MEDICATIONS IN Cardiac Rehabilitation

1. MEDICATIONS IN Cardiac Rehabilitation

2. TYPES OF DRUGS • STORAGE OF MEDICATIONS • DISPOSAL OF MEDICATIONS • SAFETY TIPS OVERVIEW

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

4. ACE INHIBITORS WHAT IT DOES: • 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. SIDE EFFECTS: • dry hacky cough • causes dizziness Ramipril(Altace) Captopril(Capoten) Quinapril(Accupril) Enalapril(Vasotec) Lisinopril(Zestril)

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

6. WHAT IT DOES: • used to treat high blood pressure, angina, and irregular heart beats SIDE EFFECTS: • 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. BETA BLOCKERS Propranolol (Inderal) Nadolol (Corgard) Atenolol (Tenormin) Metoprolol (Lopressor) Acebutolol (Sectral, Monitan)

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

8. WHAT IT DOES: • 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. SIDE EFFECTS: • 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 ASA (Aspirin, Novasen) Warfarin (Coumadin) Clopidogrel (Plavix) Ticlodipine (Ticlid)

9. 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) ANTICOAGULANTS

10. DIGOXIN WHAT IT DOES: • makes the heartbeat stronger, slower, and more regular. • used to treat a heart that is beating too fast, irregularly. SIDE EFFECTS: • 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. Digoxin (Lanoxin)

11. WHAT IT DOES: • 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. SIDE EFFECTS: • stomach upset. • if the dose is too high muscle weakness and changes in heart beat • can occur. POTASSIUM Potassium Chloride (Slow K, Micro K, K-Lor)

12. 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

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

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

15. 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

16. LIPID LOWERING MEDICATIONS 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. 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

17. NITRATES 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. SIDE EFFECTS: • headache, facial flushing and dizziness. • because of the dizziness, the fast acting nitrates should be • taken sitting down!! Nitroglycerin tablets (fast acting) Nitrospray (fast-acting)  Nitrong SR (intermediate-acting) Isordil (intermediate-acting) Ismo(intermediate-acting Imdur (intermediate-acting)  Nitrodur patches (slow-release)

18. 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.

19. 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.