonists. Naltrexone is contraindicated during pregnancy (Category C). Naltrexone is used cautiously in those with a narcotic addiction in patients with cardiovascular disease, acute hepatitis, liver failure, or depression and in patients who are suicidal. Naltrexone is used cautiously during lactation. 

Chap. 31), and during lactation. Levodopa is used cautiously in patients with cardiovascular disease, bronchial asthma, emphysema, peptic ulcer disease, renal or hepatic disease and psychosis. Levodopa and combination antiparkinsonism drugs (eg, carbidopa/levodopa) are classified as Pregnancy Category C and are used with caution during pregnancy and lactation. 

The antihistamines are used cautiously in patients with bronchial asthma, cardiovascular disease, narrow-angle glaucoma, symptomatic prostatic hypertrophy, hypertension, impaired kidney function, peptic ulcer, urinary... 

These drug are used cautiously in patients with diabetes and cardiovascular disease Metoclopramide is a Pregnancy Category B drug, dexpanthenol is a Pregnancy Category C drug. 

The nurse carefully observes patients with cardiovascular disease taking the thyroid hormones. The development of chest pain or worsening of cardiovascular disease should be reported to the primary health care provider immediately because the patient may require a reduction in the dosage of the thyroid hormone. 

The estrogens are used cautiously in patients with gallbladder disease, hypercalcemia (may lead to severe hypercalcemia in patients with breast cancer and bone metastasis), cardiovascular disease, and liver impairment. 

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