Treatment Goals for E.H.
The specific goal of treatment for E.H. would be to control the pains and acute attacks. Doing so will allow him to establish whether his angina is unstable or stable. Besides, the control of the patient’s state will help in identifying the disease and treatment course (Villano, Lanza, & Crea, 2018). To stabilize angina, drug control in the long term could involve β-blockers, antiplatelet drugs, nitrates, calcium channel brokers, and potassium channel openers.
Recommended Dietary and Lifestyle Changes
Frequent underlying causes for angina are associated with heart diseases. E.H. should prevent or control his angina, which can be achieved by reducing the risk factors for his heart. To reduce coronary diseases, he should eat healthy diets, such as trans fats helpful for weight loss, and avoid saturated foods. Besides, the patient should increase his intake of fruit, whole grains rich in fiber, and vegetables (Villano et al., 2018). E.H. can benefit from a safe exercise plan and sufficient rest.
Drug Therapy Recommendation
To stabilize E.H.’s stable condition of angina, the intake of long-acting nitrates is required. Nitrates are provided on a routine basis to help in preventing episodes of angina pectoris. The transdermal patch dosage varies from 0.2- 0.4 mg/hr and is determined by the patient’s reaction to treatment (Lotfaliany et al., 2018). Furthermore, the medication can also include topical ointment or oral sustained-release tablets.
How to Monitor Success
The efficacy of the treatment can be demonstrated with the decrease in the frequency of pains due to the use of nitrates. The patient can be involved in the monitoring process and record his symptoms and signs. The increasing frequency of attacks, activity changes, as well as elimination symptoms by the multiple dosages, can be kept on records. Such an approach can also point to cases of angina worsening.
Drug-Drug or Drug-Food Interactions
Since E.H. uses nitrates to help him manage chest pains, he needs to stay away from some drugs such as Sildenafil, also known as Viagra. It can cause severe side effects that can be especially harmful to anyone who takes nitrates. A combined intake of Sildenafil and the selected agent can cause a prolonged and extensive decrease in blood flow in the coronary and low blood pressure in the vessels (Lotfaliany et al., 2018). These conditions can result in critical stenosis and fatal outcome cardiac.
Adverse Reactions and Second-Line Therapy
The therapy should be changed if E.H. develops irregular or fast heartbeat, confusion, persistent headache, nausea, weakness or unusual tiredness, severe redness, swelling of the skin, or soreness. Moreover, calcium channel brokers (CCBs) could be used as the second line of therapy. Beta-blockers are generally prescribed to treat angina and high blood pressure. However, they are not recommended for E.H because of his asthma history, and CCBs can be utilized instead.
Patient Education on Prescribed First-Line Therapy and Alternative Medications
The patient should be informed that alcohol and drugs lower blood pressure. Long-acting nitrates can cause side effects involving dizziness, flushing, headache, and hypotension, and the doctor should be notified of such symptoms if they occur. It is not recommended for the patient to take over-the-counter drugs for alternatives since this can be fatal. Aspirin could be considered an alternative medication for reducing the aggregation of platelet or antiplatelet agents (Sepehri et al., 2018). The intake of aspirin should be discussed with the patient’s physician.
References
Lotfaliany, M., Bowe, S. J., Kowal, P., Orellana, L., Berk, M., & Mohebbi, M. (2018). Depression and chronic diseases: Co-occurrence and communality of risk factors. Journal of Affective Disorders, 241, 461-468.
Sepehri, Z. S., Masoomi, M., Ruzbehi, F., Kiani, Z., Nasiri, A. A., Kohan, F.,… Asadikaram, G. A. (2018). Comparison of serum levels of IL-6, IL-8, TGF-β and TNF-α in coronary artery diseases, stable angina and participants with normal coronary artery. Cellular and Molecular Biology, 64(5), 1-6.
Villano, A., Lanza, G. A., & Crea, F. (2018). Microvascular Angina: Prevalence, pathophysiology and therapy. Journal of Cardiovascular Medicine, 19, e36-e39.