1. MEDICINES & THE HEART

2. Medicines & the Heart You and your medicines You and your medicines Common heart medicines for preventing heart disease Common heart medicines for preventing heart disease – How they work – Common side effects Other common heart medicines you may be taking Other common heart medicines you may be taking What can you do to help yourself? What can you do to help yourself? Questions about your medicines Questions about your medicines

3. You and your medicines ALWAYS take your medicines as directed by your doctor ALWAYS take your medicines as directed by your doctor Take care not to take more medicine than the Doctor has prescribed. Take care not to take more medicine than the Doctor has prescribed. Ask your pharmacist if you do not understand anything about your medicines or cannot read the label Ask your pharmacist if you do not understand anything about your medicines or cannot read the label NEVER take other peoples medicines or give your medicines to anybody else NEVER take other peoples medicines or give your medicines to anybody else

4. You and your medicines All medicines have side effects All medicines have side effects Speak to your doctor if you experience any unwanted effects Speak to your doctor if you experience any unwanted effects Try not to forget to take a dose Try not to forget to take a dose If you do forget a dose, remember If you do forget a dose, remember – On the same day – take it straight away – The next day – carry on with the next dose Use a reminder chart Use a reminder chart

5. You and your medicines Storing your medicines – Keep in a cool dry place – Keep in original containers – Keep safe from children – Return any old or unwanted medicines to your Pharmacist for disposal Over-the-counter medicines – ALWAYS check with your Pharmacist if you want to take other medicines

6. Common Heart Medicines

7. ‘Clot-Busting’ drugs Given in heart attacks Given in heart attacks Dissolve the clot or blockage Dissolve the clot or blockage Reduces amount of damage to heart muscle Reduces amount of damage to heart muscle E.g. E.g. – Streptokinase Can ONLY be given once Can ONLY be given once If you are given this, you will be given a card to carry with you at all times If you are given this, you will be given a card to carry with you at all times – Reteplase Not suitable for everyone Not suitable for everyone

8. Aspirin Reduces your chance of another heart attack or a stroke by about one third! Needs to be taken for life! Reduces stickiness of blood cells so they are less likely to form a blood clot, which could block your arteries ALWAYS take with or after food Side effects: – – Upset stomach or bleeding problems – – Asthmatic patients need to take care – may make asthma symptoms worse

9. Clopidogrel (Plavix®) Often given alone to patients who are allergic to aspirin or who have stomach ulcers or bleeding problems Sometimes given in combination with aspirin if you have had a stent, but only for a year Reduces your chance of another heart attack or a stroke Reduces stickiness of blood cells – less likely to form a blood clot Side effects: – Nausea – Indigestion – Minor bleeding – Diarrhoea

10. Beta Blockers Given after a heart attack to reduce the chances of further damage to heart muscle Act by: – Reducing the amount of work the heart has to do – Slows the heart down – Reduces blood pressure – Reduces the amount of oxygen the heart uses Examples – Atenolol, Metoprolol Side effects: – Tiredness or fatigue, colds hand & feet, vivid dreams DO NOT STOP TAKING THEM SUDDENLY NOT SUITABLE FOR PEOPLE WITH ASTHMA OR SIMILAR BREATHING PROBLEMS

11. ACE Inhibitors May help you live longer and survive another heart attack May help you live longer and survive another heart attack ACE is a chemical which narrows the blood vessels ACE is a chemical which narrows the blood vessels ACE inhibitors stop this action ACE inhibitors stop this action Examples - Ramipril (Tritace), Lisinopril (Zestril), Captopril (Capoten), Enalapril (Innovace), Perindopril (Coversyl) Examples - Ramipril (Tritace), Lisinopril (Zestril), Captopril (Capoten), Enalapril (Innovace), Perindopril (Coversyl) Side effects: Side effects: – Kidney problems – need regular blood tests – First dose may cause dizziness – Dry cough, rash & taste changes

12. Lipid Lowering Drugs (Statins) Used to treat high cholesterol levels Used to treat high cholesterol levels High cholesterol makes you more at risk of heart disease High cholesterol makes you more at risk of heart disease Examples – simvastatin (Zocor), Pravastatin (Lipostat), Atorvastatin (Lipitor) Examples – simvastatin (Zocor), Pravastatin (Lipostat), Atorvastatin (Lipitor) Usually best taken at night, but not always! Usually best taken at night, but not always! MUST be taken for life! MUST be taken for life! Side effects: Side effects: – Usually rare – Headache & stomach upsets are most common – Muscle pain, tenderness or weakness – see doctor ASAP – Liver problems – need regular blood tests

13. Other Common Medicines - 1 Angiotensin II Receptor Antagonists Angiotensin II Receptor Antagonists – Have similar action to ACE inhibitors – Do not seem to cause persistent dry cough sometimes seen with ACE inhibitors – Examples – losartan (Cozaar), candesartan (Amias), valsartan (Diovan – Side effects: Drop in blood pressure Drop in blood pressure Dizziness or tiredness Dizziness or tiredness Rash Rash Taste changes Taste changes

14. Other Common Medicines - 2 Nitrates Nitrates – Widen your heart’s blood vessels – Short acting: Glyceryl Trinitrate Spray or tablets Glyceryl Trinitrate Spray or tablets Taken when required Taken when required – Long acting: Isosorbide mononitrate or dinitrate Isosorbide mononitrate or dinitrate Glyceryl Trinitrate patches or buccal tablets Glyceryl Trinitrate patches or buccal tablets MUST be taken regularly (remove patches at night) MUST be taken regularly (remove patches at night) – Side effects: Headache, flushing, dizziness, fast heart beat, stomach upset Headache, flushing, dizziness, fast heart beat, stomach upset

15. Other Common Medicines - 3 Calcium Channel Blockers Calcium Channel Blockers – Make your heart beat less strongly – Widen blood vessels so more oxygen can get to the heart – Reduce blood pressure – Examples - Nifedipine (Adalat), Diltiazem (Tildiem, Adizem, Dilzem), Amlodipine (Istin), Felodipine (Plendil) – Side effects : Swollen ankles, Swollen ankles, flushing & headaches, flushing & headaches, dizziness, dizziness, constipation constipation

16. Other Common Medicines - 4 Diuretics or “water tablets” Diuretics or “water tablets” – Increase output of water and salt in urine – Useful for heart failure and high blood pressure – Examples: bendroflumethiazide, furosemide, spironolactone – Side effects: Low potassium levels – need regular blood tests Low potassium levels – need regular blood tests Stomach upsets Stomach upsets Low blood pressure and dizziness, especially when standing up Low blood pressure and dizziness, especially when standing up

17. Risk Factors for heart & blood vessel disease Can’t change Can’t change – Age – Gender – Ethnicity – Family History – Previous heart or blood vessel disease Can change Can change – High blood pressure – High cholesterol – Smoking – Overweight – Lack of exercise – (Diabetes control)

18. What can you do to help yourself? Take all your medicines exactly as your doctor has prescribed Take all your medicines exactly as your doctor has prescribed – Especially the aspirin, the beta-blocker, the ACE inhibitor and the statin! – Remember you may need to take them for life! Stop smoking Stop smoking – Local NHS Stop Smoking Service UK – 0800 731 2654 Eat a healthy diet Eat a healthy diet Reduce your alcohol intake Reduce your alcohol intake Take regular exercise Take regular exercise

19. Any questions about your own medicines?