CARDIAC REHABILITATION PROGRAMME:- MEDICATION
AIM OF THIS SESSION Understand the reasons for taking your medications, Discuss the common side effects associated with these medications - knowing when to report to your doctor Opportunities for you to ask questions Share you experience or concerns
WHAT IS A HEART ATTACK? Heart attack is also called Myocardial Infarct (MI)
RISK FACTOR OF MI Modifiable Vs Non-modifiable Hypertension Diabetes mellitus Weight Smoking Target BP of 130/80 Cholesterol
WHY TAKE MEDICINES? Reduce your risk of having another cardiac event Control symptoms and improve quality of life Evidence based medicines: safe and effective Patient s choice
ASPIRIN Reduces stickiness of platelets Reduces risk of further heart attack Side effects: stomach irritation -Take with or after food wheezing or bleeding - Report to doctor Take indefinitely as reduces risk of further cardiac event
CLOPIDOGREL Used post heart attack and/or stent insertion Prevents clot formation Length of course is variable Increased risk of a bleed in combination with aspirin Do not stop without cardiologist s knowledge Alternatives : Prasugrel, Ticagrelor
ANGIOTENSIN CONVERTING ENZYMES INHIBITORS (ACE I) - RAMIPRIL, LISINOPRIL, PERINDOPRIL Vasodilator - opens up blood vessels Use post MI and in HF Protective effect on the heart & helps strengthen heart muscle S/E: cough, dizziness, rash Monitor kidney function and potassium level GP should review the dose Aim is to titrate up to the maximum tolerating dose for YOU
ANGIOTENSIN II RECEPTOR INHIBITORS - CANDESARTAN, LOSARTAN, TELMISARTAN Do the same job as an ACE I Often used if cough develops with an ACE I Also need to monitor renal function and potassium levels May also cause rash, dizziness GP should review dose
BETA-BLOCKERS - BISOPROLOL, METOPROLOL, ATENOLOL Reduce force & speed of heart rate Used after MI, in angina, arrhythmias and heart failure S/E :tiredness, headache, cold hands & feet, dizziness, wheeze, impotence Dose titration
STATINS - SIMVASTATIN, PRAVASTATIN, ATORVASTATIN Reduce the chance of another heart attack Aim to lower LDL cholesterol and total cholesterol The lower your cholesterol the better Use in conjunction with dietary advice S/E: headache, GI upset, allergic reactions, muscle ache and weakness Monitor liver function Avoid Grapefruit Juice
GLYCERYL TRINITRATE SPRAY (GTN) Relieves angina / chest pain Used under the tongue (sublingually) Should be tried 3 times at five minute intervals, if no response then call 999 Common side effects are flushing, headache and dizziness Remember to check the expiry date
ORAL NITRATES - ISOSORBIDE MONONITRATE Relaxes muscles in veins & arteries - wider - so more oxygen to heart Used for preventing angina (chest pain) S/E : headache, dizziness, flushing Asymmetric dosing to reduce tolerance Last dose at teatime Modified- release preparation available for once daily administration
DIURETICS - BENDROFLUMETHIAZIDE, SPIRONOLACTONE, EPLERENONE,FUROSEMIDE Used to reduce excess fluid after heart damage (heart failure) or to reduce blood pressure Remove excess water from body - less volume for heart to pump around Might be taking more than one Usually take in the morning S/E : may affect potassium levels, may alter blood sugar, may worsen gout
CALCIUM CHANNELS BLOCKERS -AMLODIPINE, DILTIAZEM, VERAPAMIL Widen blood vessels - increase oxygen to heart Some slow heart rate Use to treat different conditions including: high blood pressure, angina, arrhythmias S/E : headache, flushing, tiredness, GI upset, ankle swelling
ORAL ANTICOAGULANTS - WARFARIN, RIVAROXABAN, APIXABAN ETC. Commonly use in patients with atrial fibrillation, history of pulmonary embolism or deep vein thrombosis Prevent from having clots that could lead to stroke or other systemic embolism Take it same time each day Carry the anticoagulation alert card with you
WHAT HAPPENS IF I CAN T TOLERATE THE MEDICATIONS? Discuss with your doctor, nurse specialist or pharmacist Be specific more information the better DO NOT stop taking medications without discussing with us
GENERAL HINTS Use the same pharmacy Branded or generic drug name? Prepayment certificate How can I remember what to take when? Will I experience all these side effects? Buying over the counter medicines
IF YOU WOULD LIKE MORE INFORMATION Community Pharmacists British heart foundation www.bhf.org.uk medicines for the heart www.nhs.uk www.patient.co.uk Medicines Information, Frimley Park
REFERENCE Heart failure in women. www.harvardhealth.edu. Accessed 22/2/15 Reviewsof progress.org Accessed 22/2/15 http://science.nationalgeographic.com/science/photos/heart/ Accessed 22/2/15 Health.howstuffworks.com Accessed 22/2/15 http://en.wikipedia.org/wiki/coronary_stent accessed 22/2/15 www.sixminutes.com.au Accessed 22/2/15 www.snipview.com Accessed 22/2/15 www.medicines.org.uk www.baligadiagnostics.com Accessed 2/3/15 How to support patients taking new oral anticoagulant medicines Learning article Pharmaceutical Journal Accessed 2/8/17 Apixaban patient alert card. Accessed 2/8/17 www.cartoonstock.com/ Accessed 25/7/17