Ask The Pharmacist: Cardiovascular Effects of NSAIDs, Opioids & Other Workers' Comp Medications

Are there cardiovascular considerations related to common medications used in workers’ comp?

There can be. 以下是工人赔偿中三个顶级治疗类别的一些与心脏相关的副作用或注意事项.

Opioids (a.k.a., Narcotics)

All opioids can be associated with hypotension, orthostatic hypotension, and bradycardia because of their effects on the central nervous system and histamine release. In cases of severe circulatory depression (e.g., overdose), shock and cardiac arrest may occur. Hypertension and tachycardia may also manifest, but these are usually symptoms associated more with withdrawal from opioids. Methadone is associated with an increased risk of QT prolongation and TdP. Buprenorphine can also be associated with a risk of QT prolongation. These effects are thought to be dose-related, with evidence suggesting that they are more of a concern when higher doses of methadone (>100 mg/day) are used; however, smaller doses have also been associated with cardiac risk. Caution is advised when initiating methadone therapy, switching from other opioids to methadone, or titrating the dose, 医疗保健专业人员可能要求心电图监测，以筛查和持续评估任何QT间期的影响. 美沙酮或丁丙诺啡应谨慎用于患有心脏病或有QT间期延长危险因素的患者.e., family history or taking other drugs that can prolong QT interval).

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

所有非甾体抗炎药都增加了包括心肌梗死在内的严重心血管事件的风险.k.a., heart attack) and stroke. NSAIDs may also increase blood pressure, 特别是那些已经患有高血压和/或正在服用药物控制血压的人.k.a, antihypertensive medications). NSAIDs influence prostaglandins, and these substances play a role in kidney function (among other things). As a result, 使用非甾体抗炎药会增加肾脏血流量或血容量减少的风险, which can lead to exacerbations in certain conditions such as congestive heart failure, edema, or hypertension. 指南现在还建议st段抬高型心肌梗死(STEMI)患者和心肌梗死后的时间内避免使用非甾体抗炎药，因为相关的死亡风险增加, re-infarction, hypertension, heart failure, and myocardial rupture. The highest cardiovascular risk is found with COX-2 agents (e.g., Celebrex®), 官方残疾指南(ODG)建议如果有主要危险因素的患者需要非甾体抗炎药治疗, the suggested treatment is naproxen plus low-dose aspirin plus a Proton-pump inhibitor (PPI).

Muscle Relaxants

服用Soma®(carisoprodol)的患者在上市后使用期间报告了各种心血管不良事件, including tachycardia, orthostatic hypotension, and flushing. Additive effects from other central nervous system (CNS) depressants such as alcohol, other CNS depressant medications (i.e., opioids, benzodiazepines), or psychotropic agents may exacerbate these events. Flexeril®(环苯扎林)带有警告，避免在心肌梗死后急性恢复期患者使用, as use could cause re-infarction or sudden death. 有心脏病或其他可能增加QT间期延长风险的患者应谨慎使用环苯扎普利或Zanaflex®(替扎尼定), or in patients taking other medications known to prolong the QT interval. Norflex™(orphenadrine)应谨慎用于心脏病患者，可能导致心动过速. Bradycardia, flushing, hypotension, and syncope (i.e., fainting) have occurred following administration of Robaxin® (methocarbamol). Cardiac adverse reactions to other muscle relaxants commonly used in workers’ comp are rare; however, 其中一些药物的高剂量使用与低血压和各种心律失常的报告有关.

What Cardiac Effects and Monitoring Terms Should I Know?  

当你阅读每个治疗类别下的信息时，请随意参考这些术语.  

• Electrocardiogram (ECG or EKG): A test that can be used to look at the electrical activity of the heart. The heart is essentially a muscle that is driven by a natural electrical rhythm, 与心脏跳动相关的电活动的读数可以在心电图上被看作是纸上的线状描记或“波”.”
• QT interval: 指心脏电周期中两个不同点之间的时间度量(心电图上Q波的开始和T波的结束)。, and it represents the time of ventricular activity (the lower chambers) of the heart.
• QT prolongation: 表示心脏电活动的延迟会对心律产生负面影响.
• Bradycardia: An abnormally slow heart rate (defined by the American Heart Association as less than 60 beats per minute).
• Tachycardia: 心率异常加快(由美国心脏协会定义为每分钟超过100次).
• Torsade de Pointes (TdP): 一种室性心动过速，与QT间期延长有关，可导致心源性猝死.
• Hypotension: Abnormally low blood pressure, 伴直立性低血压，指从坐姿或躺姿站立时血压突然下降.
• Hypertension: Abnormally high blood pressure.

This information is meant to serve as a general overview, 任何具体问题或心血管问题都应该与你的医疗保健专业人员(如开处方的医生或配药的药剂师)进行更全面的检查.

Do you have a workers’ compensation or auto related pharmacy question? Send us an email at AskThePharmacist@olesyanazarova.com.

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References:

http://www.heart.org/en/
http://www.odgbymcg.com/