Question

June is a 70 year old female who will be entering your Phase II Cardiac Rehab. class today. Her medical history is as follows: Cardiac History: Anterior MI with PTCA & stent placement to the left circumflex artery on 2/18/19. Other medical history: Hypertension, hyperlipidemia, past smoker- quit 5 years ago. Medications- Lipitor, Coumadin, Enteric coated aspirin, Toprol, Nitroglycerin as needed. Graded Exercise Test: Not available 1. Below is June's resting ECG, is it okay to exercise her today?

Answer 1

1. June's resting ECG shows ST depression and it's not okay to exercise her today .

2. Lipitor :-

#. Astorvastin (Lipitor) Action & Therapeutic Effects

A: Inhibits HMG-CoA reductase, an enzyme responsible for the beginning synthesis of cholesterol

TE: Lowering total/LDL cholesterol and triglycerides. Reduction of lipids/cholesterol to reduce risk of MI. Slows progression of coronary atherosclerosis.

Astorvastin (Lipitor) Adverse Reactions, Side Effects, and Contradictions

AR: Rhabdomyolysis (breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream), Angioneurotic edema (Hypersensitivity Reaction)

SE: Headache, abdominal cramps, constipation, diarrhea, flatus, heartburn

C: Hypersensitivity, Active Liver Disease, Potential for Fetal Abnormalities, May appear in breast milk.

#. Coumadin :-

Indications - Treatment of venous thrombosis, pulmonary embolism, atrial fibrillation with embolization; management of myocardial infraction

Side effects (BCDFN) :-

Bleeding

Cramps

Dermal necrosis

Fever

Nausea

#. Enteric coated aspirin :-

Aspirin indications :

Myocardial infarction/ischemia

Unstable angina

Prevention of reinfarction

Aspirin contraindications :-

Hypersensitivity

Bleeding disorders

Active gastric ulcers

GI bleeding

Hemorrhagic stroke

Asthma (relative)

Not recommended to peds (<12yrs)

Aspirin side effects :-

Stomach Irritation/Indigestion

Nausea and Vomiting

Reye's Syndrome

Irreversibly inhibits platelet aggregation

#. Toprol :-

Uses :

angina, conjestive heart failure, hypertension

Common Adverse Side Effects :

Cardiovascular: bradyarrhytamia, cold extremities, heart failure, hypotension

Dermatologic: pruritus, rash

Gastrointestinal: constipation, diarrhea, ingestion, nausea

Neurologic: dizziness, fatigue, headache

Psychiatric: depression

Respiratory: dyspnea, wheezing