pharmacology (6)
Liver disease could soon be treated with statins after new research showed they improve liver function.
The study findings are at odds with the long-held belief that people with abnormal liver function have an increased risk of liver disease if they are prescribed statins.
Experts from University College London and Hippokration University Hospital in Greece published evidence in Online First showing significant cardiovascular benefit for patients with abnormal liver function tests (LFT), compared with patients who have normal liver tests.
The findings could lead to statins being used to treat patients with non-alcoholic fatty liver disease, which affects up to a third of adults in Europe and the US.
The researchers in London and Greece examined the results of a three-year experiment on 437 patients with moderately abnormal liver tests, with 227 being treated with a statin and 210 not.
Patients who started the trial with abnormal liver function tests gained the greatest cardiovascular benefit of all, with a 39% reduction in relative risk.
All About Statins From http://www.bhf.org.uk
Statins are medicines that are prescribed to help protect healthy, but high-risk, people from heart disease.
They're also used to prevent repeated problems in people who have already had a heart attack, a stroke or peripheral artery disease.
They are often in the news and you may have seen recent media reports on possible side effects from statins. Read on for everything you need to know about how they work, as well as the benefits and possible side effects.
So how do they work?
Statins reduce the amount of cholesterol produced in the body.
Your body produces cholesterol naturally, and it’s essential for many of your systems to work, but too much cholesterol can increase the risk of heart disease.
Statins reduce the amount of cholesterol that your cells make, forcing them to instead gather cholesterol from your blood stream, and thereby reducing your blood cholesterol level.
What are the benefits of taking statins?
Statins reduce the levels of ‘bad cholesterol’ – the low-density lipoprotein or LDL. High levels of LDL can lead to the build up of fatty deposits in your arteries and can lead to coronary heart disease.
A large amount of research has shown that lowering blood cholesterol reduces your risk of heart disease and heart attacks.
Do statins have side effects?
Like all medicines, statins carry potential side effects,but the side effects of statins are usually mild, easy to recognise, reversible and very rarely dangerous. Statins are among the safest drugs and one of the most studied medicines available today.
Because statins target the liver cells, your liver function will be tested before you start taking statins and then reviewed a few months later. If your liver function is affected, your doctor may want to reduce your dose or change your statin.
Some people experience muscle pain, but this usually stops soon after taking the statin. If it doesn’t, you should tell your GP. Your GP may want to reduce the dose of the statin or switch to a different one.
Very rarely, muscles can leak protein that may build up in the kidneys, and this can cause a serious condition called rhabdomyolysis. It is very rare though and affects about one in every 100,000 people.
Do statins increase my risk of Parkinson’s disease or Alzheimers?
No. There is no evidence that statins cause these conditions. Some research has identified an association, but often associations between diseased and medicines often turn out to be a coincidental link.
My doctor changed my statin. What is the difference between statins?
All statins do the same job, but different types have slightly different chemical structures. This means that if you’re sensitive to one, you might not be to another. Statins have evolved, and newer drugs such as atorvastatin and rosuvastatin are stronger than older ones.
Lots of people don’t need a strong statin to reduce their cholesterol and your doctor will find the right statin for you depending on your medical history and your cholesterol target.
Since simvastatin came ‘off-patent’ it has become cheaper, prompting doctors to swap some people from more expensive statins. Simvastatin is adequate for most people, but you should have a blood test after any change of statin.
Do I have to take statins for life?
Most people take statins on a long-term basis. As your body will always produce cholesterol, if you stop taking a statin it is likely your cholesterol levels will rise.
Can I buy statins over the counter?
Low-dose statins are available at pharmacies but these are not a substitute for prescription statins. If you are at high risk of heart disease, your doctor should prescribe a statin for you.
When should I take my statin?
As cholesterol is produced when you’re asleep, you should take them before bed if you can. It’s important to take medicines regularly, and so find a time that works for you and stick to it.
Do I need to avoid any foods or other drugs
Check with your doctor or pharmacist before taking any other medication as other drugs might affect them. If you’re taking simvastatin, avoid grapefruit - both whole and juice – as it contains a compound which blocks its breakdown.
Are statins safe and effective for women?
Yes. Studies so far show that statins are equally safe and effective for men and women. If you’re pregnant or planning a pregnancy, you shouldn’t take statins. If you’re already taking statins but would like to become pregnant, speak to your doctor first.
Do I have a choice about taking statins?
No one will force you to take any drug, but keep in mind that a statin will reduce your risk of developing heart disease or having a heart attack.
Most people who are offered statins have at least a one in five chance of having a heart attack in the next ten years. This risk is substantially reduced by taking a statin.
How else can I lower my cholesterol?
To help reduce your cholesterol level, you need to cut down on saturated fats and trans fats and replace them with monounsaturated fats and polyunsaturated fats.
You should also reduce the total amount of fat you eat. Eating a balanced diet and taking regular physical activity can also help to improve your cholesterol level.
Indications for use:
Acute severe or life threatening asthma (to be given concurrent with first dose of salbutamol).
Acute asthma unresponsive to salbutamol.
Exacerbation of chronic obrstructive pulmonary disease (COPD), unresponsive to salbutamol
Presentation:
nebules containing ipratropium bromide 250 micrograms in 1ml or 500 micrograms in 2ml.
Actions :
1. Ipratropium bromide is an antimuscarinic broncholdilator drug, it may provide short term relief in actue asthma, but beta2 agonists (such as salbutamol) generally work more quickly. Ipratropium should be considered in acute severe or life threatening asthma or COPD which fail to improve with standard therapy (including salbutamol)
2. Ipratropium is considered of greater benefit in:
a. children suffering acute asthma
b. adults suffering with COPD.
Cautions:
Ipratropium should be used with care in patients with: Glaucoma (protect the eyes from mist), pregnancy and breatfeeding.
Side Effects:
Headache, nausea and vomiting, dry mouth, diff passing urine and/or constipation, tachycardia/arrhythmia, paroxysmal tightness of the chest, allergic reaction.
Contra Indications
None
Doseage refer to JRCALC guidelines
INDICATIONS
Salbutamol is a medication that can be used for Acute Asthmatic Attack where normal inhaler therapy has failed to relieve symptoms.
For Expiratory wheezing associated with allergies, anaphylaxis, smoke inhalation or any other lower airway cause.
In Exacerbation of Chronic Obstructive pulmonary disease (COPD).
Shortness of breath in patients with severe breathing difficulty due to left ventricular failure (secondary treatment).
PRESENTATION
Salbutamol is available in nebules containing 2.5 milligrams / 2.5ml or 5 milligrams /2.5ml.
ACTIONS
Salbutamol is a selective beta2-adrenoreceptor stimulant drug. This has a relaxant effect on the smooth muscle in the medium and smaller airways, which are in spasm in acute asthma attacks. If given by nebuliser, especially if oxygen powered, its smooth-muscle relaxing action, combined with the airway moistening effect of nebulisation, can relieve the attack rapidly.
CAUTIONS
Salbutamol should be used with care in patients with: Hypertension, Angina, Overactive thyroid or in Late pregnancy (as it can relax uterus).
Severe hypertension may occur in patients on beta-blockers and half doses should be used unless there is profound hypotension.
CONTRA-INDICATIONS
There are NO contra indications within the Emergency situation.
SIDE EFFECTS
Tremors, Tachycardia, Palpitations, Headache, Feelings of tension and Peripheral vasodilation.
ADDITIONAL INFORMATION
In actue severe or life threatening asthma ipratropium should be used concurrently with the first dose of salbutamol. In acute asthma or COPD unrespsonsive to salbutamol alone, a single dose of ipratropium may be given conrrently with the second or later dose of salbutamol.
Salbutamol often provides initial relief. In more severe attacks however, the use of steroids by injection or orally and further nebuliser therapy will be required. Do not be lulled into a false sense of security by an initial improvement after salbutamol nebulisation.
Drugs in common use - Glyceryl Trinitrate GTN
Written by Administrator
Glyceryl Trinitrate (GTN) is used in the paramedic field for the relief of angina pectoris or undiagnosed chest pain believed to be of cardiac origin. The relief is brought about by the major action of GTN, that of vasodilation of both coronary and systemic arterial vessels. Coronary artery dilation allows more oxygenated blood to reach the myocardium thus reducing hypoxia.
Systemic dilation reduces peripheral resistance and blood pressure, therefore coronary workload. The reduced peripheral resistance also contributes to an increase in cardiac output.
Again by studying the major actions of the drug. the contraindictations and side effects become clear. Vasodilation of cerebral vessels will result in an increased blood flow to the brain causing headaches and dizziness. it would obviously follow that administration to head injured or acute CVA patients is contraindicated. As mentioned peripheral effects cause a drop in blood pressure resulting in the possibiltiy of postural hypotension that will in turn lead to a compensatory tachycardia.
GTN is available in 300 and 500mcg tablet preparation but preferred administration is via a 400mcg metered dose spray that is given orally into the side of the mouth. Dosages must be verified by individual services.
Atropine is the active ingredient of belladonna, the drug derived from deadly nightshade. Its effects as a parasympathetic blocking agent impede the action of the parasympathetic neurotransmitter employed along the vagus nerve, acetylcholine. if the parasympathetic system were to dominate its effects would be to slow down the rate of impuls formation at the SA node and to increase the degree of block at the AV node, obviosly a continuation of this scenario would inevitably lead to asystole. Atropine will have the opposite effect of encouraging the SA node to increase impulse production and shortening the amount of AV block. if the sheer weight of parasympathetic activity is found to be the cause of asystole, atropine may well reverse the condition.
Atropine administered in a titrated manner can also be employed to rectify certain types of bradycardia. So long as the arrhythmia is of nervous origin and not caused through nodal damage as atropine will have little or no effect on such arrhythmias. In the cardiac arrest situation atropine has NO contra indication, but administration to a patient in bradycardia may result in any of the following.
- Confusion
- Hallucinations
- Visual impairment due to pupil dilation
- Tachycardia
- Dry mouth
Epinepherine is secreted naturally by the suprarenal glands and assumes the role of a sympathetic neurotransmitter. It has an excitatory effect on the heart muscle increasing both myocardial contractility and heart rate. By causing peripheral vasoconstriction it has the effect of increasing mean blood pressures thus helping to maintain cerebral perfusion. Epinepherine is also a smooth muscle relaxant, causing dilation of the smaller air passages, increasing the oxygen intake capability of the lungs.
Because of these qualities epinepherine is the first choice in all cardiac arrest situations. The main causative factor of anaphylaxis (bronchoconstriction and hypovolaemia due to peripheral vasodilation and increased vascular permeability) can also be reversed by its actions. The European Resuscitation Council dictates dosages in cardiac arrest but administration in anaphylaxis may vary from service to service. The accepted administration routes however are intravenous, endotracheal and intramuscular.
Epinepherine has NO side effects or contraindications within the realms of cardiac arrest but may cause arrhythmias including ventricular tachycardia and fibrillation if not administered as per protocol in anaphylaxis.
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