Reminder to self - CVS patients

Most patients with CVS disorders (HF, HTN, Arrhythmias, PVD, etc) usually have a multitude of drugs (aka medication hamper) and most of the time drugs are used in combination and patients may have multiple co-morbidities.

Today's counselling session was fun, way too funny as the instructors were pulling all kinds of tricks as difficult patients - last day anyway so play play. Some simple questions with DIFFICULT PATIENTS =.= love Challenging cases, so next time go out and work - like a bed of roses ^^. After today's challenge, I think it is time to resurrect a project which I started while I was in Guardian Pharmacy - a emergency list of language translation. This one was my farewell gift - we had a Japanese clinic in the medical centre. After exams then settle. Planning to come out with a list of commonly used terms and phrases and translate them with phonetics or if possible the spelling - so the patient can read if dun understand what the heck talking me. The instructor hit me at a weak spot - my failure in the use of mandarin (still remembered during my Secondary Skool days, the Mandarin teacher ran up to me after I merely passed the exam:"...不要充考了hor.及格就夠了!")

Patients come from all walks of life and we should be able to communicate with the patient in whatever language he/she is comfortable with. Cannot speak the language, seek help from a relative or a patient or staff nearby.

Cimetidine is a drug to look out for in prescriptions as it inhibits a plethora of enzymes common with most hepatically metabolised drug-substrates.
- Need to increase the dose of drugs that need prior activation by the liver, e.g. Acyclovir
- Need to decrease dose of drugs that are active moieties
- Interacts with warfarin (increase bleeding time)
- Can be substituted with other H2-antagonists such as famotidine

Amiodarone (Affectionately known as Amy要打人) is a drug that is used to treat arrhythmias
- Interact with cimetidine (may cause heartblock)
- Outpatient use should be that of a tapering dose as patients who are on long term amiodarone has chances of heart block
- May cause drug induced problems in patients with thyroid disorders because it contains 2 iodine atoms (attached to phenyl ring)

RALES found that the combo of Spironolactone + ACEi + Loop Diuretic decreases mortality in HF patients

Pharmacist main roles with patients prescribed medication hampers are to
-Intervene on potentially lethal D/Is
-Monitor and counsel patients on drug combos that may require monitoring and not necessary to stop