斯宾塞·谢尔曼，药房.D.
临床药剂师，药房亚博真人官方版APP
Are there cardiovascular considerations related to common medications used in workers’ comp?
可能会有. Here are some heart-related side effects or precautions for three of the top therapeutic classes in workers’ compensation.
阿片类药物(.k.a.毒品)
All 阿片类药物 是否与低血压有关, 直立性低血压, and bradycardia because of their effects on the central nervous system and histamine release. 在严重循环抑制的情况下(如.g.可能发生休克和心脏骤停. 高血压和心动过速也可能出现, but these are usually symptoms associated more with withdrawal from 阿片类药物. Methadone is associated with an increased risk of QT prolongation and TdP. 丁丙诺啡也可能与QT间期延长的风险相关. 这些影响被认为与剂量有关, with evidence suggesting that they are more of a concern when higher doses of methadone (>100 mg/day) are used; however, 较小的剂量也与心脏病风险有关. 建议在开始美沙酮治疗时谨慎, 从其他阿片类药物转向美沙酮, 或者滴定剂量, and the health care professional may request ECG monitoring to screen for and continually evaluate any QT interval effects. Methadone or buprenorphine should be used with caution in patients with cardiac disease or those with risk factors for QT prolongation (i.e.(如家族史或服用其他可延长QT间期的药物).
非甾体抗炎药(NSAIDs)
All NSAIDs carry an increased risk of serious cardiovascular events including myocardial infarction (a.k.a.(心脏病发作)和中风. 非甾体抗炎药也可能增加血压, particularly in those who already have 高血压 and/or who are taking medications to control blood pressure (a.k.A、抗高血压药物). 非甾体抗炎药影响前列腺素, and these substances play a role in kidney function (among other things). 结果是, there can be an increased risk of reduced blood flow to the kidney or to blood volume with the use of NSAIDs, which can lead to exacerbations in certain conditions such as congestive 心脏衰竭, edema, 或高血压. Guidelines now also recommend avoiding use of NSAIDs in patients presenting with ST-elevation myocardial infarction (STEMI) and during the time following myocardial infarction due to an associated increased risk of death, re-infarction, 高血压, 心脏衰竭, 心肌破裂. COX-2药物的心血管风险最高.g., 西乐葆®), and the Official Disability Guidelines (ODG) recommend that if NSAID therapy is necessary for patients with major risk factors, the suggested treatment is naproxen plus low-dose aspirin plus a Proton-pump inhibitor (PPI).
肌肉松弛剂
Patients taking Soma® (carisoprodol) have reported experiencing various cardiovascular adverse events during post-market use, 包括心动过速, 直立性低血压, 和冲洗. Additive effects from other central nervous system (CNS) depressants such as alcohol, 其他中枢神经系统抑制剂药物(如.e., 阿片类药物, benzodiazepines), or psychotropic agents may exacerbate these events. Flexeril® (cyclobenzaprine) carries a warning to avoid use in patients who are in the acute recovery phase following myocardial infarction, 因为使用可能导致再梗塞或猝死. Cyclobenzaprine or Zanaflex® (tizanidine) should be used cautiously in patients with cardiac disease or other conditions that may increase the risk of QT prolongation, or in patients taking other medications known to prolong the QT interval. Norflex™ (orphenadrine) should be used cautiously in patients with cardiac disease and can cause tachycardia. 心动过缓、潮红、低血压和晕厥(1).e., fainting) have occurred following administration of Robaxin® (methocarbamol). Cardiac adverse reactions to other muscle relaxants commonly used in workers’ comp are rare; however, use of high doses of some of these drugs has been associated with reports of hypotension and various arrhythmias.
我应该知道哪些心脏影响和监测术语?
Feel free to refer to these terms as you read through the information under each therapeutic class.
- 心电图(ECG或EKG): 一种可以用来观察心脏电活动的测试. The heart is essentially a muscle that is driven by a natural electrical rhythm, and readings of the electrical activity associated with the pumping of the heart can be seen on an ECG as line tracings on paper or “waves.”
- QT间隔: Refers to a measure of time between two different points in the heart’s electrical cycle (the start of the Q wave and the end of the T wave on an ECG), and it represents the time of ventricular activity (the lower chambers) of the heart.
- QT延长: Represents a delay in the heart’s electrical activity that can negatively affect the heart rhythm.
- 心动过缓: 异常缓慢的心率(由心律失常定义) 美国心脏协会 如每分钟少于60次).
- 心动过速: An abnormally rapid heart rate (defined by the 美国心脏协会 as more than 100 beats per minute).
- 扭转角(TdP): A type of ventricular tachycardia that can be associated with a prolonged QT interval and can lead to sudden cardiac death.
- 低血压: 异常低血压, with 直立性低血压 referring to a sudden drop in blood pressure experienced upon standing from a sitting or lying position.
- 高血压: 异常高血压.
此信息旨在作为总体概述, and any specific questions or cardiovascular concerns should be more fully reviewed with your health care professional such as the prescribing doctor or dispensing pharmacist.
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