Medications Sec 1

CARDIOVASCULAR
HEALTH

Presentor:
Barbara Dalrymple, RN/ Director of Medical Rehab

CARDIAC MEDICATIONS

- Never chew or crush time-released
medications.

- Never take medications ordered for
another person. Likewise, do not give
your medications to anyone else.
Tell your physician or pharmacist if you
are allergic to any medications. Carry a
- Never take medications given to you
medical identification card which lists all
for a previous illness.
medications you are currently taking and
your diagnosis. Update the card each time
- Do not take over the counter medicines
medications are changed and reviewed for
unless you have talked with your|
accuracy at least every 2 – 3 months.
physician first. Medications
Consider safety measures when taking containing aspirin, cough suppressant,
medications. antihistamines or combinations of
- Only take medications ordered for you drugs may be harmful.
by your physician.
- Even some vitamins can alter the
effects of medicine.

CARDIAC MEDICATIONS cont.

Do not expect medications to Keep medications in their
make you feel better immediately. original labeled containers.
Give them time to work.
Discard medications that
you no longer need by flushing
Make sure you keep an accurate them down the toilet.
record of any reactions you have
See your doctor regularly.
experienced to a medication.
Medication types or doses may
Report unusual side effects or
need to be changed.
problems to your doctor
immediately.

CARDIAC MEDICATIONS
The Role Of Medications In The Prevention
And Treatment Of Heart Disease

Classes Of Medications:
Beta Blockers Common Questions:
Calcium Channel Blockers Not sure if I took my pills.
Nitrates Remember to late.
Too sick to take pills,
Diuretics vomiting.

ACE Inhibitors and ARBs Main Message:
If you have questions about your
Digoxin medications it is very important that you
speak to your physician about those
Anticoagulants: Coumadin /Warfarin, questions.
Aspirin, others

Cholesterol lowering medications:
Statins, Niacin, others

Antioxidants

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
safe, 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 Make sure you know exactly
drowsiness.
how to take each medication.

- 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.


Changes in medication dose or frequency should be done ONLY if
instructed to do so by the doctor.

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

Never decrease the amount of Always call the doctor or nurse if
medication you take. you feel there is a problem with
medication dose or frequency.
Never skip a dose.
Never stop taking a medication on
your own, even if you feel better.


Here are some tips for taking your medication regularly

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.

Your doctor might have you on a
Drug Names 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
There are many medications available today for medication to work properly, a certain
the treatment of Angina and Heart Disease. amount oft it must be circulating in
Their names can be very confusing! Basically, your bloodstream. Different
each drug has two names, a brand name and a medications have different strengths.
generic name. The generic name is the This is why some medications must be
chemical name for the drug. It is often long and taken 3 times a day while others need
difficult to pronounce. only be taken once a day.
For example: Acetaminophen is the generic
If you skip a dose then the amount of
name for Tylenol.
the drug in your bloodstream will drop
The generic drug is usually less expensive then and your medication will not work
the brand name drug. Ask the doctor or effectively. On the other hand, if you
pharmacist about this. Do not substitute decide that you are going to make up
medication on your own. The brand name for for missing your morning dose of
drugs refers to the name the pharmaceutical medication by taking twice the amount
companies give to medications. These names are at noon-time, you will too much of this
easy to pronounce. For example, Tylenol is the medication in your bloodstream and
brand name for Acetaminophen. 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.

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

Beta Blockers Drugs:
Inderol (Propanolol) Nadolol (Corgard)
Use: Timolol (Blockadren) Pindolol (Viskin)
Atenolol (Tenormin) Metoprolol
Slow the heart rate and (Lopressor)(Toprol XL)
decrease blood pressure
causing a decreased demand
for oxygen and blood by the
Possible Side Effects:
heart. Especially helpful with Fatigue, depression, sleep disturbances,
angina induced by exertion. impotence, numbness or tingling of the
Also used to treat high blood extremities, feeling of coldness.
pressure. Helps prevent
additional heart attacks.


Beta Blockers

Unwanted Side Effects:
Check with your doctor should any of the following occur:

breathing difficulty and / or wheezing cold hand and feet
Irregular heart beat confusion
nightmares and vivid dreams mental depression
skin rash slow heartbeat
swelling of ankles, feet and/or lower legs


Do not discontinue 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.

Beta-blockers can cause a
If you miss a dose of this drop in blood sugar in
medication, take it as soon as diabetics. They might mask
possible. It is within 8 hours some of the signs of
of your next dose, skip the hypoglycemia (low blood
sugar).
dose and resume your regular
schedule. Some people become dizzy,
drowsy, light-headed, or
less alert when taking beta-
Do not double the doses. blockers. Be sure you know
how you respond to them
before operating machines
or driving.


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: Possible Side Effects:
Verapamil (Ispotin, Calan) Dizziness, headache that
Cardizem (Diltiazem) persists, nausea, leg swelling
(with Nefedipine), constipation
Nefedipine (Procardia) (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.


Antiarrhythmic

Drugs: Amiodarone
Quinidine
Quinaglute
Norpace
Pronestyl (Procainamide, Procan)
Procan SR (sustained release Pronestyl)

Nausea, vomiting, diarrhea, poor appetite, rash.


ACE Inhibitors (Angiotensin-Converting Enzyme Inhibitors)

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: Contact your doctor should the following occur:
Captopril (Capoten) coughing
Enalapril (Vasotec) difficulty in breathing
Lisinopril (Prinivil) fever, chills, or sore throat
Zestrol swelling of face, mouth, hands, or feet
Accupril

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

Ask your doctor about checking your heart rate. While taking this 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 the 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 not 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 nausea
vomiting diarrhea
extremely slow heartbeat


Diuretics
Reduces water in the Lasix (Furosemide)
body. In doing so, they Aldactone (Spironolactone) – spares potassium
lower blood pressure, Dyrenium (Triamterene)
reduce the workload of Hydrodiuril (Chlorothiazide)
the heart, and reduces Aldactazide (combination of Aldactone and Hydordiuril)
Dyazide (combination of Triamterene and Hydrodiuril)
its need for blood
and oxygen.

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 Effects: Bruising, bleeding.

Important:
Call your doctor if you notice blood in your urine, black stools, or
bleeding from your gums or other 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)

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

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 not double these doses.


Nitroglycerin

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
Short-acting nitrates are:
.
sub-lingual nitroglycerin or nitroglycerin spray

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

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


Nitroglycerin

Procedure For Taking Nitroglycerin Tablets:

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


Nitroglycerin

Procedure For Taking Nitro-Ointment or Skin Patches

1. Keep the medicine at room temperature.
2. Remove old ointment before applying the next dose.
3. Change skin patches after 24 hours or ointment after 4 – 6 hours.
4. Put it on a part of the body most convenient for you (upper arm, legs,
thigh, shoulder, abdomen or just below your collar bone).
5. Apply only as much ointment as prescribed. Measure directly from the
tube onto the paper that comes with the tube.
6. 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
paste as it melts with your body heat.
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 or
calluses. Use a different spot if you notice skin redness.
9. If the patch gets wet while you are swimming or bathing, remember water
will not keep it from working.
10. Don’t put the patch/paste in a skin fold such as under the breast or at the elbow
joint.

Check with your pharmacist, he may have available ready made covering for Nitroglycerin paste users .


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

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

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

Keep closed tight to prevent the tablets from being exposed to the
air and moisture.
Carry them in an outside pocket our purse away from your body
heat.

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

Never stop taking your pills altogether without your doctor’s
permission. However, don’t worry about taking them as needed
because they are not habit forming.
Don’t drink alcohol without talking to your doctor first. Alcohol and vasodilators
don’t mix and the combination may cause lightheadedness or fainting.


Nitroglycerin

Headache may occur, but usually subsides quickly. Headaches may
no longer occur after you’ve been using the pills for a while.
You may feel warm and flushed, but the feeling usually goes away
quickly.

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

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

pain unusually severe or prolonged
severe throbbing headache
persistent flushing
severe dizziness or fainting


Cholesterol Lowering Medications

Use:
Reduces the low-density lipoproteins (LDL) and total cholesterol levels in
patients with primary hypercholesterolemia. Usually taken once a day.

Drugs: Zocor Mevacor Tips:
Lopid Lescal Need to review with your doctor any interaction
Pravachol Lipitor with other medications you take.
Questran Colestid Liver function tests should be done before and
Crestor Altoprev during treatment.
Best if taken before your evening meal since it
will be absorbed better.
Possible Side Effects: Report any adverse side effect to your physician.
Headaches, nausea, vomiting, diarrhea,
abdominal pain, high liver enzyme,
blurred vision, muscle aches and pains.


Generic versus brand name
Range
Atorvastatin vs. Lipitor 10 mg - 80 mg
Rosuvastati vs. Crestor 5 mg - 40 mg
n
Lovastatin vs. 20 mg - 80 mg
Mecavor
Simvastatin vs. Zocor 10 mg - 40 mg

Provastatin vs. Provocal 10 mg - 40 mg

Fluvastatin vs. Liscol 10 mg - 80 mg


ASA

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.

Nausea, GI bleeding, prolonged bleeding tine.

Tips:
Do not use ASA with other anticoagulants,
like Coumadin. As always, consult with your
doctor about any concerns
As with other medications, check with your you may have about your
doctor for possible interactions. medications.
It is a good idea to take this medication
with food to decrease the irritation on your
stomach.

Medications Sec 1

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