Pharmacy Times offers relevant, clinical information for pharmacists that they can use in their daily practice. These include OTC and Rx product news, disease conditions, patient education guides, drug diversion and abuse, and more.
Issue link: http://pharmacytimes.epubxp.com/i/614520
(4-5 hours a week), smoking cessation, normal blood pressure and cholesterol levels, and a healthy body mass index decreases a woman's chance of a first heart attack by 92%. 4 Medication Adherence ACS management has improved with the use of interventional treatment strategies, antiplatelet drugs, and risk- modifying drugs. 5 Outcomes after ACS are optimized by revascularization and aggressive medication therapy, includ- ing the use of anticoagulants and lipid- lowering medications. 6 Once blood vessels are damaged, arterial plaque is more prone to form- ing. 6 The risk of recurrence is high soon after the incident (within 1 month) and for the long term. 5 A high cholesterol level, high blood pressure, diabetes, and smoking encourage clot formation. 6 Statins are typically started, even if the cholesterol level is not particularly high, with a low-density lipoprotein goal of 100 mg/dL or lower. 6 For patients with unstable angina, pravastatin can reduce the death rate by one-fourth, as well as reduce the risk of subsequent myocar- dial infarctions, coronary revasculariza- tion, and stroke. 6 After an ACS episode, use of non- steroidal anti-inflammatory drugs, other than aspirin, should be stopped, as they increase cardiovascular risks and increase the bleeding risk asso- ciated with many anticoagulants. Anticoagulants, however, are often pre- scribed after an ACS episode. 6 Anticoagulants are used as secondary prevention after a diagnosis of ACS. Dabigatran, apixaban, rivaroxaban, edoxaban, and warfarin all reduce the risk for stroke, intracranial hemorrhage, and systemic embolism. Because war- farin requires regular monitoring, it is being used less often for treating ACS. The newer oral agents may be preferred to warfarin because they are easier to take, regular monitoring is not required, and they do not have dietary interac- tions. Bleeding is always a risk with the use of any anticoagulant. Dual antiplate- let treatments (eg, aspirin and clopido- grel) are commonly used, but increase the risk for major bleeding. The efficacy of ticagrelor and prasugrel compares favorably to clopidogrel for reducing ischemic events in patients with ACS. Pharmacists should help patients under- stand that anticoagulants are often life- long treatments. 5 Your Input Matters Support from family and health care pro- viders can promote self-efficacy. 2 If you notice patients not refilling their pre- scriptions, you have the opportunity to point out the benefits of taking their medications regularly. 7 If you detect frequent divergence from prescribed medication, it may warrant notifica- tion of the patient's primary physician. Statins significantly reduce morbidity and mortality in coronary artery disease, but only if they are taken regularly. 7 Benefits of statins are only seen after 1 to 2 years of continuous use. 7 Lifestyle modifications (primarily diet and exercise) are effective for reducing coronary heart disease, but are rarely adhered to despite being, safe, inexpen- sive, and helpful (Table 4 ). 4 Social sup- port can decrease anxiety and promote the benefits of self-care. 2 Pharmacists can also provide support by encour- aging patients to care for themselves, promoting the benefits of self-care, and reducing anxiety and depression through counseling. 2 n For references, go to Pharmacy Times.com/publications/issue. MORE @ PHARMACY TIMES.COM TABLE: EFFECTS OF LIFESTYLE ON HEART HEALTH LEVEL Low Heart Health Fair Heart Health High Heart Health Smoking Currently smoking Quit less than a year ago Never smoked or quit more than a year ago Healthy diet: 1 point for each: • >4 servings of fruits and vegetables per day • 2 or more servings of fish per week • <1500 mg of salt per day • ≤450 calories per week of sweets • ≥3 servings of whole grains per day 0 or 1 point 2 or 3 points 4 or 5 points Exercise No exercise Up to 49 min/week at moder- ate intensity ≥150 min/week at moderate intensity Body mass index ≥30 kg/m 2 25-29.9 kg/m 2 <25 kg/m 2 Fasting blood glucose ≥126 mg/dL 100-125 mg/dL <100 mg/dL Total cholesterol (mg/dL) (with treatment) ≥240 (>200) 200-239 (<200) <200 Blood pressure (mm Hg) (with treatment) Systolic: ≥140 Diastolic: ≥90 (>140/90) Systolic: 120-139 Diastolic: 80-89 (<140/90) <120/80 Adapted from reference 4. Debra Freiheit has been a practicing pharma- cist and human services professional for over 25 years. Specializing in medical informa- tion, Debra has compiled a broad spectrum of experience obtained through research for companies including Cerner and PPD Inc. With an emphasis on clear and concise information transfer, Debra has built a career communi- cating data with medical professionals and patients. Education and knowledge have been the motivation of a rich career of caregiving through research. Debra's current project involves the creation of a multi-national data- base of drug information. December 2015 PharmacyTimes.com 53