medications sec 1

CARDIOVASCULARCARDIOVASCULAR HEALTHHEALTH

Presentor:Presentor:

Barbara Dalrymple, RN/ Director of Medical Rehab Barbara Dalrymple, RN/ Director of Medical Rehab

Tell your physician or pharmacist if you are allergic to any medications. Carry a medical identification card which lists all medications you are currently taking and your diagnosis. Update the card each time medications are changed and reviewed for accuracy at least every 2 – 3 months.

Consider safety measures when taking medications.- Only take medications ordered for you by your physician.

- Never chew or crush time-released medications.

- Never take medications ordered for another person. Likewise, do not give your medications to anyone else.

- Never take medications given to you for a previous illness.

- Do not take over the counter medicines unless you have talked with your| physician first. Medications containing aspirin, cough suppressant, antihistamines or combinations of drugs may be harmful. - Even some vitamins can alter the effects of medicine.

CARDIAC MEDICATIONS

CARDIAC MEDICATIONS cont.

Do not expect medications to make you feel better immediately. Give them time to work.

Make sure you keep an accurate record of any reactions you have experienced to a medication. Report unusual side effects or problems to your doctor immediately.

Keep medications in their original labeled containers.

Discard medications that you no longer need by flushing them down the toilet.

See your doctor regularly. Medication types or doses may need to be changed.

CARDIAC MEDICATIONS

Classes Of Medications: Beta Blockers Calcium Channel Blockers Nitrates

Diuretics

ACE Inhibitors and ARBs

Digoxin

Anticoagulants: Coumadin /Warfarin, Aspirin, others

Cholesterol lowering medications:

Statins, Niacin, others

Antioxidants

Common Questions: Not sure if I took my pills. Remember to late. Too sick to take pills, vomiting.

Main Message:

If you have questions about your medications it is very important that you speak to your physician about those

questions.

The Role Of Medications In The Prevention The Role Of Medications In The Prevention And Treatment Of Heart DiseaseAnd Treatment Of Heart Disease

CARDIAC MEDICATIONS

Your doctor has told you that you have heart disease. As part of your treatment for heart disease you will need to exercise regularly, make dietary changes, and take medications as prescribed by your doctor.Taking your medication is extremely important to your recovery.

Taking medications properly ensures maximum benefit.

Follow these tips for Follow these tips for safe, effective use of medicinesafe, effective use of medicine..


- Avoid drinking alcoholic beverages while taking medications.

- Be careful when driving a car or operating dangerous machinery since some medications may cause drowsiness.

- Store medications in a cool, dry place.

- When given a prescription for a new medication, ask the doctor, nurse, or pharmacist for instructions on how it should be taken.

Make sure you know exactly Make sure you know exactly

how to take each medication.how to take each medication.


Remember:Remember:

Never take more medication, even if you think you need more.

Never decrease the amount of medication you take.

Never skip a dose.

Never stop taking a medication on your own, even if you feel better.

Always call the doctor or nurse if you feel there is a problem withmedication dose or frequency.

Changes in medication dose or frequency should be done Changes in medication dose or frequency should be done ONLYONLY ifif

instructed to do so by the doctor.instructed to do so by the doctor.


Taking your medicine is an important part of the treatment of Coronary Heart Disease. Taking your medications on time each day is a Good Habit to form.

If you have a problem remembering when to take your medications, here are some suggestions that might be helpful to you:

1. Keep your medicine in a place where you would see it often, such as the bathroom medicine cabinet or kitchen cabinet. This will remind you to take it.

2. Schedule your medicine at the same time you do certain other activities such as shaving, brushing your teeth, or eating a meal.

3. List the times of day you plan to take your pills on a large calendar. Place a check mark next to the time and day to show you took your pill.

Here are some tips for taking your medication regularly


Drug Names

There are many medications available today for the treatment of Angina and Heart Disease. Their names can be very confusing! Basically, each drug has two names, a brand name and a generic name. The generic name is the chemical name for the drug. It is often long and difficult to pronounce. For example: Acetaminophen is the generic name for Tylenol.

The generic drug is usually less expensive then the brand name drug. Ask the doctor or pharmacist about this. Do not substitute medication on your own. The brand name for drugs refers to the name the pharmaceutical companies give to medications. These names are easy to pronounce. For example, Tylenol is the brand name for Acetaminophen.

Your doctor might have you on a medication that you must take 3 times a day. It is important that you take your medication on time as your doctor has prescribed. In order for your medication to work properly, a certain amount oft it must be circulating in your bloodstream. Different medications have different strengths. This is why some medications must be taken 3 times a day while others need only be taken once a day.

If you skip a dose then the amount of the drug in your bloodstream will drop and your medication will not work effectively. On the other hand, if you decide that you are going to make up for missing your morning dose of medication by taking twice the amount at noon-time, you will too much of this medication in your bloodstream and this can hurt you more than help you.


Drug Names

Never double up on your medication!

Remember, if you experience any side effects from your medication don’t stop taking them on your own but rather call your doctor and inform him of your symptoms and suspicions.

If you are feeling good while taking your medications it is an indication that they are working properly to relieve your symptoms of Heart Disease.

Beta Blockers

Use:

Slow the heart rate anddecrease blood pressurecausing a decreased demand for oxygen and blood by theheart. Especially helpful withangina induced by exertion.Also used to treat high bloodpressure. Helps preventadditional heart attacks.

Drugs:Inderol (Propanolol) Nadolol (Corgard)Inderol (Propanolol) Nadolol (Corgard)Timolol (Blockadren) Pindolol (Viskin)Timolol (Blockadren) Pindolol (Viskin)Atenolol (Tenormin) Metoprolol Atenolol (Tenormin) Metoprolol (Lopressor)(Toprol XL)(Lopressor)(Toprol XL)

Possible Side Effects:Fatigue, depression, sleep disturbances,impotence, numbness or tingling of theextremities, feeling of coldness.


The following are different types of medications. Their uses, side effects, and general tips will be discussed.


Unwanted Side Effects:

Check with your doctor should any of the following occur:Check with your doctor should any of the following occur:

breathing difficulty and / or wheezing cold hand and feetbreathing difficulty and / or wheezing cold hand and feet

Irregular heart beat confusion Irregular heart beat confusion

nightmares and vivid dreams mental depressionnightmares and vivid dreams mental depression

skin rash slow heartbeat skin rash slow heartbeat

swelling of ankles, feet and/or lower legsswelling of ankles, feet and/or lower legs

Beta Blockers

If you miss a dose of this medication, take it as soon as possible. It is within 8 hours of your next dose, skip the dose and resume your regular schedule.

Do not doubledouble the doses.

Beta-blockers can cause a drop in blood sugar in diabetics. They might mask some of the signs of hypoglycemia (low blood sugar).Some people become dizzy, drowsy, light-headed, or less alert when taking beta-blockers. Be sure you know how you respond to them before operating machines or driving.


Do not discontinuediscontinue these drugs suddenly. Your doctor will wean you off of this medication gradually. If stopped suddenly it may increase your chances of a heart

attack.

Use: Increase blood flow to the heart by dilating (opening up) the

coronary arteries. Also opens up the other blood vessels in the body. It does this by blocking influx of calcium into the cell. Calcium is needed for muscle contraction. Decreases the force of the contraction of the heart and therefore the amount of work that it has to do. Dilates the peripheral arteries and reduces the resistance that the heart has to work against pumping blood out to the body. Especially effective in preventing angina induced by coronary artery spasm.

Drugs:Verapamil (Ispotin, Calan)Cardizem (Diltiazem)Nefedipine (Procardia)


Possible Side Effects: Dizziness, headache that persists, nausea, leg swelling (with Nefedipine), constipation (with Verapamil).

Take the calcium channel blocker as directed by your doctor, even if you are feeling well and not experiencing angina.

If you are taking an extended-release form of this medication (sustained-release, or SR) do not break, crush, or chew it. Swallow it whole. Take it with food or milk.

Do not stop the medication suddenly. It could bring on symptoms of angina. Check with your doctor for a schedule to wean off gradually.

Some people become dizzy or light-headed when rising from a lying or sitting position. Getting up slowly might help. Drinking alcohol can make these effects worse.

If you are taking Diltiazem or Verapamil, ask your doctor about checking your heart rate before and after your medication. While you are taking this medicine, check your pulse regularly. It is much slower than your usual rate or often below the rate recommended by your doctor, report the occurrence.


Tip

s:

Antiarrhythmic


Drugs:Drugs: AmiodaroneQuinidine Quinaglute NorpacePronestyl (Procainamide, Procan) Procan SR (sustained release Pronestyl)

Possible Side Effects: Nausea, vomiting, diarrhea, poor appetite, rash.

ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)

Use:Use: Angiotensin-converting enzyme (ACE) inhibitors are used to treat

high blood pressure and congestive heart failure. They block an enzyme in the blood that causes blood vessels to constrict. Therefore

the blood vessels are relaxed, thereby lowering blood pressure, reducing the workload of the heart, and reducing its need for blood

and oxygen.

Drugs: Captopril (Capoten) Enalapril (Vasotec) Lisinopril (Prinivil) Zestrol Accupril


Unwanted Side Effects:Contact your doctor should the following occur: coughingcoughing difficulty in breathing difficulty in breathing fever, chills, or sore throatfever, chills, or sore throat swelling of face, mouth, hands, or swelling of face, mouth, hands, or feet feet

Tips: Dizziness or light-headedness might occur after taking the first dose of this medicine. Make sure you know how you respond before driving or operating machinery.

This medicine does not cure high blood pressure, but is does control it. Continue to take it as prescribed.


Digitalis and Digoxin

Use:

Improves strength of heart or to control rate and rhythm.

Take as directed even though you feel well.

Drugs:

Brand names of Digoxin include Lanoxin and Lanoxicaps.


Digitalis and Digoxin

Tip

s:

Ask your doctor about checking your heart rate. While taking this Ask your doctor about checking your heart rate. While taking this medicine, check your pulse regularly. If your pulse is suddenly medicine, check your pulse regularly. If your pulse is suddenly higher or lower than usual, if it is regular, or if it is often below higher or lower than usual, if it is regular, or if it is often below the rate suggested by your doctor, report the occurrencethe rate suggested by your doctor, report the occurrence.

If you forget a dose of this medication and remember within 12 hours, take it immediately. If it is more than 12 hours,skip that dose and resume your regular schedule.

Do Do not not double the next dose.double the next dose.Take this medication just as your doctor prescribes. The amount needed to help most people is very close to the amount that can cause problems from overdose.

Some early warning signs of overdose are:

loss of appetite nauseavomiting diarrheaextremely slow heartbeat


Diuretics

Use:

Use:

Reduces water in the body. In doing so, they lower blood pressure,reduce the workload of the heart, and reduces its need for bloodand oxygen.

Lasix (Furosemide)Aldactone (Spironolactone) – spares potassiumDyrenium (Triamterene)Hydrodiuril (Chlorothiazide)Aldactazide (combination of Aldactone and Hydordiuril)Dyazide (combination of Triamterene and Hydrodiuril)

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Unwanted Side Effects:Contact your doctor should the following occur: skin rash

sore throat or fever muscle cramping

irregular heart beat weak pulse

confusion unusual tiredness or weakness


Diuretics

TIPS:

A diuretic can make you feel tired when you begin to take it. You might also notice an increase in the amount of urine and in your frequency of urination.

If you miss a dose take it as soon as possible. If it is close to your next schedule dose, skip the missed dose and resume your regular schedule.

Some diuretics cause a loss of potassium; others conserve it. Check with your doctor about the need for potassium supplement and/or blood test to check your potassium level.


Anitcoagulants

Use:

Prevents clot formation by interfering in the clotting mechanism.

Drugs: Coumadin Aspirin – has a mild anticoagulation effect. Is prescribed after a heart attack to help prevent formation of small clots, which may block coronary arteries already narrowed by atherosclerosis.

Possible Side EffectsPossible Side Effects:: Bruising, bleeding.

Important:Important:

Call your doctor if you notice blood in your urine, Call your doctor if you notice blood in your urine, black stools, or bleeding from your gums or other black stools, or bleeding from your gums or other abnormal places.abnormal places.


Potassium Supplements

Use: Maintaining good health. Sometimes needed to replace potassium last

as a result of illness or medication.

Drugs:Potassium bicarbonate and potassium chloride (K-Lyte/CL)

Potassium bicarbonate and potassium citrate (K-Lyte, K-Lyte DS)

Potassium chloride (Kaochlor, Kaon-CL, Kay Ciel, K-Dur, K-LOR,

Klotrix, K-TAB, Micro-K, Slow-K, Ten-K)

Unwanted Side Effects:

Should you notice any of the following, contact your doctor:Should you notice any of the following, contact your doctor: nausea, vomiting, and/or diarrhea stomach pain red or black stools irregular heartbeat unusual tiredness or weakness confusion


Potassium Supplements

Tip

s:

Too much potassium can also cause health problems,so take this medication only as directed.

If you are taking the liquid or powder form of this medicine, it must be diluted in at least four ounces of cold water or juice to reduce stomach irritation.

Allow any fizzing to stop before taking the dissolved medication.

If you are taking the extended-release form of this medicine, swallow the tablet whole without crushing, breaking, or chewing.

If you miss a dose of this medicine and remember in 2 hours, take the missed dose right away with food or liquid. Then go to regular dosing schedule. If you do not remember until later, skip the missed dose and go back to your regular dosing schedule. Do notDo not double these doses.

Use: Relieves anginal pain by temporary widening the arteries and veins.

This brings more blood and oxygen to the heart when it needs it the most and your hear doesn’t have to work so hard. Nitroglycerin relaxes the blood and lowers the blood pressure.

Drugs:

There are two major types of nitrates:

Short-acting and long-acting.


Nitroglycerin


Nitroglycerin

Long-acting nitrates are: nitroglycerin patch, nitroglycerin ointment, or Isodril. These medications are worn continuously and are used during the day and night to prevent angina. If you are using a long-acting nitroglycerin you should still take a quick acting nitroglycerin tablet anytime you feel angina.

The other forms of nitroglycerin (paste, patch, capsule) are not replacements for taking nitroglycerin under the tongue should angina occur

Short-acting nitrates are:

sub-lingual nitroglycerin or nitroglycerin spray.

If you experience angina, follow these instructions Stop whatever activity you are performing and rest. Sit or lie down.

Procedure For Taking Nitroglycerin Tablets:

1.1. Place the tablet under your tongue. Let it dissolve completelyPlace the tablet under your tongue. Let it dissolve completely and hold the saliva in your mouth 1 – 2 minutes before swallowing.and hold the saliva in your mouth 1 – 2 minutes before swallowing.2.2. If the pain persists take 1 nitroglycerin tablet every 5 minutes upIf the pain persists take 1 nitroglycerin tablet every 5 minutes up to 15 minutes. If angina persists longer than 15 minutes, you may to 15 minutes. If angina persists longer than 15 minutes, you may bebe having some heart damage or a heart attack. having some heart damage or a heart attack.3.3. Call 911 immediately. Do not drive yourself and do not have familyCall 911 immediately. Do not drive yourself and do not have family drive you to the hospital. drive you to the hospital. AmbulanceAmbulance with with professional staffprofessional staff only! only!4.4. Because nitroglycerin lowers the blood pressure you may want toBecause nitroglycerin lowers the blood pressure you may want to sit down when you take it.sit down when you take it. 5. 5. Keep nitroglycerin with you at all times. You never know when youKeep nitroglycerin with you at all times. You never know when you might need it. If an activity often causes angina you may want to might need it. If an activity often causes angina you may want to taketake a nitroglycerin before starting the activity. This may help prevent a nitroglycerin before starting the activity. This may help prevent angina.angina.


Nitroglycerin

Procedure For Taking Nitro-Ointment or Skin Patches

1.1. Keep the medicine at room temperature.Keep the medicine at room temperature.2.2. Remove old ointment before applying the next dose.Remove old ointment before applying the next dose.3.3. Change skin patches after 24 hours or ointment after 4 – 6 hours.Change skin patches after 24 hours or ointment after 4 – 6 hours.4.4. Put it on a part of the body most convenient for you (upper arm, legs,Put it on a part of the body most convenient for you (upper arm, legs, thigh, shoulder, abdomen or just below your collar bone). thigh, shoulder, abdomen or just below your collar bone). 5. Apply only as much ointment as prescribed. Measure directly from the 5. Apply only as much ointment as prescribed. Measure directly from the tube onto the paper that comes with the tube. tube onto the paper that comes with the tube.

6. When using ointment, place a clear plastic cover (saran wrap) over the6. When using ointment, place a clear plastic cover (saran wrap) over the paper with the paste. Tape all edges to protect your clothes from the paper with the paste. Tape all edges to protect your clothes from the paste as it melts with your body heat. paste as it melts with your body heat.7. Put on the daily patch the same time each day.7. Put on the daily patch the same time each day.8. Make sure your skin is dry and free of hair, rashes, cuts, scars or8. Make sure your skin is dry and free of hair, rashes, cuts, scars or calluses. Use a different spot if you notice skin redness. calluses. Use a different spot if you notice skin redness.

9. If the patch gets wet while you are swimming or bathing, remember water 9. If the patch gets wet while you are swimming or bathing, remember water

will not keep it from working.will not keep it from working.

10.10. Don’t put the patch/paste in a skin fold such as under the breast or at the elbow Don’t put the patch/paste in a skin fold such as under the breast or at the elbow joint. joint.


Nitroglycerin

Check with your pharmacist, he may have available ready made covering for Check with your pharmacist, he may have available ready made covering for

Nitroglycerin paste usersNitroglycerin paste users..


Nitroglycerin

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Nitroglycerin will lose its strength if exposed to light, moistureNitroglycerin will lose its strength if exposed to light, moistureor heat. In order to keep nitroglycerin effective, follow these or heat. In order to keep nitroglycerin effective, follow these rules:rules:

Store them in a cool, dark, dry place away from ovens, heatersStore them in a cool, dark, dry place away from ovens, heatersand sun heat.and sun heat.

Keep the pills in their own dark colored container with the cottonKeep the pills in their own dark colored container with the cottonremoved. Remove cotton as soon as possible to be able to get toremoved. Remove cotton as soon as possible to be able to get tothe pills quickly if needed.the pills quickly if needed.

Keep closed tight to prevent the tablets from being exposed to the Keep closed tight to prevent the tablets from being exposed to the air and moisture.air and moisture.

Carry them in an outside pocket our purse away from your bodyCarry them in an outside pocket our purse away from your bodyheat. heat.

Get fresh ones after 3 months. Make sure to date the bottle. FreshGet fresh ones after 3 months. Make sure to date the bottle. Freshpills produce a slight burning sensation under your tongue.pills produce a slight burning sensation under your tongue.

Never stop taking your pills altogether without your doctor’s Never stop taking your pills altogether without your doctor’s permission. However, don’t worry about taking them as needed permission. However, don’t worry about taking them as needed because they are not habit forming. because they are not habit forming.

Don’t drink alcohol without talking to your doctor first. Alcohol and Don’t drink alcohol without talking to your doctor first. Alcohol and vasodilators don’t mix and the combination may cause lightheadedness or vasodilators don’t mix and the combination may cause lightheadedness or fainting.fainting.


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Headache may occur, but usually subsides quickly. Headaches mayHeadache may occur, but usually subsides quickly. Headaches mayno longer occur after you’ve been using the pills for a while.no longer occur after you’ve been using the pills for a while.

You may feel You may feel warm and flushedwarm and flushed, but the feeling usually goes away, but the feeling usually goes awayquickly.quickly.

DizzinessDizziness may occur, but can be prevented if you lie or sit down may occur, but can be prevented if you lie or sit downwhile taking the drug.while taking the drug.

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Should you notice any of the following, contact your Should you notice any of the following, contact your doctor:doctor:

pain unusually severe or prolongedpain unusually severe or prolonged severe throbbing headachesevere throbbing headache persistent flushingpersistent flushing severe dizziness or faintingsevere dizziness or fainting

Use: Reduces the low-density lipoproteins (LDL) and total cholesterol levels in

patients with primary hypercholesterolemia. Usually taken once a day. Drugs:


Possible Side Effects: Headaches, nausea, vomiting, diarrhea, abdominal pain, high liver enzyme,blurred vision, muscle aches and pains.

Cholesterol Lowering Cholesterol Lowering MedicationsMedications

Zocor MevacorLopid Lescal Pravachol LipitorQuestran ColestidCrestor Altoprev

Tips:

Need to review with your doctor any interaction with other medications you take.

Liver function tests should be done before and during treatment.

Best if taken before your evening meal since it will be absorbed better.Report any adverse side effect to your physician.

Generic versus brand name

RangeAtorvastatin

vs. Lipitor

10 mg - 80 mg

Rosuvastatin

vs. Crestor

5 mg - 40 mg

Lovastatin

vs. Mecavor

20 mg - 80 mg

Simvastatin

vs. Zocor

10 mg - 40 mg

Provastatin

vs. Provocal

10 mg - 40 mg

Fluvastatin

vs. Liscol

10 mg - 80 mg


Use: In low doses. ASA appears to slow down clotting. This has shown to help in

the reduction of heart attack. The usual dose is 160 – 325 mg once a day.


Possible Side Effects: Nausea, GI bleeding, prolonged bleeding tine.

ASAASA

Tips:

Do not use ASA with other anticoagulants, like Coumadin.

As with other medications, check with your doctor for possible interactions.

It is a good idea to take this medication with food to decrease the irritation on your stomach.

As always, consult with your doctor about any concerns you may have about your

medications.

medications sec 1

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