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 doc- tor 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 medi- cations. What you should know about each of your medications 4 Know what side effects or reac- 1. Name & strength of each medica- tions to report to your doctor. tion. 4 Always carry a list of medica- 2. Why are you taking each medica- tions 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 medica- tion? 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 light- headed while taking ACE inhibi- tors. 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