Medications In This Chapter The medicines that you have been given are an important part h General Guidelines .........H1 of the treatment plan. This chap- h Angiotensin Converting ter provides guidelines and Enzyme (ACE) information about many heart Inhibitors........................H4 medications. It is important for you to follow h Angiotensin Receptor Blockers .........................H5 the medication regimen your doc- tor has prescribed. Let your Antiarrhythmics..............H6 h doctor or the Cardiac Rehab staff h Anticoagulants................H7 know if you have any concerns about taking your medications. h Antiplatelets...................H9 Beta Blockers...............H10 h SECTION 1 h Calcium Channel Blockers .......................H12 h General Guidelines For Taking Medication h Digitalis........................H13 The following guidelines are meant to help prevent mistakes in taking med- Diuretics.......................H14 h ication. Please follow them carefully. Never take medication in the h Combination Drugs.......H16 dark. Lipid Lowering h Always read the labels on your Agents ..........................H16 medication bottles. Nitrates.........................H19 Take exactly as ordered by your h doctor. Do not skip doses or take h Potassium extra. Bad effects can happen Supplements.................H22 from taking too much or too little of a medication. Pain Relievers...............H23 h Do not give your medication to someone else and do not take any h Over-The-Counter Medications..................H24 medication not prescribed for you. 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 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. Refill your medication before you If you are taking a long-acting or are completely out. Plan ahead for sustained release form of a med- weekends and holidays. ication, you must swallow it Have all your prescriptions filled whole. Do not break, chew, or at the same pharmacy. This will crush before swallowing. allow your pharmacist to better For liquid medications use a mea- screen for drug interactions. suring spoon or specially marked 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 Check with your doctor or phar- you remember when to take your macist before taking any over-the- medication. counter or non-prescription med- ications. What you should know about each of your medications Know what side effects or reac- 1. Name & strength of each medica- tions to report to your doctor. tion. Always carry a list of medications 2. Why are you taking each medica- 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 6. Does the medication interact or your medications 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 instruc- tions? 8. How should you store your med- ication? 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 Triazolam (Halcion) 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) Losartan (Cozaar) Propafenone (Rythmol) H4 MEDICATIONS 9. What do you do if a dose is missed? SECTION 2 10. Does the medication require any Angiotensin Converting monitoring (i.e. blood tests)? h Enzyme (ACE) Inhibitors Storage of Medications Angiotensin is a substance in the KEEP OUT OF REACH OF CHIL- body that causes blood vessels to nar- DREN row. ACE inhibitors reduce the produc- Store in a cool, dry place. tion of angiotensin by blocking the Keep away from heat or sunlight. enzyme, angiotensin converting Keep in the original container, enzyme. This allows the blood vessels tightly capped. Do not mix differ- to relax, for a reduction in blood pres- ent medications in one bottle. sure and increase in blood and oxygen Do not remove labels, these will supply to the heart. contain directions and any special Uses for ACE Inhibitors include treat- information. ment of high blood pressure (hyperten- Do not store in the refrigerator sion), congestive heart failure, and to unless directed by your pharma- protect the kidneys of diabetic patients. cist or doctor. Examples of ACE Inhibitors Do not keep in the bathroom, • Benazepril (Lotensin) near a sink, or in any damp place. • Captopril (Capoten) Heat or moisture may cause the • Enalapril (Vasotec) medication to break down. • Fosinpril (Monopril) Discard any medication that you • Lisinopril (Prinivil, Zestril) have been instructed not to take • Moexipril (Univasc) any more or any medication that • Perindopril (Aceon) is expired. • Quinapril (Accupril) What to do if you miss a dose? • Ramipril (Altace) If you’ve missed a dose, take it as • Trandolapril (Mavik) soon as possible. If several hours have Things to Remember passed or if it is nearing the time for DO NOT take other medications the next dose, DO NOT DOUBLE unless you discuss them with your THE DOSE IN ORDER TO “CATCH doctor or pharmacist. This espe- UP,” just skip the missed dose and cially includes over-the-counter continue your usual schedule. If you medications for appetite control, miss more than one dose or you have asthma, colds, cough, hay fever, or questions call your doctor. sinus problems since they may increase your blood pressure. MEDICATIONS H5 DO NOT take salt substitutes or M Dizziness or lightheadedness medications containing potassium M Skin rash while taking ACE inhibitors, unless prescribed by your doctor. CAUTIONS Tell your doctor if you are taking ACE inhibitors may cause your body to retain potassium. Signs of captopril or fosinopril. These medica- too much potassium are: confu- tions may interfere with some medical sion, irregular heart/beat, ner- tests. vousness, weakness, heaviness of Notify your doctor immediately if the legs, and numbness or tin- any of the following occur: fever and gling 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. You may become dizzy or light- headed while taking ACE inhibitors. Make sure you know SECTION 3 how you react to this medication h 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. 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 too much water and lower your ation of blood vessels and a reduction blood pressure. Use extra care in blood pressure. during exercise in hot weather. ARBs are used to treat high blood pressure and may have benefit in If you are taking captopril or moexipril, take on an empty stom- patients with congestive heart failure ach one hour before meals. and to protect the kidneys of diabetic patients. Possible Side Effects Examples of Angiotensin M Dry cough Receptor Blockers M Loss of taste • Candesartan (Atacand) M Nausea or vomiting Headache • Eprosartan (Teveten) M • Irbesartan (Avapro) Unusual tiredness M • Losartan (Cozaar) M Diarrhea • Olmesartan (Benicar) H6 MEDICATIONS • Telmisartan (Micardis) M Change in how much or how • Valsartan (Diovan) often you urinate Chest pain Combination products with a diuret- M ic such as hydrochlorothiazide are also M Fast or slow heartbeat available. M Lightheadedness or fainting • Irbesartan + Hydrochlorothiazide M Swelling in the hands, ankles or feet (Avalide) • Losartan + Hydrochlorothiazide SECTION 4 (Hyzaar) • Valsartan + Hydrochlorothiazide h Antiarrhythmics (Diovan HCT) When your heart has an irregular Things to Remember rhythm your body may not receive all the blood and nutrients it needs. Don’t use potassium supplements or salt substitutes containing Antiarrhythmics help correct irregular potassium without checking