Flavors are an important motivator for e-cigarette uptake in youth, but the role of flavored e-cigarettes on uptake of tobacco smoking or cessation remains unclear, according to a systematic review published in Addiction.
“There has been a lot of concern that young people may start vaping because they are attracted to e-liquid flavors and that it could potentially lead them to start smoking tobacco,”Caitlin Notley, PhD, professor at Norwich Medical School at the University of East Anglia in Norwich, England, said in a press release from the institution. “We wanted to find out more about the links between vape flavors, the uptake of vaping among young people and whether it leads to regular vaping and, potentially, tobacco smoking.”
The systematic review evaluated 58 interventional, observational and qualitative studies conducted from 2004 to 2020 among 512,874 young people younger than 18 years with data on use of e-cigarettes with flavored liquids. Included studies compared flavored e-cigarettes vs. another e-cigarette flavor, flavored e-cigarettes vs. unflavored e-cigarettes, and e-cigarette uptake, prevalence, incidence and outcomes in smokers vs. nonsmokers.
Total quality of evidence among all studies was low, according to the researchers, with 39 cross-sectional survey studies, 11 longitudinal cohort studies that assessed e-cigarette trajectories and eight qualitative studies that reported on e-cigarette user experiences.
The researchers said the cross-sectional and longitudinal studies suggested that flavors were a motivator for initiation and continued use of e-cigarettes. In addition, qualitative evidence demonstrated young individuals’ interest and enjoyment in e-cigarette flavors, according to the results.
However, the researchers said there was not sufficient evidence to suggest e-cigarette flavor use was associated with uptake of tobacco cigarettes. Moreover, no studies reported clear associations between e-cigarette flavors and tobacco cessation, and there were no reports of adverse events related to use of flavored e-cigarettes.
According to the researchers, an important public health goal is to protect youths from harms associated with tobacco smoke exposure, and the attractiveness of e-cigarette flavors may play an important role in diverting youths from tobacco and aiding in tobacco cessation.
“We found that flavored e-liquids are an important aspect of vaping that young people enjoy. This suggests that flavored products may encourage young people to switch away from harmful tobacco smoking towards less harmful vaping,” Notley said. “Flavors may be an important motivator for e-cigarette uptake — but we found no evidence that using flavored e-liquids attracted young people to go on to take up tobacco smoking.”
The use of e-cigarettes as a smoking cessation method did not significantly prevent relapse or successful termination, according to survey findings published in Tobacco Control.
“This is the first survey in which e-cigarettes were less popular as a smoking cessation aid than FDA-approved pharmaceutical aids,” John P. Pierce, PhD, a distinguished professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego and UC San Diego Moores Cancer Center, said in a press release. “Not only were e-cigarettes not as popular, but they were associated with less successful quitting.”
Chen R, et al. Tob Control. 2022;doi:10.1136/tobaccocontrol-2021-056901.
Pierce and colleagues evaluated data from the nationally representative PATH cohort study to determine the effectiveness of e-cigarettes as a smoking cessation aid from 2017 — when sales for nicotine e-cigarettes increased in the U.S. — to 2019. The analysis included 3,578 participants who were established smokers in 2016 with a recent quit attempt and 1,323 recent former smokers.
E-cigarette use
Between 2016 and 2017, there was a more than 40% growth in sales for e-cigarette products in the U.S., according to the researchers.
In 2017, 12.6% (95% CI, 11.3-13.9) of smokers who recently attempted to quit reported using e-cigarettes as a cessation aid (8.7% e-cigarettes only, 3.2% e-cigarettes and nicotine replacement therapy/pharmaceutical aid, 0.5% e-cigarettes and other tobacco products, and 0.2% three or more products). This marked a decline from 17.4% in 2016, according to Pierce and colleagues.
Only 2.2% (95% CI, 0-4.4) of recent former smokers said they switched to a high nicotine e-cigarette. These products were most often used as a cessation aid by respondents aged 18 to 50 years compared with those aged older than 50 years. Also, non-Hispanic white individuals, those who attended college, those with higher incomes and daily smokers were more likely to report using e-cigarettes.
Other cessation aids
Meanwhile, 2.5% (95% CI, 1.9-3.1) of respondents reported using a non-e-cigarette tobacco product as a cessation aid and 20.6% (95% CI, 18.9-22.3) used a nicotine replacement therapy or pharmaceutical aid only. The researchers reported that most respondents (64.3%) attempted the “cold turkey” method, in which no products were used.
Smoking cessation
Among respondents who reported cigarette abstinence, 18.6% (95% CI, 16-21.2) said they did not use any aids. In contrast, a lower proportion (9.9%; 95% CI, 6.6-13.2) said they used e-cigarettes.
The results further showed that e-cigarettes were associated with lower abstinence rates at 12 or more months compared with pharmaceutical aids (adjusted risk difference [aRD] = 7.3%; 95% CI, 14.4 to –0.4) or any other method (aRD = 7.7%; 95% CI, 12.2 to –3.2), according to Pierce and colleagues.
Although the finding was insignificant, the researchers also noted that respondents who switched to e-cigarettes appeared to have a higher relapse rate than those who did not switch to e-cigarettes or other tobacco products. By 2019, nearly 60% of recent former smokers who used e-cigarettes daily had resumed cigarette smoking.
While randomized clinical trials show improved cessation with e-cigarettes, they are often not conducted under “optimal conditions” and do not reflect “the effectiveness of the product in community settings,” Pierce and colleagues wrote.
An epidemic
“There is good evidence that [e-cigarettes] have become the initiation product of choice for adolescents,” Pierce told Healio. “The Surgeon General has labeled this an epidemic. Some are concerned that this effect on teens may be wiping out all of the successes in tobacco control over the past 3 decades.”
When talking to patients about smoking cessation, “clinicians can correct patient misperceptions that e-cigarettes will make their quit attempt more successful,” he said.
According to Pierce, individuals who smoke are advised to mix and match approved cessation aids. As an over-the-counter option, nicotine replacement therapy is the most popular aid, he said. It is often used in combination with varenicline or Zyban (bupropion hydrochloride, GlaxoSmithKline), he added.
In September, Pfizer voluntarily recalled all lots of its varenicline product Chantix “due to the presence of unacceptable N-nitroso-varenicline levels,” according to the FDA. The agency approved a generic version of varenicline (Par Pharmaceutical) in August.
Smoking is highly likely to increase COVID-19 severity and associated risk for mortality, researchers reported in Thorax,.
The results come from a new study that pooled observational and genetic data on smoking and COVID-19 to strengthen the evidence base, according to a press release.
“Overall, the congruence of observational analyses indicating associations with recent smoking behaviors and Mendelian randomization analyses indicating associations with lifelong predisposition to smoking and smoking heaviness support a causal effect of smoking on COVID-19 severity,” Ashley K. Clift, MA, MBBS,research fellow in the Nuffield department of primary care health sciences in the University of Oxford, U.K., and colleagues wrote.
The researchers performed large-scale observational and Mendelian randomization analyses using data from the UK Biobank. Clift and colleagues analyzed data from 421,469 participants (median age, 68.6 years; 55.1% women). Participants’ recent smoking status was obtained via primary care records and UK Biobank questionnaire data and COVID-19 outcomes were obtained via Public Health England SARS-CoV-2 testing, hospital admissions and death data up to August 2020.
Overall, there were 1,649 (0.4%) total confirmed COVID-19 infections, 968 (0.2%) COVID-19-related hospitalizations (15.9% admitted to the ICU) and 444 (0.1%) COVID-19-related deaths.
There were 13,711 (3.3%) current smokers. The current smokers had higher risk for COVID-19-related hospitalization (OR = 1.8; 95% CI, 1.26-2.29) and COVID-19-related mortality compared with never smokers. Risk for COVID-19-related mortality increased with smoking heaviness: one to nine times per day (OR = 2.14; 95% CI, 0.87-5.24), 10 to 19 times per day (OR = 5.91; 95% CI, 3.66-9.54) and 20 or more times per day (OR = 6.11; 95% CI, 3.59-10.42), according to the results.
The Mendelian randomization analyses included 281,105 white British participants, of whom 1,011 (0.4%) had confirmed COVID-19 infection. Six hundred (0.2%) participants had COVID-19-related hospitalization and there were 291 (0.1%) COVID-19-related deaths. Researchers observed an association between the genetically predicted propensity to begin smoking and higher risks for COVID-19 infection (OR = 1.45; 95% CI, 1.1-1.91) and COVID-19-related hospitalization (OR = 1.6; 95% CI, 1.13-2.27), according to the results.
In addition, there was an association between higher number of genetically predicted cigarettes smoked per day and greater risk for all COVID-19 infection (OR = 2.51; 95% CI, 1.2-5.24), COVID-19-related hospitalization (OR = 5.08; 95% CI, 2.04-12.66) and COVID-19-related mortality (OR = 10.02; 95% CI, 2.53-39.72), according to the results.
“Our results complement and extend those from survey-based studies demonstrating increased odds of COVID-19 symptoms and symptomatic burden in current smokers, as well as Mendelian randomization analyses observing an association between lifetime smoking and the risk of hospitalization and respiratory failure due to COVID-19,” the researchers wrote.
Reference:
Smoking highly likely to worsen COVID-19 severity and risk of associated death. Published Sept. 27, 2021. Accessed Sept. 27, 2021.
Studies that have found a link between smoking and COVID-19 severity provide a new reason for primary care physicians to keep talking to their patients about ways to quit smoking, an expert told Healio.
“Although smoking does not appear to put you at risk for getting COVID-19, if you get COVID-19, and you smoke, you are more at risk of getting complications and dying,” Steven A. Schroeder, MD, director of the Smoking Cessation Leadership Center at the University of California, San Francisco.
Even amid the pandemic, primary care physicians should still talk to their patients about trying to quit smoking, several experts told Healio. Photo source: Adobe stock
Schroeder acknowledged that PCPs were “overloaded” with tasks to cram into visits with patients before the COVID-19 pandemic and that for some, the pandemic has exacerbated their workload. Even so, he pushed back with his clinic’s 30-second strategy for helping patients who smoke break the habit.
“I ask, ‘Have you been smoking for a long time, and would you like to quit?’ and if so, ‘we have a clinic in our practice or there is the toll-free telephone number 1-800-QUIT NOW that you can call and get free counseling.’”
Steven A. Schroeder
Schroeder added, “if you can help the patient yourself, that’s acceptable. If you can send them to a place that can help, that’s essential. If you do not have time to help, in my opinion that is unacceptable.”
HHS data indicate clinical tasks related to “tobacco use or exposure” was the third most common education and counseling service that was ordered during ambulatory visits in 2018 — the most recent year such data were available. Robert Bales, MD, a family physician at Cleveland Clinic, encouraged PCPs to not drop the ball if a patient brings up smoking cessation during office visits.
“If patients express any interest in stopping tobacco use, it is extremely important to have that discussion directly at the point in time when they show interest,” he told Healio. “I have a patient handout with recommendations and resources for smoking cessation in my EHR that I can print for patients as we conclude the visit. Lastly, I have these patients schedule a follow up office visit for the specific intent of talking about smoking and how to stop, including medications.”
Robert Bales
Although “the topic of COVID-19 is very important … heart disease and cancer remain the top two leading causes of mortality in the United States for both men and women,” Bale said. “By addressing tobacco use we can reduce the risk for the two most common drivers of mortality in this country.”
Throughout 2021, researchers explored ways to potentially improve smoking cessation rates. Below, Healio recaps 10 stories on the topic.
VIDEO: Smoking cessation programs see ‘success with repetition’
Matthew A. Steliga, MD, spoke with Healio about a presentation he gave on smoking cessation programs for patients being screened for lung cancer. Read more and watch video.
Financial incentives improve smoking cessation among pregnant women
Pregnant women were more likely to adhere to smoking abstinence if they received financial incentives as part of their treatment plan, according to findings published in The BMJ. Read more.
Smartphone app helped Black smokers quit
Among Black adults, an acceptance and commitment therapy-based smartphone app was more effective for smoking cessation compared with a conventional app, researchers reported in Addiction. Read more.
American Thoracic Society policy highlights recommendations to reduce tobacco use, improve health
The American Thoracic Society Tobacco Action Committee released a new policy with recommendations created to reduce tobacco use, and increase research, treatment and tobacco treatment program implementation. Read more.
Parental smoking intervention cost–effective in pediatric primary care setting
A parental smoking intervention was effective and “inexpensive” to implement in pediatric primary care practices, with costs per quit that were comparable to other interventions, according to researchers. Read more.
Ramadan represents ‘untapped opportunity’ to encourage smoking cessation among Muslim men
Religiously tailored text messages intended to decrease smoking during Ramadan were “feasible and acceptable” among Muslim men in Minnesota, results of a single-arm observational study showed. Read more.
Smoking cessation program effective for people with psychiatric disorders post-discharge
A scalable, multicomponent intervention for smoking cessation appeared effective among people with psychiatric disorders following hospital discharge, according to results of a randomized clinical trial published in JAMA Psychiatry. Read more.
Text message intervention effective in reducing e-cigarette use
Young adults who received daily text messages as part of an e-cigarette cessation intervention reported higher rates of nicotine abstinence compared with a control group, according to results of a randomized clinical trial. Read more.
Study shows survival benefits of smoking cessation after lung cancer diagnosis
Current smokers with early-stage lung cancer who quit smoking after their diagnosis had improved overall and progression-free survival rates, according to a prospective cohort study. Read more.
Rheumatology staff-driven protocol boosts referrals to tobacco quit lines 26-fold
Quit Connect, an electronic health record protocol for referring rheumatology patients to tobacco quit lines implemented by staff at the University of Wisconsin, increased referrals 26-fold over a 6-month period, according to data. Read more.
Role of flavored e-cigarettes on cigarette smoking uptake, cessation unclear in youth
Flavors are an important motivator for e-cigarette uptake in youth, but the role of flavored e-cigarettes on uptake of tobacco smoking or cessation remains unclear, according to a systematic review published in Addiction. Read more.
VIDEO: Integrating tobacco cessation strategies into lung cancer practice
Matthew A. Steliga, MD, discusses a presentation from the World Conference on Lung Cancer that focused on the importance of integrating tobacco cessation strategies into lung cancer practice. Read more and watch video.
In the United States, 47.1 million adults reported using commercial tobacco products in 2020, including 30.8 million adults who reported smoking cigarettes, according to data published in Morbidity and Mortality Weekly Report.
Although researchers observed an overall reduction in tobacco use compared with previous years, Karen Hacker, MD, MPH, the director of CDC’s National Center for Chronic Disease Prevention and Health Promotion, said “our work is far from over.”
Source: Cornelius ME, et al. MMWR Morb Mortal Wkly Rep. 2022;doi:10.15585/mmwr.mm7111a1.
“We have made significant progress in preventing and reducing tobacco product use in this country by using proven strategies and implementing effective policies,” she said in a press release. “We must continue to address tobacco-related health disparities and inequities to ensure everyone has the opportunity to be as healthy as possible.”
Monica E. Cornelius, PhD, an epidemiologist at the CDC, and colleagues used data from the 2020 National Health Interview Survey to determine the prevalence of tobacco use in the U.S. The researchers evaluated five different products: cigarettes, cigars (including cigarillos and filtered little cigars), pipes (including regular pipes, water pipes and hookahs), e-cigarettes and smokeless tobacco.
Overall, 19% of adults reported using at least one tobacco product in 2020, a decrease from 20.8% in 2019, according to the researchers. The most commonly used tobacco products were cigarettes (12.5%), followed by e-cigarettes (3.7%), cigars (3.5%), smokeless tobacco (2.3%) and pipes (1.1%).
About 75% of tobacco users said they used combustible products — “the predominant cause of tobacco-related morbidity and mortality,” Cornelius and colleagues wrote.
The researchers found that cigarette use declined to the lowest prevalence since these data were first recorded in 1965, when the prevalence of cigarette smoking was 42%. In addition, they reported that e-cigarette use decreased from 4.5% in 2019 to 3.7% in 2020.
Tobacco use was more often reported by men (24.5%), adults aged 25 to 44 years (22.9%), those who identified as non-Hispanic American Indian or Alaska Native (34.9%) or other non-Hispanic race (29.1%), adults in rural areas (27.3%), those with an annual household income of less than $35,000 (25.2%), those who identified as lesbian, gay or bisexual (25.1%), those with a disability (25.4%) and those who said they regularly had feelings of anxiety (29.6%) or depression (35.6%).
“The tobacco industry has historically targeted rural and low-income areas with increased advertising, price promotions, and access to tobacco retailers, thereby contributing to an environment where tobacco use is viewed as normal,” Cornelius and colleagues wrote.
According to the researchers, the overall decline in tobacco use may be due to media campaigns like the CDC’s “Tips From Former Smokers” and policies that limit the availability of certain products, including flavored ones.
“Continued monitoring of tobacco product use and tailored strategies and policies that reduce the effects of inequitable conditions (eg, poverty, housing and access to health care) could further aid in reducing disparities in tobacco use,” the researchers concluded. “Equitable implementation of comprehensive commercial tobacco control interventions, including smoke-free policies for public places and access to cessation services, is essential for maintaining progress toward reducing tobacco-related morbidity and mortality in the United States.”
A lot of people around the world turn to yogafor both physical health and inner peace. While its benefits on the body are visibly seen, what happens inside the brain? It is a known fact that regular practice of yoga can boost mental health, but how does it actually happen?
According to Rajesh Singh Maan, a spiritual yoga guru and sacred sciences teacher, popularly known as Acharya Advait Yogbhushan, the brain ages with the body. “The most natural cause of aging is the effect of gravity on our spinal cord. There are significant conditions that contribute to acceleration of the process like obesity or a poor immune system. Yoga practices work on the body and the mind simultaneously,” he explains.
The founder of Swamarpan Foundation and a Himalayan Yogi Institute goes on to say that life is so much more than an amalgamated series of events and happenings — that these events are created by our actions and reactions through our body and senses.
“In a holistic approach, the unification of body, mind and soul is the ultimate stage of well-being, which is more about the awareness of these systems. As the mind and soul reside in the body, everything that it goes through creates an impact on them both.
“Yoga practices are not limited to physical practices and their benefits go beyond healing the body or mind. The very first principles of ‘Ashtanga Yoga’ lay out ‘Yama and Niyamas’ to be followed for a happy and prosperous life. They redefine and revive the core nature of a human and develop the quality of contentment within oneself,” he explains.
The expert also says yogasana can help one develop and maintain a “healthy and disease-free body”.
“The sensory organs and bodily responses are controlled by the central nervous system, which consists of the brain and the spinal cord, and where neurons take messages through the spinal cord to the brain. Hence, the health of the spine and the spinal cord will reflect on the health of the brain and its thought process. Correct yogic practices have been effective to slow down the aging process and maintain a healthy immune system,” he says, adding that yoga’s acute and positive effects on cognitive mind have now also been assessed with MRI and CT scans.
The World Health Organization (WHO) on Wednesday warned against the rise in coronavirus cases in the world, saying that the new surge is driven by large outbreaks in Asia and a fresh wave in Europe.
The global health body added that several countries are now seeing their highest death rates since the beginning of the pandemic.
During a virtual briefing on Wednesday, WHO Chief Tedros Adhanom Ghebreyesus, said, “The global increase in #COVID19 cases continues, driven by large outbreaks in Asia and a fresh wave in Europe. Several countries are now seeing their highest death rates since the beginning of the pandemic.”
“This reflects the speed with which Omicron spreads, and the heightened risk of death for those who are not vaccinated, especially older people,” he added.
Earlier on Tuesday, the WHO had explained the reason behind the new surge, saying that a combination of factors was causing the increase, including the highly transmissible Omicron variant and its BA.2 sublineage, and the lifting of public health and social measures.
WHO Covid technical lead, Dr Maria Van Kerkhove explained that a combination of factors is fuelling the increase of cases worldwide, beginning with a more transmissible variant.
“We still have Omicron which is transmitting at a very intense level around the world. We have sub-lineages of Omicron BA.1 and BA.2. BA.2 is more transmissible, and this is the most transmissible variant we have seen of the SARS-COV2 virus to date”, she warned.
She informed that in the last 30 days of more than 400,000 sequences sampled, 99.9% are Omicron, and 75% correspond to the BA.2 variant.
Meanwhile, in China, a rise in daily cases is being witnessed which is driven by the highly infectious ‘stealth Omicron variant’. The country saw its first deaths since January 2021 this week.
Occlusion of a large and proximal vessel may lead to myocardial ischaemia of such an extent that the patient dies rapidly of pump failure.
A. Immediate management
Routine use of a sedative (e.g., Diazepam) is not recommended unless the patient is extremely anxious.
Morphine: 2.5-10 mg intravenously (IV) with repeat doses as necessary
And
Glyceryl trinitrate: 600 µg sublingually with a repeat dose in 5 minutes if no response
It should not be administered in patients with hypotension and suspected right ventricular infarction.
B. Limiting infarct size
Antiplatelet and anticoagulant co-therapies in patients undergoing primary percutaneous coronary intervention (PCI)1 –
Aspirin: Loading dose of 150-300 mg orally or 75-250 mg IV (in patients who are not on an Aspirin maintenance dose), followed by a maintenance dose of Aspirin, i.e., 75-100 mg/day. It should be given before primary PCI. After PCI, Aspirin should be continued indefinitely.
A loading dose of a P2Y12 receptor inhibitor should be given immediately or at the time of primary PCI to patients with ST-segment elevation myocardial infarction (STEMI). Dual antiplatelet therapy, combining Aspirin and a P2Y12 inhibitor (i.e., Prasugrel, Ticagrelor, or Clopidogrel), is recommended in patients with STEMI undergoing primary PCI for up to 12 months.
Clopidogrel: Loading dose of 600 mg orally, followed by a maintenance dose of 75 mg/day
Prasugrel: Loading dose of 60 mg orally, followed by a maintenance dose of 10 mg/day. In patients with a bodyweight ≤60 kg, a maintenance dose of 5 mg/day is recommended. In patients ≥ 75 years, it is not recommended, but a dose of 5 mg/day can be used.
Ticagrelor: Loading dose of 180 mg orally, followed by a maintenance dose of 90 mg twice daily.
Intravenous glycoprotein (GP) IIb/IIIa receptor antagonists, such as
Abciximab: Bolus of 0.25 mg/kg IV and 0.125 µg/kg/minute infusion (maximum 10 µg/minute) for 12 hours.
Tirofiban: 25 µg/kg over 3 minutes IV, followed by a maintenance dose of 0.15 µg/kg/minute up to 18 hours.
Eptifibatide: Double bolus of 180 µg/kg IV (given at a 10-minutes interval), followed by an infusion of 2 µg/kg/minute for up to 18 hours.
Parenteral anticoagulant therapies in primary PCI:
Unfractionated Heparin (UFH): 70-100 IU/kg IV bolus when no GP IIb/IIIa inhibitor is planned; 50-70 IU/kg IV bolus with GP IIb/IIIa inhibitors.
Enoxaparin: 0.5 mg/kg IV bolus
Bivalirudin: 0.75 mg/kg IV bolus, followed by IV infusion of 1.75 mg/kg/hour for up to 4 hours after the procedure.
Antiplatelet therapies in patients not receiving reperfusion therapy:
Aspirin: Loading dose of 150-300 mg orally, followed by a maintenance dose of 75-100 mg/day
Clopidogrel: Loading dose of 300 mg orally, followed by a maintenance dose of 75 mg/day orally
Parenteral anticoagulant therapies in patients not receiving reperfusion therapy:
UFH: 60 IU/Kg IV bolus with a maximum of 4000 IU, followed by an infusion of 12 IU/kg with a maximum of 1000 IU/Hour for 24-48 hours.
Enoxaparin: In patients below 75 years, 30 mg IV bolus followed 15 minutes later by 1 mg/kg subcutaneously (SC) every 12 hours until revascularisation or hospital discharge for a maximum of 8 days. The first two SC injection dosage should not exceed 100 mg/injection. In patients ≥75 years, no IV bolus should be given. Subcutaneous dose of 0.75 mg/kg with a maximum of 75 mg/injection for the first 2 SC doses.
Fondaparinux (only with Streptokinase): 2.5 mg IV bolus, followed by an SC administration of 2.5 mg once daily for up to 8 days or hospital discharge.[1]
Other measures:
Oxygen: 4-6 L/minute by mask
Fibrinolytic therapy [Used in chest pain that has developed within the previous 12 or preferably 6 hours with either development of new left bundle branch block (LBBB) or STEMI]:
Streptokinase: 1.5 million International Units (IU) by IV infusion over 30-60 minutes. If blood pressure falls due to infusion, the rate should be reduced or stopped temporarily and restarted at a dose of half the previous rate.
Alteplase: 15 mg IV bolus;
0.75 mg/kg IV over 30 minutes (maximum 50 mg), followed by 0.5 mg/kg IV over 60 minutes (maximum 35 mg).
Reteplase: 10 units+10 units IV bolus given 30 minutes apart
Tenecteplase: Single IV bolus:
30 mg (6000 IU) if < 60 kg;
35 mg (7000 IU) if 60 to < 70 kg;
40 mg (8000 IU) if 70 to <80 kg;
45 mg (9000 IU) if 80 to < 90 kg;
50 mg (10000 IU) if ≥ 90 kg;
it is recommended to reduce to the half dose in patients ≥ 75 years.[1]
For mild or moderate allergic reactions to Streptokinase:
• Promethazine: 25 mg IV
Or
• Hydrocortisone: 100 mg IV
For severe allergy:
• Adrenaline: 1 in 1,000 solution, 0.5-1 ml (0.5-1 mg) IV over 5 minutes
If response is poor:
• Adrenaline: 1 in 1,000 solution 2-5 ml (2-5 mg) IV over 5 minutes
And should be added:
• Promethazine: 25 mg IV
Or
• Hydrocortisone: 100 mg IV
C. Management in the post-infarct period
i. Beta-blockers (continued indefinitely)
• Atenolol: 25-100 mg orally daily
Or
• Propranolol: 40-80 mg orally 2-3 times daily
ii. Angiotensin-converting enzyme inhibitors (ACEIs)
• Enalapril: 5-40 mg orally daily
iii. Statins
Clinical trials have supported a combination of lifestyle modification and continuous treatment with Aspirin, beta-blocker, a statin, and, in many cases, ACEIs in the treatment of myocardial infarction.
Citation
a, bIbanez B, James S, Agewall S et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. doi: https://doi.org/10.1093/eurheartj/ehx393 https://academic.oup.com/eurheartj/article/39/2/119/4095042
Stroke is the second leading cause of death worldwide. According to the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) guidelines, the drugs that should be used in the emergency management of acute stroke are:
Cardiac and Stroke Care Unit (CSCU) is a facility providing emergency care for cardiac and stroke cases as an integrated facility where few additional drugs are required:
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