1, nitrates: pay attention to drug resistance With the increasing number of patients with suspected and confirmed coronary heart disease, nitrates have become the “friend” of many people and are the drug of choice for the treatment of myocardial ischemia. However, this drug is prone to drug resistance after long-term application. An effective measure to solve this problem is to change the conventional dosing method, which requires a “gap” period of about 10 hours per day for nitrates. For example, short-acting nitrates should not be taken on an 8-2-8-2 schedule, but rather on an 8-12-4-10 schedule. When giving intravenous nitrates, such as nitroglycerin and isosorbide mononitrate, do not give 24-hour intravenous drip or pump, but also need to have a “blanking period” to choose the time period of pain onset to give the drug is better. If there are more painful episodes at night, you can choose to give the drug at night. The second hospital of Zhengzhou University, cardiovascular medicine Zhang Qiang 2, blood ester drugs: do not forget to monitor liver function Many people think that as long as the blood lipid level is adjusted to the normal range, you can stop using lipid-regulating drugs, but in fact, it is not. Statins are very versatile, making them play an important role in the primary and secondary prevention of cardiovascular disease. In patients with coronary artery disease or with atherosclerotic disease, as well as in high-risk patients, lipid levels should be stabilized within a more stringent range on a case-by-case basis, rather than just being within the normal range. Especially in patients with coronary artery disease, statins must be taken for a long time after stent implantation, but care must be taken to monitor liver function. For those with abnormal liver function caused by lipid-regulating drugs, attention should be paid to reducing the dosage or temporarily stopping the drugs, and liver-protective drugs can be added. Patients with elevated triglycerides should take fibrates. The above two types of drugs are generally not used, otherwise liver function damage or even myopathy is more likely to occur. 3, β-blockers: slow heart rate caution β-blockers can slow the heart rate, for sympathetic activity increased in young patients or women who may be pregnant should be used as one of the drugs of choice. However, they should be used with caution in patients with slow heart rate and high atrioventricular block. 4. Calcium antagonists: observe the presence of lower limb edema The application of calcium antagonists to patients with coronary artery spasm can prevent coronary artery spasm. However, its side effect of causing anterior tibial and ankle edema is often overlooked. It is common to encounter patients who visit the clinic because of lower extremity edema, but the liver and kidney function tests are fine, and only after asking the medical history do we know that it is caused by the patient taking nifedipine. The edema quickly subsided after discontinuing the calcium antagonist and using a small amount of diuretics. 5. Angiotensin-converting enzyme inhibitors (ACEl) and angiotensin II receptor antagonists (ARB): common cough side effects The ACEI class of drugs is routinely given to patients with hypertension, coronary artery disease, angina pectoris and other cardiovascular diseases to delay cardiovascular remodeling, reduce complications, prolong life expectancy and reduce morbidity and mortality. However, its side effect of causing cough is more common. This is a time to consider reducing the drug dosage for continued observation. Patients with intolerable cough can be switched to ARB class drugs. 6. Diuretics: check whether the blood potassium is low Diuretics are both the cornerstone of the treatment of heart failure and the first-line drug for lowering blood pressure. When applied, potassium-protecting and potassium-removing diuretics are generally used in combination to prevent the occurrence of water-electrolyte disorders. Nowadays, the number of patients with hyperuricemia is increasing, and thiazide diuretics may induce or aggravate gout attacks and should be used with caution.