Jane’s Adventures at the Pharmacy

Hello, I’m Jane. I’m a pharmacist and I would like to tell you about some of my adventures.

Yesterday I had a patient named Joe. He was worried, because he had coronary artery disease. The patient read on the internet that he can have a coronary angioplasty. I told him that the best option is to talk to his doctor about the surgery, because he will have a coronary angiogram (a type of X-ray used to check blood vessels) which will determine which treatment is best. Joe also asked me about the procedure. I told him that during the procedure, a small balloon is inserted to push the fatty tissue in the narrowed artery outwards. This allows the blood to flow more easily. Coronary angioplasty is also performed as an emergency treatment during a heart attack. He was grateful for the information and added that lately he had experienced chest pain, chest tightness, chest discomfort and shortness of breath. I recommended that he should see the doctor immediately, because his medicines or the dosage might be inappropriate. Joe told me about the medicines he was taking. The doctor prescribed him low-dose aspirin and clopidogrel. I informed him that daily low-dose aspirin makes the blood less sticky and helps to prevent heart attacks and stroke. It's best to take low-dose aspirin with food so it doesn't upset his stomach. Clopidogrel is an antiplatelet medicine. It prevents platelets from sticking together and forming a dangerous blood clot. The main side effect of clopidogrel is excessive bleeding. The patient may have nosebleeds, heavier periods, bleeding gums or bruising. The doctor also recommended that Joe should also have nitrates with him, because they are used to widen blood vessels. Nitrates work by relaxing the blood vessels, letting more blood pass through them. This lowers blood pressure and relieves any heart pain the patient has. Nitrates can have some mild side effects, including headaches, dizziness and flushed skin. Joe also wanted to know what the risk factors are. He found out from me that these include age, sex, family history, smoking, poor diet, lack of physical activity and stress. I also told him how to prevent heart diseases. Patients shouldn’t smoke, they need to control other health issues, such as high cholesterol and diabetes, exercise at least 30 minutes a day on most days of the week, eat a diet that's low in salt and saturated fat, maintain a healthy weight, reduce and manage stress.

In the end I gave Joe his medicines and he returned home satisfied with the advice.

The next patient was Amber. She had symptoms such as: fluttering in the chest, racing heartbeat, chest pain, shortness of breath and dizziness. I told her, she can may have arrhythmia and should see the doctor immediately. The patient told me she had already seen the doctor and received some medicines, one of which was Atenolol. Amber wanted to get some information about this beta-blocker. So I told her, that it's used to treat high blood pressure and arrhythmia. Atenolol slows down heart rate and makes it easier for the heart to pump blood around body. It can make the patient feel dizzy, sick or tired and give constipation or diarrhoea. These side effects are usually mild and short-lived. I also told Amber that very first dose of atenolol may make her feel dizzy, so she needs to take it at bedtime. I also suggested not to stop taking atenolol suddenly, because this can make her condition worse. She was satisfied with the advice, but wanted to know more about a different beta blocker – bisoprolol. I told her, that bisoprolol is a medicine used to treat high blood pressure and heart failure. The first dose of bisoprolol may make you feel dizzy, so the patient needs to take it at bedtime. After that, if the patient doesn't feel dizzy, it's best to take it in the morning. The main side effects of bisoprolol include feeling dizzy or sick, headaches, cold hands or feet, constipation or diarrhoea – these are usually mild and short lived. I also added that she should not change medicines herself and has to talk to her doctor beforehand. She was pleased with the advice and wanted to know what the cause of arrhythmia might be. I told her, that common causes of arrhythmias or conditions that can lead to arrhythmias include: coronary artery disease, diabetes, excessive use of alcohol or caffeine, smoking or stress. I also added some information about risk factors such as: family history, smoking, lack of physical activity and poor diet. Amber was shocked and asked me about the possible complications of heart disease. I thought about it and said that complications of heart disease include: heart failure, heart attack, stroke and sudden cardiac arrest. She was frightened, so I calmed down her and added, that these complications don’t have to occur provided she stays in touch with her doctor. Amber was pleased with the information.

In the end I gave Amber her medicines and she returned home satisfied with the advice.