Medications in This Chapter the Medicines That You Have Been Given Are an Important Part ❤ General Guidelines

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Medications In This Chapter The medicines that you have been given are an important part ❤ General Guidelines...... H1 of the treatment plan. This chap- ❤ Angiotensin Converting ter provides guidelines and Enzyme (ACE) information about many heart Inhibitors...... H4 medications. ❤ Angiotensin Receptor It is important for you to follow Blockers...... H5 the medication regimen your doctor has prescribed. Let your ❤ Antiarrhythmics...... H6 doctor or the Cardiac Rehab staff ❤ Anticoagulants...... H7 know if you have any concerns about taking your medications. ❤ Antiplatelets...... H9

❤ Beta Blockers...... H10 Section 1 ❤ Calcium Channel ❤ General Guidelines Blockers...... H12 For Taking Medication ❤ Digitalis...... H13 The following guidelines are meant to help prevent mistakes in taking medi- ❤ Diuretics...... H14 cation. Please follow them carefully. 4 ❤ Combination Drugs...... H16 Never take medication in the dark. ❤ Lipid Lowering 4 Always read the labels on your Agents...... H16 medication bottles. 4 Take exactly as ordered by your ❤ Nitrates...... H19 doctor. Do not skip doses or take ❤ Potassium extra. Bad effects can happen Supplements...... H22 from taking too much or too little of a medication. ❤ Pain Relievers...... H23 4 Do not give your medication to someone else and do not take any ❤ Over-The-Counter medication not prescribed for you. Medications...... H24 4 Make sure to tell all doctors or H2 MEDICATIONS

dentists what medications you are have any allergies and the reac- taking. tion. This can be very important 4 Some medications should be in an emergency. The Cardiac taken with food and some should Rehab staff can provide you with be taken on an empty stomach. a medication wallet card and help Know how your medication needs you fill it out. to be taken. 4 Refill your medication before you 4 If you are taking a long-acting or are completely out. Plan ahead for sustained release form of a medi- weekends and holidays. cation, you must swallow it whole. 4 Have all your prescriptions filled Do not break, chew, or crush at the same pharmacy. This will before swallowing. allow your pharmacist to better 4 For liquid medications use a mea- screen for drug interactions. suring spoon or specially marked 4 If you are worried you might for- device. Do not use your silver- get to take your regular medicine, ware. a medicine chest (pillbox) can help 4 Check with your doctor or phar- you remember when to take your macist before taking any over-the- medication. counter or non-prescription medications. What you should know about each of your medications 4 Know what side effects or reac- 1. Name & strength of each medications to report to your doctor. tion. 4 Always carry a list of medica- 2. Why are you taking each medications with you. Include the name, tion? strength, and dose of both pre- 3. How much and how often do you scription and non-prescription need to take it? medications, including natural or 4. How long will you need to take it? herbal drugs. Also include if you 5. Possible side effects or reactions. What do you do if side effects CAUTION occur? Do not discontinue your medications 6. Does the medication interact or without contacting interfere with any of your other your doctor, even if medicines, over-the-counter prod- you feel better. ucts or alcohol? 7. Are there any special instructions? 8. How should you store your medication? 9. What do you do if a dose is missed? MEDICATIONS H3 Grapefuit Juice/Drug Interactions Grapefruit juice can interact with some prescription medications. If you are taking any of the following medications, it is recommended that you decrease or eliminate grapefruit in your diet. Medications that can Interact with grapefruit juice Medication name Possible effects Diazepam (Valium) Increased sedation Alprazolam (Xanax) Triazolam (Halcion) Increased or prolonged sedation Lovastatin (Mevacor) Headaches, muscle pain Atorvastatin (Lipitor) gastrointestinal complaints Simvastatin (Zocor) Amlodipine (Norvasc) Increased adverse effects Felodipine (Plendil) Nicardipine (Cardene) Nifedipine (Procardia, Adalat) Nimopidine (Nimotop) Nisoldipine (Sular) Verapamil (Isoptin, Calan, Verelan, Covera HS) Cyclosporine Increased gastrointestinal (Sandimmune, Neoral) complaints (Nausea, stomach pain Tacrolimus (Prograf) Prednisone Carbamazepine (Tegretol) Estinyl Estradiol (Estiny) Itraconazole (Sporonox) Quinidine (Cardioquin, Quinaglute, Quinidex) Caffeine Viagra (Sildenafil) Cialis (Tadalafil) Cilostazol (Pletal) Amiodarone (Cordarone) Colchicine Bupropion (Zyban, Wellbutrin) Propafenone (Rythmol) Escitalopram (Lexapro) Venlafaxine (Effexor) H4 MEDICATIONS 10. Does the medication require any Section 2 monitoring (i.e. blood tests)? ❤ Angiotensin Converting Storage of Medications Enzyme (ACE) Inhibitors 4 KEEP OUT OF REACH OF Angiotensin is a substance in the CHILDREN body that causes blood vessels to 4 Store in a cool, dry place. narrow. ACE inhibitors reduce the 4 Keep away from heat or sunlight. production of angiotensin by blocking 4 Keep in the original container, the enzyme, angiotensin converting tightly capped. Do not mix differ- enzyme. This allows the blood vessels ent medications in one bottle. to relax, for a reduction in blood pres- 4 Do not remove labels, these will sure and increase in blood and oxygen contain directions and any special supply to the heart. information. Uses for ACE Inhibitors include treat- 4 Do not store in the refrigerator ment of high blood pressure (hyperten- unless directed by your pharma- sion), congestive heart failure, and to cist or doctor. protect the kidneys of diabetic patients. 4 Do not keep in the bathroom, Examples of ACE Inhibitors near a sink, or in any damp place. • Benazepril (Lotensin) Heat or moisture may cause the • Captopril (Capoten) medication to break down. • Enalapril (Vasotec) 4 Discard any medication that you • Fosinpril (Monopril) have been instructed not to take • Lisinopril (Prinivil, Zestril) any more or any medication that • Moexipril (Univasc) is expired. • Perindopril (Aceon) What to do if you miss a dose? • Quinapril (Accupril) • Ramipril (Altace) If you’ve missed a dose, take it as • Trandolapril (Mavik) soon as possible. If several hours have passed or if it is nearing the time for Things to Remember the next dose, DO NOT DOUBLE 4 DO NOT take other medications THE DOSE IN ORDER TO “CATCH unless you discuss them with your UP,” just skip the missed dose and doctor or pharmacist. This espe- continue your usual schedule. If you cially includes over-the-counter miss more than one dose or you have medications for appetite control, questions call your doctor. asthma, colds, cough, hay fever, or sinus problems since they may increase your blood pressure. 4 DO NOT take salt substitutes or MEDICATIONS H5

medications containing potas- t Skin rash sium while taking ACE inhibitors, unless prescribed by your doctor. CAUTIONS 4 ACE inhibitors may cause your Tell your doctor if you are taking body to retain potassium. Signs captopril or fosinopril. These medica- of too much potassium are: con- tions may interfere with some medical fusion, irregular heart/beat, ner- tests. vousness, weakness, heaviness Notify your doctor immediately if of the legs, and numbness or any of the following occur: fever and tingling in the hands, feet or lips. chills, hoarseness, trouble in breathing Check with your doctor if any of or swallowing, or swelling of the face, these signs occur. mouth, hands or feet. 4 You may become dizzy or lightheaded while taking ACE inhibitors. Make sure you know how Section 3 you react to this medication ❤ Angiotensin II Receptor before driving an automobile or Blockers (ARBs) operating machinery. Alcohol may Angiotensin Receptor Blockers make this effect stronger. (ARBs) are similar to ACE Inhibitors. 4 Dizziness, lightheadedness, or They block the action of angiotensin fainting may occur if you exercise by blocking the binding of angiotensin or if the weather is hot. Heavy to the receptor. This results in a relax- sweating may cause you to lose ation of blood vessels and a reduction too much water and lower your in blood pressure. blood pressure. Use extra care during exercise in hot weather. ARBs are used to treat high blood pressure and may have benefit in 4 If you are taking captopril or patients with congestive heart failure moexipril, take on an empty stom- and to protect the kidneys of diabetic ach one hour before meals. patients. Possible Side Effects t Dry cough Examples of Angiotensin t Loss of taste Receptor Blockers • Candesartan (Atacand) t Nausea or vomiting • Eprosartan (Teveten) t Headache • Irbesartan (Avapro) t Unusual tiredness • Losartan (Cozaar) t Diarrhea • Olmesartan (Benicar) t Dizziness or lightheadedness • Telmisartan (Micardis) H6 MEDICATIONS

• Valsartan (Diovan) t Change in how much or how often you urinate Combination products with a diuretic t Chest pain such as hydrochlorothiazide are also available. t Fast or slow heartbeat • Irbesartan + Hydrochlorothiazide t Lightheadedness or fainting (Avalide) t Swelling in the hands, ankles or feet • Losartan + Hydrochlorothiazide (Hyzaar) • Valsartan + Hydrochlorothiazide Section 4 (Diovan HCT) ❤ Antiarrhythmics Things to Remember When your heart has an irregular 4 Don’t use potassium supplements rhythm your body may not receive or salt substitutes containing all the blood and nutrients it needs. potassium without checking with Antiarrhythmics help correct irregular your physician first. rhythms and increase your heart’s effi- 4 You may take these medicines ciency. with or without food. Examples of Antiarrhythmics 4 This medication may make you • Amiodarone (Cordarone) dizzy or drowsy. Avoid driving, • Disopyramide (Norpace, Norpace CR) using machines, or doing anything • Dofetilide (Tikosyn) else that could be dangerous if you are not alert. • Flecainide (Tambocor) • Ibutilide (Corvert) Possible Side Effects • Mexiletine (Mexitil) t Back pain • Moricizine (Ethmozine) t Cough, stuffy or runny nose, sore • Procainamide (Pronestyl, Procan) throat • Propafenone (Rhythmol) t Headache • Quinidine (Quinidex, Quinaglute) t Dizziness • Tocainide (Tonocard) t Notify your physician if you have Things to Remember any of these side effects: 4 Do not miss taking a dose and t Allergic reaction: itching, hives, do not take more than what is swelling in face or hands, swell- ordered. ing or tingling in mouth or throat, 4 Take at evenly spaced times at the tightness in chest, trouble swal- same time every day. lowing 4 Do not stop taking unless ordered by your doctor. MEDICATIONS H7

4 Do not confuse quinidine with ing in chest), joint pain, blurred quinine. These are different vision, incoordination, ringing in medications with different uses. ears. Quinine is a medication used to t Moricizine: Palpitations, dizzi- treat nighttime leg cramps. ness, nausea, trouble breathing, 4 It is best to take these medica- headache. tions with meals unless otherwise t Propafenone: Stomach pain, dry directed so by your doctor of mouth, anxiety, drowsiness, inco- pharmacist. ordination, palpitations (pounding 4 Sensitivity to sunlight may occur in chest), blurred vision, edema, while you are taking Amiodarone. weakness. Use sunscreen and protective t Procainamide: Fever, chills, joint clothing until tolerance is deter- pain, skin rash, sore mouth, gums, mined. or throat, unusual tiredness or weakness, trouble breathing. Possible Side Effects t t All Antiarrhythmics: Nausea, vom- Quinidine: Bitter taste, flush- iting, diarrhea, constipation, wors- ing, stomach pain or cramping, ening of heart rhythm, dizziness, blurred vision, severe headache, fainting, fatigue, confusion, loss of ringing in ears, appetite, rash. trouble breathing, fainting. t t Amiodarone: Halos around lights, Tocainide: Tingling, tremor, sensitivity to lights, blurred vision, blurred vision, sweating, drowsi- dry eyes, blue-gray skin color, ness, confusion, headache. numbness and tingling in hands and feet, hair loss, shortness of Section 5 breath, coughing. t Disopyramide: Difficult urination, ❤ Anticoagulants chest pain, dry mouth or throat, Anticoagulants interfere with the muscle weakness, rapid weight clotting ability of your blood. They gain, decreased sexual ability. are often called blood thinners, but t Flecainide: Headache, tremor, they don’t really thin the blood. They abdominal pain, ringing in ears, lengthen the time it takes your blood edema, change in taste, dry to clot. They are used to prevent clot mouth, blurred vision, difficulty formation in arteries, veins, heart focusing, depression, incoordina- chambers, and on artificial heart tion. valves. They will not dissolve blood t Mexiletine: Stomach pain, tremor, clots that have already formed, but depression, palpitations (pound- they do prevent clots from enlarging. H8 MEDICATIONS

Dosing of anticoagulants varies Aspirin increases the blood thin- widely between individuals. Your dose ning action of anticoagulants, so it is determined by a blood test called is very important to take the same the prothrombin time (protime or PT), dose every day. which measures how fast your blood 4 Limit your alcohol intake. clots. The PT is then converted to a Drinking too much alcohol may standardized ratio and reported at the change the way your anticoagu- International Normalized Ratio (INR). lant works. If you have questions Your INR will be determined during about drinking alcohol, please ask regular visits to your doctor. your physician. Dosage changes may occur based on CAUTION the results of this blood test. Tell your 1. Anticoagulants can interact with doctor if you have missed any doses, many other medications, result- which could affect the test results. ing in an increase or decrease The most widely used anticoagulant in effectiveness. Do not start or is: Warfarin (Coumadin) stop taking any other medication Things to remember without consulting your doctor or 4 Take your anticoagulant exactly pharmacist. This includes common as prescribed, and at the same over the counter medications such time every day. It may be helpful as aspirin, ibuprofen (Advil), and to keep a daily record of the time naproxen (Aleve). you take it. 2. The effect of your anticoagulant 4 Inform all of your doctors, den- depends on the amount of vita- tists, pharmacists, and nurses that min K in your body. Vitamin K is you are taking an anticoagulant. found in meats, dairy products, If you are having dental work or and green leafy vegetables (like other procedures done, special broccoli, cabbage, collard greens, precautions may be necessary to kale, lettuce, and spinach) as well prevent bleeding. as in some multiple vitamins and 4 Carry identification stating which nutritional supplements. It is best anticoagulant you are taking and to have about the same amount of your dosage. vitamin K in your diet every day. 4 If your doctor prescribes aspirin Do not make radical changes in along with your anticoagulant, your diet. Also check with your it is important to take the same doctor if you are unable to eat for dose of aspirin every day. Do not several days or if you have con- take additional aspirin for pain or tinuing stomach upset, diarrhea, fever, use acetaminophen instead. or fever. MEDICATIONS H9 3. If you miss a dose and realize it Section 6 that same day, take it as soon as possible. If you don’t remember ❤ Antiplatelets until the next day, do not take the Platelets are components of the missed dose and do not double blood that clump together to help the next one. Doubling doses form blood clots. Antiplatelet medica- could cause bleeding. tions interfere by preventing platelets 4. Do not begin taking warfarin dur- from sticking together. They help ing pregnancy, and do not become prevent the formation of blood clots pregnant while taking it. It may within the heart or blood vessels. cause birth defects. Antiplatelets are often used after heart surgery. Possible Side Effects Notify your doctor immediately if any Examples of Antiplatelets of the following occur: • Dipyridamole (Persantine) t Red or black tarry stools • Aspirin (Ecotrin, Ascriptin, t Red or dark brown urine Bufferin, Bayer, etc.) t Back pain, abdominal pain or • Dipyridamole + Asprin (Aggrenox) swelling • Ticlopidine (Ticlid) • Clopidogrel (Plavix) t Dizziness • Cilostazol (Plendil) t Unexplained nosebleeds t Severe or constant headaches Things to remember t Vomiting of blood or material that 4 Check with your doctor to see looks like coffee grounds if you can take aspirin for other reasons (headache, fever). This t Excessive bleeding from gums applies whether you are pre- when brushing teeth, or excessive scribed aspirin, dipyridamole or bleeding or oozing from cuts. ticlopidine. t Unexplained bruising or purplish 4 Store aspirin in a tightly closed areas on the skin. bottle in a cool, dry place. If aspi- t Unusually heavy or unexpected rin has a strong vinegar smell, it menstrual bleeding. has broken down and should be t Skin rash or itching discarded. 4 If aspirin upsets your stomach, The Cardiac Rehab staff can show you a take it with food or an antacid. video and give you additional information Buffered or enteric coated aspirin on what you need to know while you are can also be used. taking Warfarin (Coumadin). H10 MEDICATIONS 4 Dipyridamole is most effective Section 7 taken on an empty stomach with a full glass of water. If this method ❤ Beta Blockers upsets your stomach, this drug Beta blockers work by affecting may be taken with food. the response of various parts of the 4 If you are on ticlopidine, this body to nerve impulses. The heart’s medication should be taken with a response is to reduce heart rate and meal or snack. the strength of muscle contraction. By 4 Clopidogrel can be taken without lowering the heart’s need for blood regard to meals. and oxygen, the heart can work more efficiently. CAUTION Beta blockers are used to treat high Ticlopidine may lead to increased bleeding. blood pressure (hypertension), relieve Report an unusual bleeding or dark-colored chest pain (angina), correct irregu- stools to your doctor. Make sure your doctors and dentists are aware you are on this lar heart rhythms (arrhythmias), and medication. Lab tests are required dur- prevent additional heart attacks in ing treatment with ticlopidine. These may patients who have had a heart attack. include blood counts and liver function tests. Examples of Beta blockers • Acebutolol (Sectral) Possible Side Effects • Atenolol (Tenormin) Dipyridamole, Ticlopidine • Betaxolol (Kerlone) and Clopidogrel • Bisoprolol (Zebeta) t Dizziness, light-headedness, • Carteolol (Cartrol) or fainting • Carvedilol (Coreg) t Stomach cramping, nausea, • Labetalol (Trandate, Normodyne) vomiting, diarrhea • Metoprolol (Lopressor, Toprol XL) t Weakness • Nadolol (Corgard) t Headache • Nebivolol (Bystolic) t Flushing, skin rash, itching • Penbutolol (Levatol) • Pindolol (Visken) Aspirin • Propranolol (Inderal, Inderal LA) t Abdominal pain, nausea, vomiting • Sotalol (Betapace) t Bloody or black tarry stools • Timolol (Blocadren) t Vomiting of blood or material resembling coffee grounds Things to Remember 8 DO NOT stop taking this medica- t Skin rash, hives, itching tion without first checking with t Ringing in the ears your doctor. Some conditions MEDICATIONS H11

(such as chest pain) may become CAUTION worse when the medication is 1. You may become dizzy, drowsy, or stopped suddenly. lightheaded while taking this med- 4 When getting up from a lying or ication. This side effect often goes sitting position, you may become away after the first few weeks dizzy or faint. If this occurs, get- of therapy. Make sure you know ting up slowly may help. Alcohol how you react to this medication may make this effect worse. before driving an automobile or 4 You may become more sensitive operating machinery. to cold temperatures, especially if 2. This medication may reduce or you have blood circulating prob- prevent chest pain resulting from lems. Dress warmly during cold exercise or physical exertion. This weather and be careful during may tempt you to “over do” it. prolonged exposure to cold. Make sure you discuss with your 4 Ask your doctor about checking doctor a safe level of exercise for your pulse or heart rate. If it is you. much slower than your usual rate 3. If you are a diabetic, beta blockers (or less than 50 beats per minute), may cause your blood sugar levels check with your doctor. to fall. This medication may also 4 If you are taking the extended- cover up signs of low blood sugar, release capsule or tablet form of and changes in the heart rate. metoprolol or propranolol, swal- 4. DO NOT take other medications low the capsule or tablet whole. unless you discuss them with your DO NOT crush, break, or chew doctor or pharmacist. This espe- before swallowing. cially includes over-the-counter 4 If you are taking sotalol, take medications for appetite control, on an empty stomach one hour asthma, colds, cough, hay fever, before meals. or sinus problems since they may increase your blood pressure. 4 Labetalol, metoprolol, and propranolol are most effective taken with Possible Side Effects a meal or a snack. t Difficulty breathing 4 Acebutolol, atenolol, betaxolol, t Chest pain bisoprolol, nadolol, and pindolol t Cold hands or feet may be taken without regard to food. t Unusually slow heart rate t Depression t Nightmares t Skin rash H12 MEDICATIONS

t Swelling of ankles, feet, or lower Examples of Calcium legs Channel Blockers t Decreased sexual arousal or • Amlodipine (Norvasc) impotence • Diltiazem (Cardizem, Cardizem t Dizziness or lightheadedness SR, Cardizem CD, Dilacor XR, t Drowsiness Tiazac) t Nausea of vomiting • Felodipine (Plendil) • Isradipine (Dynacirc) Alpha/Beta Blocker • Nicardipine (Cardene, Cardene Carvedilol (Coreg) is a drug that has SR) both the properties of a beta-blocker • Nifedipine (Adalat, Adalat CC, and an alpha-blocker. Both actions Procardia, Procardia XL) decrease blood pressure. Carvedilol • Nimodipine (Nimotop) can be used to treat high blood pres- • Nisoldipine (Sular) sure or in combination with other • Verapamil (Calan, Calan SR, medications to treat congestive heart Isoptin, Isoptin SR, Verelan) failure. Carvedilol must be taken with Things to Remember food to reduce the risk of too low 7 DO NOT stop taking this medica- blood pressure. tion without first checking with your doctor. Some conditions Section 8 (such as chest pain or irregular heart rhythms) may become worse ❤ Calcium Channel Blockers when the medication is stopped Calcium Channel Blockers affect the suddenly. movement of calcium into the cells 7 DO NOT take other medications of the heart and blood vessels. As a unless you discuss them with your result, they relax blood vessels and doctor or pharmacist. This espe- increase the amount of blood and cially includes over-the-counter oxygen delivered to the heart, while medications for appetite control, reducing the heart’s work load. asthma, colds, cough, hay fever, Calcium Channel Blockers are used or sinus problems since they may to relieve and control chest pain (angi- increase your blood pressure. na), treat high blood pressure (hyper- 4 If you are taking diltiazem or tension), and correct irregular heart verapamil, ask your doctor about rhythms (arrhythmias). checking your pulse or heart rate. If it’s much slower than your usual rate (or less than 50 beats MEDICATIONS H13

per minute), check with your doc- t Dizziness or lightheadedness tor. t Flushing or feeling of warmth 4 You may get a headache during t Nausea the first week or two of taking t Skin rash this medication. This effect is more common if you are taking nifedipine. This should become Section 9 less noticeable after a while. If it continues, see your doctor. ❤ Digitalis 4 When getting up from a lying or Digitalis medication is used to sitting position, you may become improve the strength and pumping dizzy or faint. If this occurs, get- action of the heart or to control the ting up slowly may help. Alcohol rate and rhythm of the heart. Digitalis may also make this effect worse. helps your heart beat stronger and 4 If you are taking the extended- keeps it from beating too fast. This release capsule or tablet form of will lead to better blood circulation. diltiazem, nicardipine, nifedipine, nisoldipine, or verapamil, swallow Examples of Digitalis the capsule or tablet whole. DO • Digoxin (Digitek, Lanoxin, NOT crush, break or chew before Lanoxicaps) swallowing. • Digitoxin 4 Avoid taking calcium channel Things to Remember blockers with grapefruit products. 4 Take exactly as your doctor has ordered it and at the same time CAUTION every day. Do not stop taking it Chest pain resulting from exercise because you feel better. or physical exertion is reduced or pre- 4 If you miss a dose and remember vented with this medication. This may within 12 hours, take as soon as tempt you to “over do” it. Make sure you remember. However, if it is you discuss a safe level of exercise more than 12 hours after your with your doctor. scheduled dose, do not take the Possible Side Effects missed dose and do not double t Difficulty breathing the next dose. Continue your usual schedule. If you have any t Irregular or unusually fast or slow questions or miss more than one heart rate dose, call your doctor. t Chest pain 4 Ask your doctor about checking t Swelling of ankles, feet, or lower your pulse or heart rate. Your legs H14 MEDICATIONS

doctor may want to know if your t Fatigue, muscle weakness rate is slower or faster than usual. 4 Your doctor may recommend a These side effects may be signs that low-sodium (low salt) diet and a there is too much medication in your potassium supplement. Choose body. Contact your doctor immediate- foods that are low in sodium and ly. Your dose may need to be changed. high in potassium and emphasize Once you and your doctor have deter- them in a well-balanced diet. mined the correct dose, you usually 4 Your doctor may check the will not experience side effects if you amount of Digoxin in your body take Digoxin exactly as prescribed. with a blood test. 4 Check with your doctor or phar- Section 10 macist before taking any over-the- counter medications. They could ❤ Diuretics (“Water Pills”) change the way your digitalis Diuretic medication reduces the works. amount of sodium and water in the body by increasing the flow of urine. Possible Side Effects Sodium can cause your body to retain t Irregular heartbeat or changes in extra water which can cause your pulse (slow heart rate) hands and feet to swell. Your heart t Loss of appetite has to work harder to pump the extra t Nausea/vomiting water throughout your body, which t Lower stomach pain can raise your blood pressure. By los- t Diarrhea ing the extra water, your heart will not t Unusual tiredness or weakness have to work as hard and your blood t Slow or irregular heartbeat pressure can be controlled. Diuretics will not cure your high t Vision changes such as flashes blood pressure but will help control or flickering of light, sensitivity to light, seeing things larger or it. You must continue to take it, even smaller than they are, blurring, if you feel well, if you expect to keep color changes (yellow or green) your blood pressure down. and seeing halos or borders on Diuretics are sometimes combined objects with other medications used to treat t Drowsiness high blood pressure into a single pill. Potassium-depleting diuretics allow t Confusion potassium to be excreted in urine. t Depression t Headache MEDICATIONS H15 Examples of To keep this from affecting sleep: potassium-depleting diuretics A. If you are to take a single dose • Acetazolamide (Diamox) each day, take it in the morn- • Benedroflumethiazide (Naturetin) ing after breakfast. • Bumetamide (Bumex) B. If you are to take more than • Chlorthalidone (Hygroton) one dose a day, take the last • Chlorothiazide (Diuril) dose no later than 6 p.m. • Ethacrynic Acid (Edecrin) 4 There is no need to change how • Furosemide (Lasix) much fluid you drink while taking • Hydrochlorothiazide (Hydrodiuril, diuretics. HCTZ, Esidrex) 4 If you take a potassium-depleting • Hydroflumethiazide (Diucardin) diuretic, your doctor may want • Indapamide (Lozol) you to eat or drink foods that • Methylclothiazide (Enduron) have a high potassium content, or • Metolazone (Zaroxolyn) instruct you to take a potassium supplement. • Polythiazide (Renese) • Torsemide (Demadex) 4 If you take a potassium-sparing • Trichlormethiazide (Naqua) diuretic, it will probably not be Potassium-sparing diuretics do not necessary for you to take extra potassium medication. Check with allow potassium to be lost in urine. your doctor first. Examples of 4 Dizziness, or lightheadedness potassium-sparing diuretics may occur, especially when get- • Amiloride HCI (Midamor) ting up from a sitting or lying • Eplerenone (Inspra) position. Getting up slowly may • Spironolactone (Aldactone) help. Alcohol may make this effect • Triamterene (Dyrenium) worse. 4 Sensitivity to sunlight may occur. Examples of combination diuretics Use sunscreens and wear protec- • Amiloride/Hydrochlorothiazide tive clothing until tolerance is (Moduretic) determined. • Spironolactone/Hydrochlorothiazide 4 Do not take other medications (Aldactazide) without your doctor’s approval. • Triamterene/Hydrochlorothiazide This includes nonprescription (Dyazide, Maxzide) medicines for appetite control, asthma, colds, cough, hay fever or Things to remember: sinus problems. 4 You may notice an increase in urine or frequency of urination. H16 MEDICATIONS Possible side effects Beta Blocker + Diuretic t Dry mouth* Atenolol + Chlorthalidone (Tenoretic) t Thirst* Bisoprolol + HCTZ (Ziac) t Irregular heart beat* Metoprolol + HCTZ (Lopressor HCT) t Nausea, vomiting* Nadolol + Bendroflumethazide (Corzide) t Mood changes* Propranolol + HCTZ (Inderide) Timolol + HCTZ (Timolide) t Muscle cramps or pain* t Unusual weakness or tiredness* Calcium Channel Blocker t Loss of appetite + ACE Inhibitor t Joint pain Amlodipine + Benazepril (Lotrel) t Impotence Felodipine + Enalapril (Lexxel) t Sensitivity to sunlight Verapamil + Trandolapril (Tarka) t Skin rash or hives t Unusual bleeding or bruising Section 12 *Signs of potassium loss. Notify your doctor. ❤ Lipid Lowering Medications High levels of cholesterol and/or Section 11 triglycerides in the blood may block blood vessels and increase the risk of ❤ Combination Drugs developing heart or blood vessel dis- Combination drugs are pills that ease. Lipid lowering agents work best contain two or more medicines in one when used along with a low-cholester- tablet. They offer the advantage of ol, low-fat diet. decreasing the number of pills that How they work one takes and decreasing cost. Below HMG-COA reductase inhibitors are is a list of some combination drugs. used to lower the levels of cholesterol ACE Inhibitors + Diuretics and triglycerides in the blood. They do Benazepril + HCTZ (Lotensin HCT) this by reducing the production of cho- Captopril + HCTZ (Capozide) lesterol by the body and by increasing Enalapril + HCTZ (Vaseretic) the rate at which the body removes Lisinopril + HCTZ (Prinzide, Zestoretic) cholesterol from the blood. Moexipril + HCTZ (Uniretic) MEDICATIONS H17 Examples of Lipid (for lovastatin only). Lowering Medications CAUTION A. HMG-COA Reductase Inhibitors Do not take these medications if you • Atorvastatin (Lipitor) are pregnant. • Lovastatin (Mevacor) Possible Side Effects • Pravastatin (Pravachol) t Nausea, vomiting, diarrhea, consti- • Simvastatin (Zocor) pation, gas, indigestion • Fluvastatin (Lescol) t Headache, dizziness, weakness, • Rosuvastatin (Crestor) sleeplessness Things to remember t Cold or flu-like symptoms, cough 4 You should follow a proper diet t Rash, itching and exercise program in addition t Muscle pain, chest pain, fever, to taking your medication. blurred vision 4 Lovastatin should be taken with your evening meal. If you are tak- B. Bile Acid Sequestrants ing it twice a day, it should be How they work taken with the morning and eve- These drugs are used to lower cho- ning meals. lesterol. They do this by binding to bile 4 Simvastatin should be taken acids in your intestines and prevent- once daily in the evening (without ing their absorption. Your body must regard to meals). replace these bile acids by converting 4 Atorvastatin or Rosuvastatin can cholesterol to bile acids. be taken any time of the day without regard to meals. Examples • Cholestyramine (Questran) 4 Fluvastatin and Pravastatin should be taken at bedtime with- • Colestipol (Colestid) out regard to meals. • Colesevelam (Welchol) 4 Notify your doctor if you develop Things to remember unexplained headache, muscle 4 Bile acid sequestrants are most pain, tenderness or weakness, nau- effective when used with a low sea, vomiting, or diarrhea, particu- cholesterol, low saturated fat diet. larly if accompanied by a fever or 4 They may interfere with the action general body discomfort. of other drugs taken at the same 4 Lab tests may be required during time. Take other medications either treatment. These tests may include 1 hour before or 4 to 6 hours after blood counts, cholesterol level, the bile acid sequestrants. liver function tests, and eye exams H18 MEDICATIONS

4 They should be taken just before These drugs lower blood levels eating or with meals. of triglycerides and cholesterol by 4 They may cause constipation. A decreasing the production of triglycer- laxative, stool softener or drinking ides by the body and by increasing the liquids may be helpful. rate of excretion of cholesterol. 4 Periodic lab tests will be required Things to remember during treatment. Tests may 4 Take gemfibrozil 30 minutes before include blood count, triglycerides, the morning and evening meals. and cholesterol. 4 They are most effective when used 8 DO NOT take the powder or gran- with a low cholesterol, low satu- ules in the dry form. It must be rated fat diet. mixed with any beverage, very liquid soups or cereals, or pulpy fruits 4 It may cause dizziness or blurred (applesauce or crushed pineapple). vision - use caution when driving. 4 Increase your daily intake of liq- 4 Lab tests may be required dur- uids while taking this medicine. ing treatment. These may include blood counts, cholesterol and trig- Possible Side Effects lycerides, liver function tests, and t Severe constipation, fatty or black blood glucose levels. stools, gas, belching, nausea, vom- 4 Take Fenofibrate once daily with iting, heartburn, diarrhea, loss of food. appetite t Headache, anxiety, dizziness, Possible Side Effects fatigue t Stomach upset, vomiting, nausea, diarrhea, constipation t Asthma, wheezing t Headache, dizziness, fatigue t Itching, hives t Rash, itching, eczema t Unusual bleeding from gums or rectum t Sore throat, fever, chills, muscle pain or soreness t Deficiencies of fat soluble vitamins A and D D. Zetia Zetia is a medication that lowers C. Fibric Acid Derivatives cholesterol. It works by blocking the Examples absorption of cholesterol from your • Gemfibrozil (Lopid) intestines during digestion. It lowers • Fenofibrate (Antara, Lofibra, total cholesterol and LDL, but is most Tricor, Triglide) effective when added to another cholesterol medication. MEDICATIONS H19

Examples some flushing, taking 325mg of • Zetia + Zocor (Vytorin) aspirin a half hour before each dose of niacin may help prevent Things to remember this. Check with your doctor 4 You should follow a heart-healthy before trying this. diet and exercise program in addi- 4 Take niacin with meals. tion to taking your medication. 4 Take extended release niacin at 4 Lab tests will be required during bedtime. treatment. These tests may include cholesterol and triglyceride levels 4 When getting up from a lying or and liver function tests. sitting position, you may become dizzy or faint. If this occurs, get- 4 Vytorin should be taken in the ting up slowly may help. evening without regard to meals. Possible Side Effects Possible Side Effects t Flushing, itching, tingling, sensa- t Diarrhea, abdominal pain tion of warmth. t Fatigue, dizziness, headache t Abdominal pain, nausea, vomiting, t Muscle pain, chest pain, joint diarrhea pain, back pain t Dizziness, headache t Sore throat, cough

E. Nicotinic Acid (Niacin) Section 13 Niacin (in large doses) reduces cholesterol and triglyceride levels. ❤ Nitrates Nitrates are useful in either relieving Examples the pain of angina (chest pain) attacks • Niaspan or reducing the number of such • Niacor attacks. Nitrates relieve chest pain by Things to remember improving the supply of blood and 4 Skin flushing and a sensation of oxygen to the heart by widening the warmth, especially of the face and walls in your blood vessels. upper body, may occur. Itching, The most common nitrates are nitro- tingling, and headache may also glycerin and isosorbide. They are avail- occur. These effects usually last able in the following forms: 30 to 60 minutes after taking a dose and usually decrease as you Nitroglycerin continue to take the medication. • Sublingual tablets (Nitrostat) 4 If you have persistent or bother- • Long-acting tablets and capsules (Nitro-bid) H20 MEDICATIONS

• Ointment, topical (Nitro-bid, 4 Storage: Keep in the original Nitrol) container. Keep the container • Spray, translingual (Nitrolingual) closed tightly. Store at room • Transdermal patch (Minitran, temperature. Protect from Nitro-Dur, Transderm-Nitro, moisture. Unused nitroglycerin Nitrodisc, Deponit) tablets should be discarded 6 months after the original bottle Isosorbide is opened. Do not put any • Sublingual tablets (Isordil) other medications in the nitro- • Chewable tablets (Sorbitrate) glycerin bottle. • Oral tablets (Isordil Titradose, 2. Translingual spray — Nitroglycerin Sorbitrate, ISMO, Monoket) 4 Spray onto or under the tongue. • Long-acting tablets/capsules Do not inhale spray. At the (Isordil Tembinds, Sorbitrate SA, onset of an angina attack, spray Imdur) 1 or 2 doses onto oral mucosa. No more than 3 doses are rec- Things to remember ommended within 15 minutes. If 1. Sublingual tablets — Nitroglycerin you still have pain after 3 doses, or Isosorbide call 911 or your local emergency 4 When you start to feel an angi- number. Do not drive yourself na attack, sit down, then place to the hospital. a tablet under your tongue and 4 It may be used 5 to 10 minutes let it dissolve. Do not crush, before you begin an activ- chew or swallow. If angina is ity that normally causes your not relieved in 5 minutes, dis- angina. solve a second tablet under 3. Sustained release capsule or tablet your tongue. If pain is not — Nitroglycerin or Isosorbide relieved within another 5 min- 4 These forms are used to pre- utes, dissolve a third tablet. If vent angina attacks. They will you still have pain after taking not relieve chest pain that has three tablets, call 911 or your already started. Long-acting local emergency number. forms should be taken on a Do not drive yourself to the regular schedule. If you miss hospital. a dose, take it as soon as you 4 Take the medication before remember if your next dose is activity that normally causes not scheduled within six hours. your angina. Do not double the dose in 4 It may cause stinging or tin- order to “catch up.” gling when it touches under the tongue. MEDICATIONS H21

4 Swallow whole. Do not break, not subject to excessive move- crush or chest long-acting tab- ment. Do not apply patch to the lets or capsules. forearms or below the knees. 4. Topical nitroglycerin ointment Avoid cuts or irritations. Rotate 4 Nitroglycerin ointment is used application site slightly each to prevent angina. It works too time to avoid skin irritation. slowly to relieve pain that has 4 Your physician may have you already started. Occasional use apply or remove patch at spe- of sublingual tablets may be cific times of the day. necessary. 4 Carefully read the instructions CAUTION before using. Patients who use nitrates must talk 4 The ointment comes with mea- to their doctor before using any of suring papers. Use them to the erectile dysfunction drugs (Viagra, measure the length of the oint- Cialis, Levitra). There are several med- ment and to apply the ointment ical conditions that prevent a person to the skin. Do not use your from using these medications safely. fingers. Using these medications together 4 The ointment can be applied to (even hours or days apart) can lower any area on the skin (not just blood flow to the heart arteries, caus- the chest). Preferably, apply it ing a heart attack. If you have symp- to an area of skin with little or toms of angina or a heart attack and no hair. Do not rub or massage have used any of these drugs, you ointment into the skin. When should not use your nitroglycerin. Go reapplying ointment, remove to the nearest Emergency Room for any ointment remaining from treatment. the previous dose. Rotate appli- You must always tell your doctor cation sites to prevent contact all the medications you are taking dermatitis. (including over-the-counter medicines) 5. Transdermal nitroglycerin patches so that problems can be avoided. 4 Nitroglycerin patch is used to prevent angina attacks. It will Possible side effects not relieve chest pain that has t Nitrates may cause headaches, already started. Occasional use a feeling of fullness in the head, of sublingual tablets may be flushing or redness of the skin. necessary. Carefully read the These side effects are usually instructions before using. temporary and disappear on their 4 Apply the patch once each day own. If they persist, consult your to a skin site free of hair and doctor. H22 MEDICATIONS

t You may feel dizzy, light-headed Things to remember: or faint, especially when getting 4 Some people find that potassium up from a lying or sitting posi- supplements taste unpleasant or tion. Remember to get up slowly. cause stomach discomfort. Taking Alcohol may also make this effect this medication after meals or worse. with food and a full glass of water t Other effects: blurred vision, dry will lessen stomach upset. mouth, appetite loss, skin rash/ 4 Do not chew or crush tablets, itching, rapid heartbeat, nausea, always swallow them whole. Oral vomiting, restlessness. liquids, soluble powders and effer- vescent tablets should be mixed or dissolved in 4 to 8 ounces of cold Section 14 water or juice. Drink the mixture slowly. ❤ Potassium Supplements 4 Tell your doctor or pharmacist if Potassium supplements are used to you are taking or if you are plan- treat or prevent low potassium blood ning to take any over-the-counter levels when dietary intake is too low. or prescription medications with Low potassium levels may also be potassium supplements. cause by illness or treatment with cer- 4 The following drugs and drug tain drugs (diuretics, or “water pill,” classes may interact with potas- for example). Potassium is most fre- sium supplements: quently supplied as: • Salt substitutes Examples of • Anticholinergics (Banthine) potassium supplements • Spironolactone (Aldactone) • Slow-K • Triamterene (Dyrenium) • K-Tab • Amiloride (Midamor) • K-lyte • Captopril (Capoten) • K-Dur • Lisinopril (Prinivil, Zestril) • Kor-Con • Enalapril (Vasotec) • K-lor • Benazepril (Lotensin) • Quinapril (Accupril) • Klotrix • Fosinopril (Monopril) • Micro-K • Ramipril (Altace) • Kaon-Cl • Moexipril (Univasc) • Ten-K 4 Notify your doctor if you experi- Potassium chloride is available in liq- ence tingling of the hands and uid, powder, capsule and tablet form. feet, unusual tiredness or weakness, a feeling of heaviness in MEDICATIONS H23 the legs, severe nausea, vomiting, Oxycodone and acetaminophen: abdominal pain or black stools. • Percocet • Roxicet Possible side effects: • Endoct t Nausea, vomiting, diarrhea • Tylox t Stomach discomfort, pain, or gas • Oxycet t Skin rash • Propoxyphene and acetamino- t Confusion phen: Darvocet-N 50, Darvocet-N t Irregular heartbeat 100, Wygesic t Unusual tiredness or weakness t Numbness or tingling in hands Things to remember: or feet 4 Take exactly as prescribed by your physician. If you think that your medicine is not relieving pain, Section 15 check with your doctor before ❤ Pain Relievers increasing the dose. Combination medicine containing 4 Take with food to avoid possible narcotic analgesics and acetaminophen nausea or vomiting. (Tylenol) are used to relieve pain after 4 A stool softener or fiber laxative heart surgery. When used together, may be helpful since narcotic anal- this combination may relieve pain bet- gesics (especially codeine) may ter than either medication used alone. cause constipation. 4 If you feel dizzy or faint when Examples of oral getting up from a sitting or lying analgesic combinations position, get up slowly. Other sedating medicines may make this Codeine and acetaminophen effect worse. • Tylenol #2 8 DO NOT drink alcoholic bever- • Tylenol #3 ages while taking a narcotic anal- • Tylenol #4 gesic. Hydrocodone and acetaminophen: 8 DO NOT take other pain medication unless you discuss them first • Lorcet with your doctor. Avoid taking • Lortab any medicines that contain acet- • Hydrocet aminophen or a narcotic. • Norco • Vicodin • Vicodin ES H24 MEDICATIONS

CAUTIONS Please ask your doctor or pharmacist You may become dizzy, drowsy, or which medications are acceptable for lightheaded, or feel an exaggerated you to take. Show them a list of the sense of well-being while taking this prescription medications you are tak- medication. Make sure you know how ing. you react to this medicine before driv- The most commonly purchased OTC ing a car or before operating machin- products are pain relievers, antacids, ery. cold/allergy products and vitamin Notify your doctor immediately if any supplements. Below is a list of vari- of the following occur: severe confu- ous OTC products and instructions on sion, drowsiness or weakness, seizures, their use with your heart medications. diarrhea, prolonged nausea or vomiting, shortness of breath or trouble Pain Medications breathing, increased sweating, skin The most commonly used pain medi- rash, or cold, clammy skin. cations are aspirin, acetaminophen and ibuprofen. Through each of these med- Possible side effects ications will relieve pain, you should t Dizziness or lightheadedness use caution in selecting one to use. t Drowsiness 4 Acetaminophen (Tylenol) is a t Nausea or vomiting good choice for the occasional t Loss of appetite relief of pain, headache or fever. If you have a need for regular t Weakness pain control, such as the pain t Blurred vision from arthritis, talk to your doctor. t Constipation Limit total daily doses to 4000mg. t Dry mouth 4 Aspirin (Anacin, Bayer, Bufferin, t Nightmares Ecotrin, Empirin) is used to treat fever, pain and inflammation. You may already be taking a low dose Section 16 of aspirin to prevent the formation of blood clots. Your doctor ❤ Over-The-Counter may tell you to avoid taking addi- Medications tional aspirin. Some OTC products As a patient with heart disease, you contain aspirin as an ingredient, should use care when choosing an such as Alka-Seltzer. You should over-the-counter (OTC) drug. An inap- read an OTC product’s label or propriate OTC product may worsen ask your pharmacist if aspirin is your heart disease by interfering with an ingredient. The Cardiac Rehab your prescribed medications or diet. staff can provide you with a list of MEDICATIONS H25

common medications that contain your doctor. If you need temporary aspirin. relief of sinus pressure, a nasal decon- 4 Ibuprofen (Advil, Bayer Select, gestant (Afrin, Dristan, Duration, Neo- Motrin OB, Nuprin) is a non- Synephrine) may be used. Follow the steroidal anti-inflammatory drug product’s directions closely. (NSAID) that is also used to treat fever, pain, and inflammation. Antacids Ibuprofen, and the newer NSAIDS You may already use an antacid naproxen (aleve) and ketoprofen to relieve indigestion or heartburn. (Orudis KT), may increase your However, an antacid may interact with blood pressure or decrease the your prescribed medications or diet amount of urine you eliminate. restrictions. When selecting an antac- If you are taking a diuretic, beta- id, you should choose a “low sodium” blocker, or angiotensin convert- or “sodium free” product to avoid ing enzyme inhibitor (ACEI), you increasing the amount of sodium in should use acetaminophen instead your diet. Antacids that contain either of a NSAID. no sodium or only small amounts are: Aluminum hydroxide, Di-Gel, Gas-X, CAUTION Gelusil, Milk of Magnesia, Mylanta, If you are taking Warfarin Riopan, Rolaids Sodium Free, Trilacac, (Coumadin), you should avoid using and Tums. Avoid any antacids that aspirin or NSAID products. These have sodium bicarbonate as an ingredi- medications may increase the blood ent. Products you should not use are: thinning action of Warfarin and can Alka-Seltzer, Bromo-Seltzer, Gaviscon increase the risk of bleeding. and Sodium Bicarbonate. If you’re Allergy/Cold Medications unsure about the sodium content of Care in choosing an appropriate an antacid, check with your pharma- allergy or cold medication is impor- cist. tant. Many oral preparations contain CAUTION a decongestant to help clear a stuffy Antacids may reduce the absorp- nose or head. Decongestants, like phe- tion of other medications when nylephrine, pheylpropanolamine, and taken together by binding to them or pseudoephedrine, may increase your changing the acidity of the stomach. heart rate or blood pressure by nar- Medications that may be affected by rowing the blood vessels. You need antacids are: Allopurinol, Atenolol, to avoid using a combination cold Digoxin, Iron supplements and product that contains a decongestant, Quinidine. If you need to take an ant- unless you’ve discussed it first with H26 MEDICATIONS acid while on one of these prescription Examples of vitamins medications, you should separate each and their actions dose by two hours or more. 4 Vitamin C and Vitamin A — may promote wound healing Herbal and Natural Supplements 4 Folic Acid, Vitamin B6 , and Some supplements sold as natu- Vitamin B12 lowers the level of ral and herbal products can contain homocysteine in the body. Too ingredients that may interfere with the much homocysteine may contrib- medications you are taking. It is not ute to heart disease. a good idea to take over-the-counter 4 Do not use over-the-counter nia- or health food supplements without cin as a substitute for prescription checking with your doctor or pharma- niacin. cist first. Fish Oil Capsules In some people, part of having high lipid levels includes having high triglycerides. Fish oil capsules have been shown to lower high triglycerides. It is important to talk with your doctor before taking fish oil capsules. Taking the proper dose is required to lower triglycerides. The only side effects reported are “fish” burps and mild stomach upset. Omacor is a fish oil supplement available only by prescription. Many others are available without a prescription. Vitamins Some vitamin supplements may be prescribed by your physician. They may or may not require a prescription. Always follow the directions your doctor gives you. Do not take more that the recommended amount each day. The following lists examples of vitamins and their actions: