Principles in Drug Therapy
There are certain basic principles to follow in drug therapy that should be applied in our patient with angina pectoris. Whenever possible, start with a simple regimen, for example, a limited number of drugs taken once daily. This will help clarify the problem if side effects occur and it will enhance patient compliance. Medications should be increased one drug at a time, as necessary, until symptoms are relieved, the maximum dose is achieved or side effects occur.
In order to achieve control of our patient's risk factors, he was referred to a comprehensive smoking cessation program and advised to lose weight to his ideal level. He was given a diet low in calories, saturated fats and sodium. Because of his total cholesterol of three hundred, and LDL cholesterol of 219, lipid lowering therapy with a statin was begun. His initial angina management included aspirin and instruction in the proper use of sublingual nitroglycerin.
Treatment with a beta blocker in our patient was given for control of his angina pectoris, hypertension, its beneficial effect in slowing left ventricular response to atrial fibrillation and longevity enhancing properties. Warfarin was administered to our patient because of his CHA2DS2 VASc score of two. An ACE-inhibitor was started to reduce his risk of future cardiac events and to treat his hypertension.
The patient was further advised to report any change in his symptoms or potential side effects of his medications. He was asked to weigh himself daily and he and his wife were taught to take his blood pressure and asked to record it daily. He was also advised to begin an aerobic exercise program with daily walking. He was referred to a cardiac rehabilitation center for follow-up of his exercise prescription, his cardiac risk factors and for further counseling. Finally, he was scheduled for interval evaluation.