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Chapter 4. Pharmacotherapy of heart diseases
General considerations pharmacological treatment
1. Before prescribing any drug, you must once again carefully read the instructions for it, written for doctors, or the corresponding section in the pharmacological reference book.
2. When prescribing a new drug, you should make sure that it is registered with the Russian Ministry of Health and Social Development.
3. The minimum amount of medication possible for a given clinical situation should be prescribed, avoiding polypharmacy.
4. When prescribing several drugs, re-analyze information about their interactions.
5. Once again analyze the patient’s life history and illness and make sure there are no contraindications to taking the drug.
6. When prescribing medications that have multiple side effects, carefully weigh the risk/benefit ratio, avoiding situations of “treating one thing and damaging another.” The basic principle: treatment should not be more dangerous than the disease.
7. The saturating, or full therapeutic, dose is the amount of the drug that allows you to achieve the optimal therapeutic effect in the absence of pronounced signs of side effects.
8. A maintenance dose is the amount of the drug that allows you to maintain (consolidate) the achieved therapeutic effect and ensures the stability of the therapeutic concentration of the drug in the blood.
When prescribing pharmacotherapy, it is necessary to take into account the patient’s adherence to it, since the patient takes on the main part of the treatment (purchase and administration of medicines, self-monitoring and follow-up visits to the doctor, etc.). If the patient is not sufficiently adherent to pharmacotherapy, then he refuses to take the drugs, no matter how effective, from the doctor’s point of view, they may be. Therefore, treatment should be prescribed not only taking into account indications or contraindications, but also taking into account the wishes of the patient, his lifestyle and many other factors listed below.
Factors influencing adherence to treatment: number of medications taken and frequency of dosing, timing of medications, educational, cultural and family status, gender, price pharmacological drugs and their availability, the number of visits to the doctor and follow-up examinations required during treatment, the time spent waiting for the doctor and examination, the individual level of the doctor, the effectiveness of the “doctor-patient” link.
After determining the treatment regimen, the patient should receive from the doctor detailed recommendations regarding the characteristics of the drugs taken, their side effects, criteria for their effectiveness, which the patient can evaluate independently, as well as recommendations for the frequency of outpatient treatment monitoring: laboratory and instrumental. When planning long-term treatment, it is also advisable to teach the patient the skills of keeping a self-monitoring diary, in which he should record the implementation of medical recommendations and self-monitoring data blood pressure, pulse rate, diuresis, etc., and also describe your subjective feelings. A self-monitoring diary not only disciplines the patient, but also allows the doctor to quickly obtain objective information about the progress of the patient’s treatment. The doctor should familiarize the patient with the following recommendations.
It should also be noted Special attention the patient on the frequency and time of taking medications, which are often violated, and yet compliance with these conditions plays a big role in achieving the desired effect in the treatment of the disease. What should the frequency of taking medications actually mean:
2 times a day - every 12 hours, morning and evening, at the same time (for example, at 8.00 and 20.00);
3 times a day - every 8 hours, morning, afternoon and evening, at the same time (and not at breakfast, lunch and dinner!);
at night - just before bedtime;
in the morning on an empty stomach - immediately after waking up.
...NOTE FOR PATIENTS ABOUT TAKING MEDICINES
Tablets should not be chewed, tablets and capsules should not be broken, crushed or dissolved in water unless specifically instructed to do so.
It is preferable to buy medications in the dosage prescribed by your doctor, rather than splitting a higher dose tablet into several doses or taking several lower dose tablets at the same time.
If not special instructions, all medications are recommended to be taken 40–60 minutes after meals.
It is best to take your medications with your usual boiled water room temperature.
If the tablet or capsule is difficult to swallow, you may want to drink a few sips of water slowly and follow the tablet with plenty of liquid before taking it. If this does not help, ask your doctor to change the dosage form or drug. The tablet should not get stuck in the throat, since the medicines are designed for the acidity and conditions of the stomach and duodenum, and not the esophagus (problems with the esophagus may occur and the effect of the medicine may be reduced).
When prescribing medications, be sure to check with your doctor about the dose, frequency of administration, dependence on food intake, withdrawal conditions (can you stop taking it immediately or should you gradually reduce the dose), possible side effects drugs.
If you need to take multiple medications at the same time, list them by hour to avoid confusion.
Discuss with your doctor in advance what to do if you forget to take your medicine on time. You should not take a forgotten dose as a supplement to the next one, as this can lead to an overdose and serious complications.
If you voluntarily take medications (such as vitamins) or nutritional supplements, inform your doctor about this.
When purchasing medications, make sure the packaging is intact, check the expiration date and dosage. Buy medicines from reliable pharmacies, not from hands or trays. Be wary of medications given to you by others who no longer need them or are not suitable: even if the medication’s expiration date has not yet expired, there is a danger that the storage conditions were not met.
Do not stockpile medications: your treatment regimen may change.
Store medications in a dry, dark place without changes in temperature and access sun rays. The bathroom or kitchen is not a suitable place to store medications. Only those medications for which these conditions are indicated by the manufacturer are stored in the refrigerator. Keep medications out of the reach of children: most drugs used in cardiology are deadly. child's body even in minimal doses.
When choosing medications and their dosages must take into account the age of the patient. In elderly and elderly patients, there are peculiarities in the pharmacodynamics of most drugs associated with age-related changes functions of the liver and kidneys and causing more frequent development of side effects, the effect of cumulation and increased toxic effects.
Features of treatment of elderly patients:
starting treatment with small doses (usually half the recommended dose);
slowly increasing doses;
careful monitoring of side effects of medications.
Pharmacotherapy of certain diseases
Cardiac ischemia
The basic principles of pharmacological treatment of stable forms are discussed below. coronary disease hearts. Treatment of unstable forms is partially reflected in the chapter “Basic principles of diagnosis and treatment emergency conditions in cardiology,” but for the most part this is the prerogative of specialized clinics. In unstable forms of coronary artery disease, the main tasks of a doctor of any specialty are: timely diagnosis of these conditions, ensuring the patient’s life and preventing complications until qualified assistance becomes possible.
The main objectives of treatment of stable forms of coronary artery disease: prevention of attacks (antianginal therapy) and improvement of prognosis (prevention of complications, prevention of progression). Treatment components: non-drug methods, pharmacological therapy, surgical treatment.
General considerations for the treatment of stable forms of coronary artery disease
1. Rational treatment of IHD involves a combination of at least two components described above. The lack of non-drug methods makes treatment futile even if effective pharmacotherapy and/or successful surgery. Surgery IHD is currently only palliative in nature, since it does not affect the cause of IHD (with the exception of IHD associated with birth defects coronary arteries). Only non-drug methods are practically ineffective even in the treatment of stable angina FC I.
2. Priority of pharmacological or surgical methods The doctor determines the treatment after full examination patient, which includes x-ray imaging of the coronary arteries (coronary angiography). The exception is patients with angina pectoris FC I, in whom, however, there is the prospect of invasive examination and subsequent surgical treatment if the condition worsens. In other words, if there are indications for coronary angiography, then it should be performed in as soon as possible. Pharmacotherapy in most cases should be considered as the main method of treatment only until the results of coronary angiography are available.
Indications and contraindications for coronary angiography are discussed in more detail in the corresponding chapter.
Non-drug methods
Non-drug methods for treating stable forms of coronary artery disease primarily involve addressing avoidable risk factors for disease progression. More detailed information about the methods of influence is contained in the chapter “Atherosclerosis. Modern concepts atherogenesis, prevention and treatment." The main components are not drug treatment:
patient information and education;
individual diet, diet therapy;
to give up smoking;
weight correction;
physiotherapy;
psychotherapy and autogenic training;
Antiplatelet therapy
Antiplatelet drugs that improve the prognosis of coronary artery disease are recommended for all patients in the absence of contraindications, as well as for patients who have undergone myocardial revascularization.
Acetylsalicylic acid
The most commonly used antiplatelet agent is acetylsalicylic acid. Mechanism of antiplatelet action acetylsalicylic acid is based on the irreversible binding of platelet cyclooxygenase with a subsequent decrease in the synthesis of platelet aggregation inducers (prostaglandins, thromboxane).
IN last years Other equally important pharmacological effects of acetylsalicylic acid are being studied, for example, increasing the synthesis of ferritin, which is an antioxidant, reducing the ability of low-density lipoproteins to oxidize, as well as inducing the synthesis of adenosine, which has a powerful anti-inflammatory effect. Taking into account modern concepts of the occurrence and progression of atherosclerosis, these components of the pharmacological action of acetylsalicylic acid necessitate its administration to most patients with coronary artery disease.
If there are contraindications to aspirin, ticlopidine or clopidogrel is usually prescribed. If clopidogrel is contraindicated, warfarin is used until an INR level of 2–3.5 is achieved. Prescribing regimens for warfarin and monitoring therapy are described in the chapter “Surgical treatment of heart disease.”
1. Acetylsalicylic acid is indicated for all patients, regardless of the presence of symptoms and stage/type of coronary artery disease, at a dose of 50–325 mg/day.
2. When choosing a dose, it should be taken into account that acetylsalicylic acid blocks cyclooxygenase not only in platelets, but also in the vascular endothelium, reducing vascular wall production of prostacyclin, which has a vasodilator and antiplatelet effect. The effect of acetylsalicylic acid on prostacyclin synthesis is dose-dependent: it increases with increasing dose.
According to the results of the most authoritative studies in this area, the optimal doses of acetylsalicylic acid, which provide effective blocking of platelet cyclooxygenase with little effect on the formation of prostacyclin in the endothelium, are 50–100 mg/day.
Inhibition of prostacyclin synthesis by acetylsalicylic acid may help reduce some of the effects of ACE inhibitors, which must be taken into account when prescribing them simultaneously, especially in patients with chronic heart failure. Some authors consider it inappropriate to prescribe acetylsalicylic acid in any dose to patients taking ACE inhibitors, and it is recommended to replace it with another antiplatelet agent (ticlopidine, clopidogrel).
3. The antiplatelet effect of acetylsalicylic acid persists throughout life cycle platelet, that is, within 5–7 days, which should be taken into account first of all when forced to discontinue the drug (for example, due to the upcoming surgical intervention or with the development of bleeding). At the same time, it is the irreversible blocking of platelet aggregation that distinguishes acetylsalicylic acid from many other antiplatelet agents that have a short-term effect.
4. When choosing dosage forms of acetylsalicylic acid, it is recommended to give preference to those whose use gives minimal side effect on the gastrointestinal tract, namely enteric forms. The following features should be taken into account:
despite almost complete absence local impact on the gastric mucosa, enteric forms retain a systemic damaging effect (associated with inhibition of the synthesis of prostaglandins that protect the mucous membranes), so the risk of damage is still present, and the use of enteric forms of acetylsalicylic acid does not eliminate the need to fully monitor antiplatelet therapy (see. below);
When using enteric forms, the achievement of the peak concentration of the drug is delayed by an average of 2 hours compared to the period of action of conventional forms. This should be taken into account during emergency antiplatelet therapy (for example, in acute coronary syndrome). In such clinical situations, it is preferable to use rapidly soluble forms of acetylsalicylic acid ( effervescent tablets), and in their absence, tablets in enteric form should be chewed.
5. With long-term use of acetylsalicylic acid drugs, compensatory thrombocytosis may occur.
6. Nitric oxide donors (for example, nitrates) significantly reduce the risk of upper bleeding gastrointestinal tract in patients taking acetylsalicylic acid.
Control of antiplatelet therapy
Teaching patients self-diagnosis of possible bleeding, that is, the main signs of acute and chronic gastrointestinal bleeding: the appearance of black stools (melena), weakness, decreased blood pressure in combination with tachycardia. The patient should be warned about the need to control bleeding gums when brushing teeth - this early sign hypocoagulation.
Periodic endoscopy - once every 2 years in the absence of complaints.
Risk factors for gastrointestinal bleeding during antiplatelet therapy:
age over 65 years;
history of gastric and duodenal ulcers or peptic ulcers;
Helicobacter pylori infection;
alcohol abuse;
nutritional features - presence in daily diet a large number of spices and extractive products, such as pepper, onions, garlic, horseradish, mustard, etc.;
frequent use of non-steroidal anti-inflammatory drugs.
HMC-CoA reductase inhibitors
The mechanism of action and indications for the use of statins are described in more detail in the chapter “Atherosclerosis. Modern concepts of atherogenesis, prevention and treatment.”
Antianginal therapy
The main antianginal drugs used for treatment of ischemic heart disease: beta blockers, nitrates, calcium antagonists (calcium channel blockers).
The goal of antianginal therapy is to prevent angina attacks. Beta blockers and calcium antagonists also improve the prognosis in some categories of patients. In general, it is convenient to consider pharmacotherapy of stable forms of coronary artery disease according to the scheme “providing mechanisms – final goal – drug”.
Algorithm for prescribing antianginal therapy
1. In the absence of contraindications, beta blockers are the drugs of choice. It is necessary to evaluate the effectiveness of beta blockers for a particular patient, and if available, titrate the drug dose to the maximum therapeutic dose; assess the feasibility of using long-acting forms of beta blockers.
3. If the beta blocker is poorly tolerated or ineffective, it should be replaced with a nitrodrug with a duration of action corresponding to the class of angina (see recommendations below) or with a suitable calcium antagonist.
4. If the beta blocker is insufficiently effective at the maximum therapeutic dose, add a dihydropyridine calcium antagonist or an appropriate nitrate dosage form to the therapy.
5. If the decision on the need for combined antianginal therapy is made against the background of already being treated with one antianginal drug, then before prescribing a second one, the dose of the first should be increased to the maximum therapeutic one.
6. When prescribing a combination of antianginal drugs, it should be borne in mind that in some cases, when joint use of two antianginal drugs, their effect is not enhanced, but, on the contrary, weakened, but the side effects of both drugs are increased (for example, the combined use of nitrates and dihydropyridine calcium antagonists).
7. As an addition to antianginal therapy, metabolic drugs, such as trimetazidine, are prescribed. In rare situations - when the main antianginal drugs are poorly tolerated - metabolic drugs can be used as an alternative.
Nitro drugs
The most commonly used are 3 drugs in this group: nitroglycerin, isosorbide dinitrate, isosorbide-5-mononitrate. Fundamental differences in pharmacological action No.
The classification of drugs by duration of action is more important:
nitrates short acting(up to 1 hour);
nitrates of moderate prolonged action (up to 6 hours);
long-acting nitrates (up to 16 or 24 hours).
Nitrates exist in various dosage forms: tablets, aerosol sprays, time-release patches active substance, solutions for intravenous administration. In everyday life clinical practice the most commonly used are oral, cutaneous and aerosol routes of administration of nitrates. Parenteral methods are used primarily in the practice of emergency conditions and intensive care.
Pharmacological effect of nitrates:
decreased myocardial oxygen consumption;
decrease in preload - decrease in blood pressure, LV volume, peripheral vascular resistance;
antithrombotic and antiplatelet effects;
expansion of epicardial coronary vessels and arterioles;
vasodilation of coronary vessels, including stenotic ones.
General Considerations for Nitrate Treatment
1. The choice of a nitrodrug for coronary artery disease should be individual for each patient and take into account not only the stage and extent of the disease, but also social aspects.
2. At the beginning of treatment, nitro drugs are most often prescribed normal action. In the future, you can switch to prolonged forms of administration, but it should be remembered that prolonged forms are more likely than regular-acting nitrates to cause an addictive effect.
3. A patient receiving nitro drugs as part of routine therapy should be explained the need to always have nitrates with him. fast acting: usually nitroglycerin tablets or nitrates in aerosol form (see pharmacokinetics of nitrates in this same chapter). It is necessary to teach the patient how to take fast-acting nitrates (see below).
4. Long-term use of nitrates causes addiction to them and a decrease in the therapeutic effect. Increasing the dose often worsens side effects. The problem of developing tolerance to nitrates has not been solved to this day, however, if you follow a number of rules, you can overcome or significantly delay the addictive effect (see p. 291).
5. If nitrates are poorly tolerated, you can prescribe drugs that have a nitrate-like effect: molsidomine, Sidnopharm, Corvaton. It should be borne in mind that these drugs have a less pronounced vasodilating effect than nitrates, and they do not have prolonged forms.
6. Nitrates can be prescribed for vasospastic angina.
7. In addition to the development of tolerance, a significant drawback of nitrates is rebound syndrome, which occurs when the drug enters the body abruptly, which should be taken into account during long-term therapy.
The main side effects of nitrates: headache, arterial hypotension, tachycardia, orthostatic hypotension, fluid retention in the body.
With regular long-term use, the antianginal effect of nitrates may weaken or even disappear completely (development of tolerance).
Measures to prevent the development of tolerance to nitro drugs:
prescribing the minimum doses necessary to achieve a therapeutic effect;
prevention of fluid retention in the body;
compliance with the dosing regimen (the so-called asymmetrical administration), which provides for a minimum 6-8 hour break between taking doses of nitro drugs, as well as an optimal 12-13 hour break between evening and morning appointments. As a rule, the nitrate-free period is planned for the night, when there is no great need for nitrates. The exception is in patients with severe angina, when continuous use of nitrates is recommended;
If possible, you should take breaks from treatment with nitro drugs (the so-called intermittent dosing method).
...patient memo
HOW TO TAKE NITROGLYCERIN CORRECTLY
1. If an attack occurs, be sure to sit down or lie down.
2. Place a nitroglycerin tablet under your tongue and dissolve it until completely dissolved (or use an aerosol). You should not take food or liquid at the same time.
3. If there is no effect, take the nitroglycerin tablet again after 3-5 minutes.
4. If there is no effect, take a nitroglycerin tablet after another 3-5 minutes. Taking nitroglycerin more than three times is not advisable!
5. If the attack continues, call “emergency help.”
6. If the attack is stopped, sit or lie down for a while. You should not get up suddenly after taking nitroglycerin!
The table below shows the pharmacokinetics of a number of nitrates:
Scheme for prescribing nitrates depending on the functional class of angina:
angina pectoris functional class I
Intermittent intake of short-acting nitrates that provide a pronounced and brief effect - buccal plates, aerosols, etc.
These medications should be taken 5–10 minutes before physical activity, usually causing an attack;
angina pectoris functional class II
intermittent intake of moderately prolonged-acting nitrates;
angina pectoris functional class III
constant intake of nitrates of moderately prolonged or prolonged action with a nitrate-free period of 6–8 hours;
angina pectoris functional class IV
constant intake of nitrates, providing a round-the-clock effect.
Contraindications to the use of nitro drugs:
hypertrophic obstructive cardiomyopathy;
obstruction of the left ventricular outflow tract;
mitral regurgitation;
taking medications for treatment sexual dysfunction(the time difference must be at least 24 hours, including sublingual administration of nitrates. Taking such drugs is unacceptable while taking long-acting nitrates).
This section of the site
This section of the site contains general information about the work of the Therapeuticum medical center, basic rules and recommendations for the use of homeopathic and phytotherapeutic medicines, tips on a healthy lifestyle and a home remedy.
Patient Reminder
Homeopathic and herbal medicines must be taken strictly in accordance with the doctor’s prescriptions or in accordance with the recommendations of the instructions for use;
While taking homeopathic and herbal medicines, it is not advisable to drink strong coffee, tea, mint, garlic, tonic, carbonated and energy drinks;
Homeopathic medicines should be taken with clean water, but not coffee, tea or juices;
Alcohol intake during and after treatment should be discontinued. If the patient cannot stop drinking alcohol, then it is possible to drink dry white wine.
If you have any questions or negative changes in your health, you must notify your doctor and not self-medicate;
Homeopathic medicines should be stored in a dry, dark place, at a temperature from +10C to +25C. Do not store homeopathic and herbal remedies in the refrigerator or near household appliances(TV, computer, microwave oven, mobile phone).
If during homeopathic treatment If you are forced to continue taking conventional (chemical) medications, then all information about them should be provided to your doctor. Often during treatment homeopathic medicines dose chemicals may be reduced.
During homeopathic treatment it is necessary to avoid self-use various skin ointments(zinc bolts, hormonal ointments etc.).
Exercise, a harmonious daily routine and proper nutrition improve the results of our therapy.
ATTENTION
After February 1, we will be forced to raise prices for medical services. For our patients!
On January 4, 2016, the sale of the Certificate for Services begins medical center Therapeuticum. You can buy a certificate for 3 appointments for 5,400 rubles. and for 6 appointments for 10,800 rubles, based on 1,800 rubles. in one doctor's visit. The certificate provides priority right to make an appointment with a doctor. The certificate begins to be valid from the day of payment and can be used by any family member or friend of the certificate holder to any doctor in the clinic, except for a gynecologist and a doctor’s home visit service. The certificate expires on December 30, 2016.
· Administer medications according to medical prescription.
· Ensure compliance therapeutic dose and frequency of application.
· Perform individual dosage.
· Provide a method of administration.
· Observe the time of administration.
· Connect with food intake.
Teaching the patient how to take medications
1. Motivate the patient to correctly carry out drug treatment, using the rules of bioethics and deontology.
2. Find out possible reaction the body to certain drugs.
3. Make a list of all medications prescribed by your doctor.
4. Add to the list of medications home first aid kit which the patient receives without a medical prescription.
5. Add to list herbal remedies: vitamin and mineral supplements, decoctions, herbal teas.
6. Mark the medications to be taken on the list, for example:
· in the morning - with the letter “U”,
· during the day - “D”,
· in the evening - “B”,
and also group medications depending on food intake:
· while eating;
· after meal;
· before bedtime.
7. Write down the special characteristics for each drug (for example, tablet shape, size, color, inscriptions on it).
8. Note the peculiarities of administering medications (sublingual, intranasal, rectal),
9. Determine the rules for taking each drug, for example: what to take the medicine with, what amount of liquid, what foods to combine with.
10. Pay attention to symptoms that may appear during treatment: dizziness, weakness, diarrhea or constipation, rash, arrhythmia, difficulty breathing.
11. Write down the telephone number of the attending physician and emergency services.
The nurse should take into account that the patient and his relatives have the right to information about the medications prescribed by the doctor and to refuse their administration.
The nurse does not have the right to dispense medications at the request of patients, without a doctor’s prescription, with the exception of cardiac medications (validol, nitroglycerin) and sedative drops. If the patient refuses to take the medicine, the nurse should try to persuade him, convince him or invite a doctor.
Rules for the distribution of drugs for enteral use
PURPOSE: Prepare medications for distribution and administration by patients.
INDICATIONS: Doctor's prescription.
CONTRAINDICATIONS: Identified during the examination of the patient by a doctor or nurse.
EQUIPMENT:
1. Assignment sheets.
2. Medicines for internal use.
3. Mobile table for the day of laying out medicines,
4. Container with boiled water,
5. Beakers, pipettes (separately for each bottle with drops).
6. Scissors.
PATIENT PREPARATION:
1. Inform the patient about the prescribed drug, its effect, therapeutic effect, a possible side complication.
2. Obtain consent.
METHODS OF DISTRIBUTION OF MEDICINES
INDIVIDUAL
Place the lek on the mobile table. substances, pipettes, beakers, scissors, carafe of water, prescription sheets.
1. Wash your hands and dry them.
2. Moving from patient to patient, distribute the medication. substances directly at the patient’s bedside according to the prescription sheet (m/s must carefully read the name of the drug, its dosage on the packaging, pay attention to the expiration date).
3. Giving medication. medicine to the patient, warn him about the features of this medicine: bitter taste, pungent odor, change in color of urine or feces after administration.
4. The patient must take medication. substance in your presence.
Squeeze the package of foil or paper tablets into a beaker, and carefully place the tablets from the bottle into a spoon. Liquid lek. The products should be mixed thoroughly.
ADVANTAGES OF THIS METHOD OF DISTRIBUTION OF MEDICINES:
1. The nurse controls the intake of medication. substances.
2. The nurse can answer the patient's questions about the medication prescribed for him. means.
3. Errors have been eliminated when distributing medications. funds.
GUARD
To save time, the nurse lays out the lek in advance. funds in trays, divided into cells. In each cell, the patient’s name and room number.
ALGORITHM
1. Wash your hands and dry them.
2. Read the appointment sheet carefully
3. Read the name of the medicine carefully. means and dosage on the package, check it with the prescription sheet.
4. Pay attention to the expiration date of the medication. facilities.
5. Lay out the lek. funds in cells for each patient for one appointment.
6. Place the tray with medications. medications in the wards (do not leave medications on the bedside tables of the patient if the patient is not in the ward, with the exception of validol, nitroglycerin).
7. Make sure the patient takes the medication. funds in your presence.
8. Treat used beakers and pipettes in accordance with the requirements of the Sanitary Regulations and Regulations.
DISADVANTAGES OF THIS METHOD OF DISTRIBUTION OF MEDICINES
1. Lack of control over medication intake. funds by the patient (patients forget to take them, throw them away, take them late).
2. The individual scheme of reception and distribution is not followed (before meals, during meals, after meals, etc.).
3. Errors during dispensing are possible (due to the carelessness of the nurse, medications may end up in another cell).
4. It is difficult to answer the patient’s questions about the medications prescribed to him, because they are in the tray without pharmaceutical packaging.
When using medications, you must follow the 5 principles of safe administration of HP. ("5P"):
· right choice patient
· right choice medicine
correct choice of drug dose
Correct timing of drug administration
correct choice of method of drug administration
Nurse Without the knowledge of the doctor, he has no right to prescribe or replace one medication with another. If a drug is given to a patient by mistake or its dose is exceeded, the nurse must immediately inform the doctor about this.
There are certain rules for the issuance (administration) of medications to patients.
Before giving the patient medicine, you must thoroughly wash your hands, carefully read the label, check the expiration date, the prescribed dose, then monitor the patient's intake of the medicine (he must take the medicine in the presence of a nurse). When the patient takes the medicine, the date and time, the name of the medicine, its dose and method of administration should be noted in the medical history (prescription sheet).
If the drug is prescribed to be taken several times a day, in order to maintain a constant concentration in the blood, the correct time intervals should be observed. For example, if a patient is prescribed benzylpenicillin 4 times a day, it is necessary to ensure that it is administered every 6 hours.
Medicines prescribed to be taken on an empty stomach should be distributed in the morning 30-60 minutes before breakfast. If the doctor recommended taking the medicine before meals, the patient should receive it 15 minutes before meals. The patient takes the medicine prescribed with meals with food. The patient should drink the medicine prescribed after meals 15-20 minutes after eating. Sleeping pills are given to patients 30 minutes before bedtime. A number of drugs (for example, nitroglycerin tablets) must be kept in the patient’s hands at all times.
When performing an injection, you must thoroughly wash your hands and treat them with an antiseptic solution, follow the rules of asepsis (wear sterile gloves and a mask), check the label, check the expiration date, and mark the opening date on the sterile bottle. After administering the drug, you should note in the medical history (prescription sheet) the date and time, the name of the drug, its dose and method of administration.
Medicines should only be stored in the packaging supplied from the pharmacy. You cannot pour solutions into other containers, transfer tablets, powders into other bags, or make your own inscriptions on the packaging of medicines; It is necessary to store medications on separate shelves (sterile, internal, external, group A).
The nurse must know and be able to explain to the patient the change in the effect of drug therapy under the influence various factors- such as following a certain regimen, diet, drinking alcohol, etc. Taking medications in combination with alcohol causes unwanted side effects.
Alcohol taken with clonidine causes quick loss consciousness, a sharp drop in blood pressure and retrograde amnesia (inability to remember events preceding the loss of consciousness).
Alcohol in combination with nitroglycerin sharply worsens the condition of patients with coronary artery disease and can cause a significant decrease in blood pressure.
Alcohol in large doses potentiates, i.e. enhances the effect of indirect anticoagulants (dicoumarin and other coumarin derivatives, in particular warfarin) and antiplatelet agents (acetylsalicylic acid, ticlopidine, etc.). As a result, heavy bleeding and hemorrhage may occur in the internal organs, including to the brain, with subsequent paralysis, loss of speech and even death.
Alcohol at diabetes mellitus enhances the hypoglycemic effect of insulin and oral antidiabetic drugs, which is fraught with the development of severe comatose state(hypoglycemic coma).
· The most common complication with any method of drug administration is allergic reactions. The nurse must always remember his responsibility for the patient's life when performing medical procedures related to drug therapy.
Prevention allergic reactions:
· Before starting the working day, the nurse should check the presence and completeness of the anti-shock first aid kit.
· Before administering the drug, the nurse should examine the patient's allergy history. It is necessary to find out whether he has taken medications in the past and whether he has had any reactions. When asking about allergies, you should keep in mind the possibility of cross-allergy. If there were reactions, but the doctor still prescribed the drug, its administration should be postponed until you consult a doctor.
· Just because a patient has not had any reactions to medications or has not taken them in the past does not mean that an allergy is not possible. It is necessary to find out whether the patient has risk factors for allergies. If any, you should consult your doctor to confirm the prescription.
· Under no circumstances should you test for drug allergies yourself!
· When administering the drug and after it, the patient should be monitored for the appearance of allergy symptoms. If you suspect the development of an allergy, stop administration immediately.
· The nurse should be attentive to patients receiving drug therapy. If a patient receiving medication course, complains of fever or skin rashes, you should discontinue the drug and call a doctor immediately.
· If you suspect anaphylaxis, you should act in accordance with the instructions approved by the medical facility.
Antibiotics
Remember! Antibiotics do not affect viruses and are therefore useless in the treatment of diseases caused by viruses (for example, influenza, hepatitis A, B, C, chicken pox, herpes, rubella, measles). Do not forget to read the instructions carefully (please note that when long-term use the antibiotic is used with an antifungal drug, nystatin).
Antibiotics used to prevent and treat inflammatory processes caused by bacterial microflora. The huge variety of antibiotics and the types of their effects on the human body was the reason for the division of antibiotics into groups.
Based on the nature of their effect on bacterial cells, antibiotics are divided into 3 groups:
1. bactericidal antibiotics(bacteria die, but remain physically present in the environment)
2. bacteriostatic antibiotics(bacteria are alive but unable to reproduce)
3. bacteriolytic antibiotics(bacteria die and bacterial cell walls are destroyed)
Based on their chemical structure, antibiotics are divided into the following groups:
1. Beta-lactam antibiotics, which in turn are divided into 2 subgroups:
Penicillins - produced by colonies of the mold Penicillium
Cephalosporins - have a similar structure to penicillins. Used against penicillin-resistant bacteria.
2. Macrolides(bacteriostatic effect, i.e. the death of microorganisms does not occur, but only the cessation of their growth and reproduction is observed) - antibiotics with a complex cyclic structure.
3. Tetracyclines(bacteriostatic effect) - used to treat respiratory and urinary tract, treatment of severe infections such as anthrax, tularemia, brucellosis.
4. Aminoglycosides(bactericidal effect - characterized by the fact that under the influence of an antibiotic, the death of microorganisms occurs. Achieving a bactericidal effect is especially important when treating weakened patients) - are highly toxic. Used to treat severe infections such as blood poisoning or peritonitis.
5. Levomycetins(bactericidal effect) - use is limited due to the increased risk of serious complications - damage bone marrow, producing blood cells.
6. Glycopeptides- disrupt the synthesis of bacterial cell walls. They have a bactericidal effect, but are bacteriostatic against enterococci, some streptococci and staphylococci.
7. Lincosamides- have a bacteriostatic effect, which is due to inhibition of protein synthesis by ribosomes. In high concentrations, they can exhibit a bactericidal effect against highly sensitive microorganisms.
8. Antifungal antibiotics(lytic action - destructive effect on cell membranes) - destroy the membrane of fungal cells and cause their death. Antifungal antibiotics are gradually being replaced by highly effective synthetic antifungal drugs.
Antishock and anti-inflammatory drugs
The most common remedy in this series is analgin, but it should be borne in mind that it has a rather weak and short-lived effect. It is better to use ketonal (ketoprofen), which is comparable in strength to analgin, but is more harmless (one ampoule 1-2 times, maximum 3 times per day).
Ketans (ketorolac) have an even stronger effect; they are administered up to 3 ampoules per day, but not more than 5 days, due to the risk of developing gastrointestinal bleeding.
Local anesthetics
The use of these drugs is the best option for pain relief of serious injuries. Anesthetics such as lidocaine and bupivacaine last the longest (novocaine may not be used, since it is more weak drug by duration of action).
Remember! Some people may be allergic to local anesthetics. If a person was treated by a dentist and no problems arose during treatment, then most likely there should not be an allergy.
If a person has spent enough time in the cold long time, then to warm it up, as a rule, they use drugs that stimulate breathing and heart contractions - caffeine, cordiamine, sulfocamphocaine and others. However, if possible, it is better to limit their use or even eliminate them, since they cause too much harm to the body.
