MEDICATIONS IN Cardiac Rehabilitation

OVERVIEW TYPES OF DRUGS STORAGE OF MEDICATIONS DISPOSAL OF MEDICATIONS SAFETY TIPS

TYPES OF DRUGS Ace Inhibitors Anti-Arrhymthmics Beta Blockers Anticoagulants Calcium Channel Blockers Digoxin Diuretics Potassium Lipid Lowering Medications Nitrates Herbal Remedies

ACE INHIBITORS Ramipril(Altace) Captopril(Capoten) Quinapril(Accupril) Enalapril(Vasotec) Lisinopril(Zestril) WHAT IT DOES: SIDE EFFECTS: widens blood vessels so that blood flows more easily and not as much pressure is put on artery walls. controls high blood pressure and takes the load off the heart in cases of congestive heart failure. dry hacky cough causes dizziness

ANTI-ARRHYTHMICS Amiodarone (Cordarone) Sotalol (Sotacor) and other Beta Blockers  see Beta Blockers Digoxin (Lanoxin)  see Digoxin Calcium Channel Blockers  see calcium channel blockers WHAT IT DOES: SIDE EFFECTS: helps to make an irregular heartbeat “regular”. for Amiodarone: stomach upset, color changes in the eyes, blurry vision, muscle weakness, shakiness and clumsiness.

BETA BLOCKERS WHAT IT DOES: SIDE EFFECTS: used to treat high blood pressure, angina, and irregular heart beats cold hands and feet, vivid dreams, and fatigue. if diabetic, signs of low blood sugar such as tremors and palpitations may be hidden. Confusion may be the only symptom. can make some breathing problems worse. Atenolol (Tenormin) Metoprolol (Lopressor) Acebutolol (Sectral, Monitan) Propranolol (Inderal) Nadolol (Corgard)

CALCIUM CHANNEL BLOCKERS Nifedipine (Adalat) Diltiazem (Cardizem) Amlodipine (Norvasc) Felodipine (Plendil) Verapamil (Isoptin) WHAT IT DOES: SIDE EFFECTS: controls blood pressure and helps to treat angina used to treat abnormal heart beats. swelling of ankles and feet, headaches,dizziness and facial flushing. for Verapamil only: constipation and fatigue.

ANTICOAGULANTS ASA (Aspirin, Novasen) Warfarin (Coumadin) Clopidogrel (Plavix) Ticlodipine (Ticlid) WHAT IT DOES: SIDE EFFECTS: keep blood from clotting in places it shouldn’t. prevent clots from forming prevent one’s that have already formed from getting bigger does not dissolve blood clots which have already formed. easy bruising or bleeding nose bleeds heavy bleeding after brushing teeth coughing up blood bowel movements that are black, and have a foul odour vomit that is red, or that looks like coffee grounds

ANTICOAGULANTS For Coumadin only: Vitamin K also affects the way blood clots, and the way Coumadin works, so it is a good idea to keep the amount of Vitamin K in your diet the same from day to day. Examples of Foods that are High in Vitamin K: green, leafy vegetables cauliflower liver soybeans (soybean oil) lentils garbanzo beans cannola oil mayonnaise green tea wine, beer, and hard liquor (limit to no more than 1-2 drinks a day)

DIGOXIN Digoxin (Lanoxin) WHAT IT DOES: SIDE EFFECTS: makes the heartbeat stronger, slower, and more regular. used to treat a heart that is beating too fast, irregularly. changes in vision (blurred or double vision, or green or yellow halos around objects), tiredness, and worsening of the original heart problem. worsening heart problems. swelling in feet or ankles, trouble breathing, or sudden weight gain due to fluid retention. loss of potassium can make these problems worse.

Potassium Chloride (Slow K, Micro K, K-Lor) POTASSIUM WHAT IT DOES: SIDE EFFECTS: Potassium is needed in the body to keep the hearbeat normal, to control water balance, and to keep nerves and muscles working properly. Symptoms of potassium deficiency are fatigue; dizziness; confusion; irregular heart rhythm; and muscle weakness. stomach upset. if the dose is too high muscle weakness and changes in heart beat can occur.

POTASSIUM Other Things to Remember: many people can get enough potassium from their diets. Some good sources include: Bananas Oranges Apricots Dates Raisins Cantelopes Tomatoes Spinach Prunes and prune juice Lima beans

POTASSIUM Other Things to Remember: a spice based salt substitute like Mrs. Dash may be better as opposed to salt substitutes like Co-Salt.

Furosemide (Lasix) Hydrochlorthiazide (Hydrodiuril) DIURETICS WHAT IT DOES: SIDE EFFECTS: diuretics or “water pills” help the body get rid of excess water and salt. relieve congestive heart failure. reduce high blood pressure tiredness or weakness or dizziness, thirst, dry mouth, changes in heartbeat, numbness or tingling in hands, feet and lips. Metolazone (Zaroxolyn) Spironolactone (Aldactone)

LIPID LOWERING MEDICATIONS WHAT IT DOES: Lipids are also known as “fats” HDL (high density lipoprotein) – “good” cholesterol. - removes cholesterol from your circulation. LDL (low-density lipoprotein) – “bad” cholesterol. -causes your heart arteries to plug. Triglycerides- This is a source of energy. At high levels, it may cause heart disease in some people. Total Cholesterol-This is the total of all cholesterol-both the “bad” and the “good”. Atorvastatin (Liptor) Simvastatin (Zocor) Pravastatin (Pravachol) Lovastatin (Mevacor) Cerivastatin (Baycol) Gemfibozil (Lopid) Fenofibrate (Lipidil) Benzafibrate (Bezalip) Colestyramine (Questran) Niacin

LIPID LOWERING MEDICATIONS SIDE EFFECTS: most cholesterol medications can cause stomach or bowel upset in a few people. some may experience sore muscles – report this to doctor. Niacin only: Facial flushing and skin rashes WHAT IT DOES (cont..): some diseases (examples-diabetes, liver problems, kidney problems, and low thyroid) may cause high cholesterol, as well as poor diet, lack of exercise and some medications. exercise and diet are the first and most important in keeping your cholesterol healthy, but for some people this is not enough.

NITRATES SIDE EFFECTS: headache, facial flushing and dizziness. because of the dizziness, the fast acting nitrates should be taken sitting down!! WHAT IT DOES: widens your blood vessels throughout your body by relaxing the muscles that surround them, including those in the heart. relieves angina pain. Nitroglycerin tablets (fast acting) Nitrospray (fast-acting) Nitrong SR (intermediate-acting) Isordil (intermediate-acting) Ismo(intermediate-acting Imdur (intermediate-acting) Nitrodur patches (slow-release)

NITRATES Other Things to Remember: Proper way to take Nitrospray  Sit yourself down(this avoids the possibility of fainting)  Wet a tablet with your saliva, place it under your tongue until its is completely absorbed. With Nitrospray, spray under your tongue.  Repeat every 5 minutes up to a total of 3 tablets (or sprays). If in 15 minutes you still have angina pain, call 911. Proper Way to Apply Nitrodur Patches  Apply your patch to a hairless are on your skin (try and avoid using your forearms and your lower legs, rotate sites.

NITRATES Other Things to Remember: Keep Nitro tablets in their original dark bottle  Cap screwed on tight and stored in a cool area.  Carry medication with you at all times. Getting headaches while taking Nitro?  try taking Tylenol Intermediate and long-acting nitrates  arrange a “nitrate-free” period of time (a period of time when you’re not taking it.