IS YOUR PATIENT’S DRUG REGIME SAFE?
REASONABLE ADMINISTRATION OF DRUGS IN PATIENTS WITH CARDIOVASCULAR DISORDERS
Shevchenko I. V., Kompaniets O. G., Ponomaryova A.I.
Kuban State Medical University, Department of Clinical Pharmacology, Krasnodar
Cardiovascular disorders, which include a large variety of diseases, should imply a scrupulous examination of the patient and a reasonable administration of drugs, especially in the elderly. Doctors often prescribe combinations of drugs without considering possible interactions that may occur. A drug interaction, which involve pharmacodynamics or pharmacokinetics, can increase or decrease the effects of one or both drugs. Adverse effects or therapeutic failure may result. Contraindications or warnings should be considered as well.
Out of a big variety of commonly prescribed pharmaceutical preparations to patients, who have cardiovascular disorders, four groups of drugs were analyzed, among which are nonsteroidal antiinflammatory drugs (NSAIDs), antidepressants, nootropics and anticoagulants.
NSAIDs may cause increased risk of serious cardiovascular thrombotic events, myocardial infarction and stroke, which can be fatal. The risk increases with duration of use. So, patients with cardiovascular disorders may be at greater risk. We studied case reports of cardiologic patients in Krasnodar Regional Heart Center and found out that 28% of the patients took NSAIDs because of concomitant vertebrogeneous deseases and artralgia. Some reports suggest that NSAIDs, taken together with angiotensin-converting enzyme (ACE) inhibitors may diminish the antihypertensive effect of the latter. 11% of the analysed case reports said that the patients were prescribed both NSAIDs and ACE inhibitors. The effects of NSAIDs and anticoagulants are synergistic, such that users of both drugs together have a risk of serious bleeding, higher than users of either drug alone. In our studies 6% of the patients combined NSAIDs and anticoagulants.
Antidepressants should be carefully taken by patients with heart failures. Their side effects can result in myocardial infarction, changes in AV conduction, hypertension, hypotension, particularly orthostatic hypotension, tachycardia. Our studies showed that 12% of the patients with heart failures took antidepressants, out of whom 2% were ordered tricyclic antidepressants (TCAs), being the most dangerous for such patients.
Another example of a clinician’s alert is a group of nootropics, which are used to treat cerebral vascular insufficiency. Their adverse effects include hypotension, tachycardia, hypertension, which should be taken into account when combining with hypotensive therapy or in patients with heart failures. Analysis of the studied case reports showed that 32% of the patiens got nootropics, 12.5% were found to have hemodynamic changes which needed correction with the help of hypotensive therapy.
To sum up, over half of patients with cardiovascular disorders take drugs which may cause deterioration of an essential disease or negative effects when combined with cardiotropic preparations. This fact should attract yet more attention of physicians and cardiologists. In this connection it is exceedingly important to raise internists’ awareness of preparations with the minimal cardiotoxic effect.
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Материалы IX международного конгресса «Здоровье и образование в XXI веке» РУДН, Москва
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