Page 2 of 2: Osce-Buster: A Discharge Plan

mugdha1 · Credits: 2887 My Scrapbook

1]Aspirin reduces the 'stickiness' of blood which reduces the risk of blood clots forming. Clopidogrel is an alternative to aspirin which helps to prevent blood clots. It is usually used in people who are not able to take aspirin.
2]A beta-blocker slows the heart rate and reduces the risk of abnormal heart rhythms.
3]An ACE (angiotensin converting enzyme inhibitor) reduces the risk of developing heart failure and further MI.
4]A statin reduces the cholesterol level

Although the four drugs above are commonly advised, treatments may vary depending on other factors such as complications, or other associated diseases diseases.

kanikadua · Credits: 9353 My Scrapbook

EVERYDAY ACTIVITIES

1. initially start with gentle excercises.gradually increase the time as it hlps to keep the body fit. if u like swimming u can restart it by4-6 weeks.
2. normally sexual activity to be avoided for one week.
3.The DVLA will need to be informed about your MI. if it is uncomplicated and u are feeling fine, u can return to driving by 4 weeks.

please correct.

kanikadua · Credits: 9353 My Scrapbook

sorry. sexual activity to be avoided for 4 weeks

sanashakil · Credits: 2430 My Scrapbook

in case of MI the DVLA need not be notified!
thats what i read in OHCM
tell me if im right

jan282005 · Credits: 629 My Scrapbook

thanks

go_chin_san · Credits: 254 My Scrapbook

should advice to avoid air travel for at least 6 weeks and resume sex when he can manage 2 flights of stairs without difficulty

chewingum · Credits: 11736 My Scrapbook

And never forget Support groups,leaflets,websites for more information.

mpi · Credits: 227 My Scrapbook

thanx everyone for the nice contribution!!!

nsa · Credits: 2227 My Scrapbook

hello....i found all the info in this forum very helpful!! thank you so much! im posting this info from a patient leaflet, which i edited a bit to make it shorter...hope this will also be of use..
Hi, hope the following helps! I think this OSCE comes with different drug combos?
Anyway, you can begin with the GRIPS (greet patient etc..introduce yourself & state the purpose of your visit, congratulate him on his recovery/discharge etc.. and then you can explain abt each medication, dose,how it works in brief, how to take, possible side effects etc..
Advice to pt
GRIPS

If you have had a myocardial infarction (often called a heart attack), you will usually be advised to take four drugs (medicines) for the rest of your life. The drugs are: an aspirin, a beta-blocker, an ACE inhibitor, and a statin. These drugs improve your outlook (prognosis).

You have to take them for 2 reasons

To reduce the chance of having another myocardial infarction (MI).
To help prevent heart disease from getting worse.
Aspirin works by reducing the 'stickiness' of platelets. Platelets help the blood to clot if a blood vessel is cut. If you cannot take aspirin (for example, if you are allergic to it) then another anti-platelet drug called clopidogrel may be used instead.
• The usual dose of aspirin is 75 mg per day. This is a low dose (anti-platelet dose).
• Side-effects are uncommon. An important side-effect is bleeding in the gut that occurs in some people. If you have ever had a stomach or duodenal ulcer, or a bleed from your gut, you must tell your doctor. Extra care is needed when taking aspirin. For example, if you have had any of these conditions and take aspirin you may be advised to take another tablet that reduces stomach acid to protect the gut.
• If you develop dyspepsia whilst taking aspirin (abdominal pains) then stop the aspirin and see a doctor. Dyspepsia may indicate a gut problem or a bleed caused by aspirin.
• Ideally, you should not take anti-inflammatory drugs or steroids if you take aspirin. For example, drugs used to reduce inflammation in arthritis, and in particular, ibuprofen. Aspirin plus these drugs increases the risk of a bleed in the gut. However, some people need these drugs. In this case, your doctor may advise another drug to reduce stomach acid to lower the risk of a bleed in the gut.
• Rarely, aspirin may cause a bleed in another part of the body such as into the brain to cause a stroke. In particular, do not take aspirin if you have a bleeding disorder such as haemophilia.
• A small number of people are allergic to aspirin. If you are allergic to aspirin you may get breathing difficulties, wheezing or a swollen face and tongue if you take aspirin. If any of these symptoms occur, stop taking the aspirin and see a doctor.
• Some people with asthma cannot take aspirin as it brings on asthma symptoms.
• You should not take aspirin if you also take a drug called methotrexate.
The above list may sound alarming but most people who take aspirin do not have any problems or side-effects. Also, the benefits of taking aspirin following an MI usually greatly outweigh the risk of side-effects and problems.
B blockers
They ease the workload of the heart. This prevents the heart rate from going too fast, reduces blood pressure, and helps to stabilise the electrical activity of the heart. Beta-blockers are also used to treat angina and high blood pressure.
It is best to read the leaflet that comes with the drug packet for a full list of instructions and possible side-effects. You should not take a beta-blocker if you have asthma or chronic obstructive pulmonary disease (COPD) with an asthmatic component.
• Beta-blockers are not used in people with certain types of heart problems. For example, people with a very slow pulse, sick sinus syndrome, or second or third degree atrioventricular (AV) block.
• Most people do not develop any side-effects. However, tell your doctor if you have any side-effects. The most common are: cool hands and feet, sleeping problems, impotence, pins and needles, and tiredness. A change in dose or preparation may help if you develop any troublesome side-effects.
One of their actions is to interfere with the enzyme (chemical) found in the bloodstream called angiotensin. Blocking this enzyme widens blood vessels, and lowers the blood pressure, which eases the burden on the heart. ACE inhibitors also appear to have a direct action on the heart which has a protective effect.
ACEI
It is best to read the leaflet that comes with the drug packet for a full list of instructions and possible side-effects. The main things you have to remember when giving ACEI are:
• After the very first dose, on the first day you start an ACE inhibitor:
o Stay indoors for about four hours as occasionally some people feel dizzy.(or take just before you go to bed) This is because the very first dose causes a large drop in blood pressure in a few people, and may cause a faint.
o If you do feel dizzy, sit or lie down and it will usually ease off.
o If you become very dizzy, contact your doctor immediately.
• Your body quickly becomes used to the new drug. After the first dose on the first day of treatment, there is no need to take any special precautions.
• A low dose is usually started at first, but built up to a standard dose over 2-4 weeks.
• A blood test is usually done before starting an ACE inhibitor, and about 7-10 days after the first dose. This checks the function of the kidneys. (The kidneys are affected in a small number of people who take an ACE inhibitor.) A blood test at least every year is then usual.
-other se- cough.

Statins - to lower the cholesterol level
Statins work by reducing the amount of cholesterol that is made in the liver. Cholesterol contributes to the build up of atheroma('fatty lumps' that build up on the inside lining of blood vessels)which can lead to heart disease, strokes and other blood vessel problems. In general, the lower the cholesterol level, the better. Your GP or practice nurse will give you a target cholesterol level to aim for. This is usually for your blood cholesterol level to come below 5 mmol/l or to be reduced by 20-25% from your original level, whichever is lower. You will need a blood test before starting a statin, and 4-12 weeks later. This checks if the cholesterol level has come down, and that your liver is not affected. A blood test every so often may then be advised to keep a check on your cholesterol level. The dose may be increased until your target level is reached.
It is best to read the leaflet that comes with the drug packet for a full list of instructions and possible side-effects.
• You should not take a statin if you have liver disease, are pregnant or are breastfeeding.
• Most people do not get any side-effects. A minor stomach upset is the most common side-effect, but rarely requires treatment to stop.
• Tell a doctor urgently if you develop muscle pains. A muscle problem is a rare but serious side-effect.
• It is best to take your statin at bedtime as more cholesterol tends to be made by the liver at night than during the day.

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GTN (Glyceryl Trinitrate)
This comes as tablets or sprays. You take a dose under your tongue 'as required' when a pain develops. GTN is absorbed quickly into the bloodstream from under the tongue. A dose works to ease the pain within a minute or so. Many people always carry their GTN spray or tablets with them. Some people take a GTN tablet or a spray before any exercise. For example, before climbing stairs. If the first dose does not work, take a second dose after five minutes. (If the pain persists for 15 minutes despite taking GTN, then call an ambulance.)

GTN works by relaxing the blood vessels. This reduces the workload on the heart, and also helps to widen the coronary arteries and increase the flow of blood to the heart muscle.

GTN tablets 'go off' after a few weeks. Therefore, you need a fresh supply every eight weeks and return any unused tablets to the pharmacist. You may prefer to use a GTN spray which has a longer shelf life than tablets. A dose of GTN may cause a headache and/or flushing for a short while. This side-effect often improves, or goes, with continued use

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