Medications and your Heart. RBCH Foundation Trust

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1 Medications and your Heart RBCH Foundation Trust

2 Today I will try and cover Confusing cocktail of drugs? What are they for? How do I take them? What if I forget to take them? What are common side effects? Who can I talk to about my medicines?

3 Do s and Don t Can be on many tablets for various conditions. Medicines are individual for you. DON T SHARE some work better than others, breathless diuretic, not help asthmatic. Take regularly same time each day DON T STOP without discussion with Dr. Some tablets appear to have no visible benefit antihypertensives, may just get side-effects. Discuss there are alternatives. Forget to take, - not 2 but take as normal the next day DON T increase the dose narrow therapeutic window (between dose needed for effect + dose that causes lots of side effects) DON T run out. Order 7/7/ ahead, plan for bank holidays etc. WHERE CAN YOU GET A SUPPLY? Abroad may be buy at OTC, temporary resident, hospital A+E emergency supply at chemist buy (show them your list)

4 LIST IN WALLET (or repeat prescription) What you take, drug, strength _+ dose Keep it up to date GP name + number, also regular pharmacy name + number

5 Getting confused? TALK TO CHEMIST Medidose boxes, non-click lock lids, large print labels. Some medicines may be able to be reduced/stopped., if lose weight, diabetes increase exercise, as may help with hypertension.

6 WHY are you on the drugs? Angina Heart Attack High Blood Pressure Heart Rhythm Heart Failure Prevention of coronary heart disease

7 Angina: Caused by poor supply of oxygen to the heart. (B-Blockers, calcium channel blockers, nitrates & potassium channel activities) Heart Attack (MI) blood clot in coronary arteries (Pain relief, clot busters + aspirin, medicines to prevent further attacks). High Blood Pressure (hypertension) untreated many probs, heart disease, kidney damage + stroke. (Lots of drugs, ACEI, B-B, CaCh B + diuretics) Heart Failure inadequate pumping of the heart (breathless + fatigue). ( Diurtics, digoxin, ACEI + spironolactone). Heart ryhtm (anti- arrytymics + anticoagulants) Valvular Heart disease if need replacement anticoagulation Prevention Cholesterol loweing + decrease BP + aspirin. Lifetsyle modifications essential essentials too.

8 Drugs are classified into groups depending on how they work. Medicines have both a brand name and a drug/generic name Confusing

9 ANTIPLATELETS The inside of blood vessels may become abnormal due to cholesterol despoits, surface exposed can become focus for clot formation. Irregular heart beat can also lead to increase in clot formation Effect can occur on heart valves/after stents

10 ASPIRIN Is everyone here on aspirin? Same aspirin as for pain relief but a small dose 75mg Stops platelets (these are the small blood cells that clump together to form a clot) becoming sticky Decreases risk of heart attack & stroke Side-effects indigestion, stomach bleed & high doses, with food.

11 CLOPIDOGREL (Plavix) Used alongside aspirin in some patients e.g after a stent for a certain period of time (highest risk of event) Used when aspirin is not tolerated Sometimes if you re on both of these or have been having problems with indigestion may be prescribed OMEPRAZOLE (20mg) protects tummy

12 ANTIHYPERTENSIVES -Many have other benefits other than direct decrease in BP Risk factor for stroke and heart attacks Usually won t notice any symptoms Important to take medicine even though you don t notice a benefit difficulty if getting side effects May need more than one drug to control it combination therapy Lifestyle changes are very important too. (even if on meds) Exercise Diet Low salt increased fruit and veg Stopping smoking.

13 BETA-BLOCKERS end in olol Atenolol, Bisoprolol, Nebivolol, Metoprolol, carvedilol, propanolol Used in lots of different heart conditions Block the action of adrenaline (hormone that makes the heart beat faster ) Therefore slows the heart Prevtn angina attacks Lowering blood pressure Reducing the risk of heart attack Some B-Blockers help with rhythm control (sotalol) Side effects - constrict air passages, - wheezing. Tiredness, fatigue, cold hands + feet. Impotence, nightmares, erectile problems etc Not suitable for all asthamtics/wheezy/ diabetics as can mask symptoms Should not be stopped suddenly. Can make angina worse

14 ACE INHIBITORS Ramipril, Lisinopril, Perindopril, Enalapril, Captopril Very effective at treating + preventing heart failure Decreases blood pressure by relaxing walls of blood vessels, allowing them to widen (cause less vasoconstriction, inhibit angiotensin 2 + increase bradykinin) Dose + frequency depends which one of these you take Starts low, increased depending on blood pressure and kidney function First dose often given at night (can get low BP) Possible side-effects e.g. Irritating cough, skin reactions, kidney problems

15 ANGIOTENSIN 2 RECEPTORS ANTOAGONISTS Valsartan, Losartan, Candesartan Alternative if cannot tolerate ACEI No cough

16 CALCIUM CHANNEL BLOCKERS Nifedipine, Amlodipine, Diltiazem, Verapamil Relax muscle wall of arteries + veins, increase BF and decrease CO Swollen ankles Amlodipine Constipation verapamil + interactions Bradycardia diltiazem

17 NITRATES Isosorbide Mononitrate, ISMO, Monomax, Imdur Relax veins returning to the heart Less blood in the heart, less need to pump Increased coronary artery flow Widens vessels around the heart to help it carry more blood and oxygen to the heart muscle Used to prevent angina and control chest pain. May need to increase the dose (as tolerated) MR 24 hr period Normal = twice a day

18 Nitrates cont d GTN Spray/Tablets Has everyone got theirs? Should always carry it. Best not carried next to body heat May get flushing, headache, dizziness (postural hypertension) sit down Expiry date Spray under tongue (NOT SWALLOW) Can buy over counter

19 NICORANDIL (max 30mg bd) Relax muscle of artery wall vasodilation + decreased arterial energy consumption. Helps to produce alternative blood vessel network.

20 DIURETICS - Water tablets FUROSEMIDE, BUMETANIDE, METALAZONE, BENDROFLUMETHIAZIDE, AMILORIDE, SPIRONOLACTONE. Remove Na+ and H2O Acts in kidneys to reduce fluid increase volume of urine by removing salt & water from body Do not have high salt intake, decrease diuretic effect Eat fruit + veg to guard against potatssium loss Take in the mornings

21 CHOLESTEROL LOWERING STATINS Simvastatin, Atorvastatin, Pravastatin, Rosuvastatin Can bring cholesterol down by up to 20% Cholesterol is from both the diet (saturated fats) and produced by the liver Take at NIGHT Report a muscle pain/weakness (gerneralised) No grapefruit juice

22 ANTI-ARYTHMICS Digoxin for AF Fast and irregular. Digoxin slows and strengthens the heartbeat Vomiting / nausea / palpitations Amiodarone headache/flushing/dizziness/stomach upsets/ thyrpoid gland/lungs/liver Blood tests + chest X-Ray. SUNSCREEN

23 ANTICOAGULANTS Warfarin Irregular hear beats artificial waves (conduction not [just] from SA node, but other pacemakers in atria, so atria don t empty completely every time. Prevents blood clots forming Regular blood tests Variable doses Interactions Cranberry Juice avoid Will have Yellow anticoagulation booklet.

24 ALCOHOL Generally in moderation fine Several medications that are a real no no with alcohol Heart meds on the whole OK Specific drugs, ask Pharmacist/chemist. Would usually say on the bottle/tube etc if NOT to take alcohol If in warfarin, same amount of alcohol.. rather than binges

25 Viagra

26 IN SUMMARY There are lots of medications, & it can cause us confusion trying to remember everything about each. If there are new tablets it can take a while to take everything about them on board.. obviously the more.. the worse. HELP IS AT HAND>> DON T BE AFRAID TO ASK

27 Any Questions? About anything I ve mentioned or Any other meds Can take you details and get back to you if cant answer query

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