Your doctor will bring you some medications to take after surgery when you are discharged from the hospital. These medications are therapeutic for you, and you should pay attention to the following points during the process of taking them.
1.You should know, the name and appearance of each medication you take.
2.Take the medication on time as ordered by your doctor.
3.Do not stop taking your medication without your doctor’s permission.
4.Do not give your medication to your family and close friends. The medication is good for you, but may be harmful to others.
5. Please tell your doctor about any side effects you experience while taking the drug. Some drugs have mild side effects that will disappear over time, but some may persist and should not be ignored.
I. Anticoagulants (platelet inhibitors)
The high viscosity of blood in patients with coronary artery disease slows down the coronary circulation and makes it easy for platelet aggregation and thrombosis to occur. Anticoagulants are a class of drugs that need to be taken for a long time after CABG surgery, which can improve blood rheology and prevent angina pectoris after CABG surgery, and long-term adherence to anticoagulants after CABG surgery can effectively prolong the long-term patency of the vascular bridge and extend the life of the bridge vessel.
Commonly used drugs include enteric aspirin, Poliovel, Pansentin, and resistacid. These drugs can inhibit platelet aggregation and dilate blood vessels, thus preventing vasoconstriction and thrombosis.
Aspirin can cause gastrointestinal symptoms such as nausea, vomiting, indigestion and constipation, and gastrointestinal bleeding. It should be used with caution if you have a history of gastric ulcer, gastrointestinal bleeding, or hemophilia.
Adverse reactions to Polivic (clopidogrel) include bleeding, with an incidence of 1.4%. The most common gastrointestinal reactions are: abdominal pain, dyspepsia, diarrhea and nausea. Others are constipation, dental disease, vertigo and gastritis. We recommend aspirin dosage of 100 mg/day and aspirin can be taken for life. Bolivar is taken for 1 year.
II. Nitrates
Nitrates are the most commonly used class of drugs for patients with coronary heart disease. Their basic effect is to directly relax vascular smooth muscle, reduce myocardial anterior and posterior loads, and lower myocardial oxygen consumption, so as to improve the oxygen supply to the ischemic myocardium.
The most commonly used is sublingual nitroglycerin, which is quickly absorbed through the oral mucosa, almost similar to intravenous injection, with fast onset of action, but not suitable for oral administration, because it can be rapidly metabolized after oral administration and the efficacy is poor; the second is the long-acting isosorbide nitrate, such as cardiac pain, Xinkang, long-acting cardiac pain treatment, long-acting isoleadin, etc. Long-acting preparations are taken once a day, with good compliance and satisfactory efficacy.
The adverse reactions of nitrates are mostly caused by vasodilator effect, commonly including flushing, reflex heart rate acceleration and pulsating headache, and overdose can cause postural hypotension. In addition, nitrates can rapidly develop resistance, which can be reversed after discontinuation of the drug.
Most patients have a high preoperative nitrates dosage for CABG, and the question of whether they should continue long-term application after surgery is still debated. Some doctors believe that nitrates can be discontinued after 3-6 months after surgery because the bridge vessels can already normalize myocardial blood supply; some doctors believe that bypass can only improve blood supply to large coronary vessels, but the adequacy of blood supply to small and medium distal vessels cannot be proved, and nitrates still need to be taken to expand coronary vessels to make good myocardial blood supply. We suggest that patients continue to take nitrates for 6 months after CABG, and after 6 months, we will decide whether to continue the application according to the patient’s condition and activity requirements.
In addition, the incidence of angina and infarction is only reduced after CABG, which is not the same as no longer having angina or infarction. Therefore, in case of cold weather and great activity, post-CABG patients may still have angina pectoris, and some emergency drugs must still be carried with them in case of angina pectoris attack, such as nitroglycerin tablets or sprays, of which the tablets are fast-acting and reliable, but not easy to store (because they are easily powdered and decomposed by heat or light), and sprays are effective in 30 seconds, which are more effective than tablets, fast-acting and easy to use. Easy to use.
β-blockers
β-blockers can prevent angina pectoris induced by exercise or emotion by slowing down heart rate, inhibiting myocardial contraction and reducing myocardial oxygen consumption, but they are not effective for angina pectoris related to coronary artery spasm. β-blockers are the only drugs that can reduce the mortality and sudden death rate after acute infarction.
The adverse reactions of β-blockers can be divided into two categories, one is related to their pharmacological effects, due to excessive doses of reactions, such as heart failure, hypotension, bradycardia and conduction block, and the other is not related to receptor blockade reactions, such as insomnia, diarrhea, affect blood lipids, blood glucose levels, etc.
The dosage of beta-blocker before CABG in patients with coronary artery disease may be relatively large, such as betalactam can be used up to 200-300mg/day, so that the patient’s heart rate before surgery is controlled at 55-65 beats/min. After CABG, beta-blocker still needs to be applied, but the usage and dosage can be adjusted according to the situation, so that the heart rate can be controlled at 70-85 beats/min. Long-term application of β-blockers should not be stopped abruptly, because it can cause “rebound” and aggravate myocardial ischemia, and even infarction. For example, if the heart rate and blood pressure are stable, the dose can be reduced by 12.5mg each time, and the interval between dose reductions should be more than one week or one month.
Fourth, lipid-regulating drugs
Atherosclerosis is the main risk factor for the occurrence of coronary heart disease. High blood lipid level will accelerate the process of atherosclerosis and cause the obstruction of myocardial blood supply, which is also the main factor affecting the long-term patency of vascular bridge after CABG. Lipids include cholesterol, triglycerides and phospholipids, which are clinically monitored as cholesterol, triglycerides, HDL, LDL, and further monitored as apolipoproteins.
The cut-off criteria for hyperlipidemia currently used in China are as follows.
Ideal level of cholesterol is 5.18 mmol/L; mild hypercholesterolemia is 5.18-6.5 mmol/L; severe hypercholesterolemia is 6.5-7.8 mmol/L; severe hypertriglyceridemia is >5.65 mmol/L; normal level of LDL is 1.3 g/L; critical high risk level of LDL is 1.3-1.5 g/L. (LDL high risk level >1.6g/L; HDL high risk level <0.35g/L; ApoA 1.0-1.4g/L; ApoB 0.8-1.0g/L; Atherogenic index 1) LDL/HDL ratio >3.55 (men), 3.22 (women); cholesterol/HDL ratio > 4.5.
There are exogenous and endogenous sources of lipids, the former from diet and the latter synthesized in the body. Lipid metabolism disorder is the main factor of atherosclerosis, and good control of lipid level is the key to the long-term outcome after CABG. The correct application of lipid-regulating drugs (formerly called “lipid-lowering drugs” is inaccurate) can effectively control the formation and development of atherosclerosis.
Most of the patients after CABG pay attention to diet control, but do not pay enough attention to the application of lipid-regulating drugs, and do not regularly check the lipid index after surgery, resulting in persistent lipid increase and recurrence of angina pectoris after surgery.
Lipid-regulating drugs are broadly divided into statins (lovastatin, simvastatin, pravastatin, fluvastatin, methotrexate, sulforaphane, etc.); fibrates (gefirozil, fenofibrate, norethindrone, Lipin, etc.); niacin (vitamin B5, vitamin PP, Vesicare, Lupin, etc.); and others (cholestyramine, cholestyramine, etc.).
The adverse effects of lipid-regulating drugs include gastrointestinal symptoms such as diarrhea, bloating, nausea, occasional abnormal liver function, myalgia, etc. Therefore, during the application of lipid-regulating drugs, liver function indicators and blood lipid levels should be monitored. In addition, the blood lipid level should not be too low, too low blood lipid will increase the incidence of brain hemorrhage and cancer. Lipid-regulating drugs should be applied for a long time and reviewed regularly, usually once every three months, to make appropriate adjustments according to the results.
V. Calcium antagonists
It can relax vascular smooth muscle, dilate coronary artery, release coronary artery spasm, improve myocardial ischemia caused by coronary artery spasm, reduce myocardial oxygen consumption, improve blood rheology, reduce circulatory resistance, improve tissue blood supply, and have different degrees of anti-platelet aggregation effect, long-term use can prevent new coronary artery damage and stop coronary artery lesion It can stop the development of coronary artery lesions by preventing new coronary artery damage.
Commonly used drugs include Loxodil, Hepeson, Hepeson, Bexin, Nifedipine, etc. All kinds of calcium antagonists have the effect of dilating coronary vessels, but they have different effects on lowering blood pressure and heart rate, for example, Baxin, Loxin and Nifedipine have strong effect on lowering blood pressure, and Hepeson and Hepeson have prominent effect on lowering heart rate. Nifedipine (cardiac pain) is not suitable for post-infarction myocardial ischemia, and verapamil (isoptin) is not suitable for those with sinus node malfunction, atrioventricular block, or cardiac insufficiency.
After CABG, especially intraoperative application of arterial bridges (such as internal mammary artery, radial artery, etc.), postoperative application of calcium antagonists can prevent bridge vasospasm and improve myocardial ischemia caused by coronary spasm. The specific application of which drug can be considered according to the patient’s heart rate, blood pressure and other conditions. At present, the application of calcium antagonists in slow-release or controlled-release dosage forms, such as Baxin and Loxin, can reduce the reflex heart rate increase and blood pressure fluctuation caused by short-acting drugs such as nifedipine (cardiac pain).
The adverse effects of calcium antagonists include headache, facial flushing, palpitations, ankle edema, dizziness, and weakness, etc. Some patients discontinue the drugs because of obvious side effects.
If other comorbidities such as diabetes mellitus or hypertension are combined, they should be treated at the same time.
VII. Precautions for the application of cardiovascular drugs in the elderly
With the development of economy and health care, the proportion of elderly people in the total population is increasing. Most of the patients with coronary heart disease are elderly people, so the problem of medication for elderly patients should also be a cause for concern. The chance of side effects after medication in the elderly is 7 times higher than that in young people. Elderly people suffer from multiple diseases at the same time, so they often apply multiple drugs at the same time, which makes drug interactions more complicated, and side effects increase exponentially. Therefore, the application of cardiovascular drugs in the elderly should not only consider the efficacy of such drugs in the elderly, but also consider the “compliance” of taking the drugs, and should pay attention to “individualization”.
The following principles should be followed when administering medications to the elderly.
1. Keep the medication as simple as possible, avoid taking multiple drugs at the same time unless necessary, and pay special attention to the possible side effects when drugs are used together.
2, so that patients understand the simple pharmacological knowledge of the drugs taken, understand the possible interactions, and choose the appropriate variety of drugs in the same category.
3.Change the variety and dosage of drugs as little as possible, some drugs need to be monitored regularly (such as digoxin concentration, electrolyte condition).
4. Pay attention to the “compliance” of the elderly in taking medication, reduce the number of doses, and indicate the name, usage and dosage of medication in large letters.
The above drugs should be taken according to the patient’s specific conditions, and the patient should be discharged from the hospital according to the doctor’s prescription, and regular postoperative reviews should be conducted to observe the development of the disease and adjust the drug usage and dosage to ensure good long-term results after surgery.