Heart Medication

Take your medications only as directed.  If you have any questions about how to take your medications, check with your doctor.
ACE Inhibitors
(Vasotec, Enalapril, Zestril, Prinivil, lisinopril, Capoten, captopril, Monopril, Fosinopril, Lotensin, Benazepril, Accupril, Quinapril, Altace, Ramipril)
These medications are used to treat high blood pressure or heart failure. They do not cure these conditions, but do help to decrease blood pressure and help the pumping function of your heart. They may be taken without regard to food. Some ACE inhibitors may cause a dry, nagging cough as a side effect. If you cannot tolerate this, talk to your doctor.
Aspirin may be prescribed for you as a blood thinner. It is sometimes used in combination with one of the other anti platelet medications. Aspirin has been shown to decrease the risk of heart attack and to decrease the damage to the heart should a heart attack occur. If you are not sure that you should be taking aspirin, ask your doctor.  Aspirin for this use is usually taken as one tablet a day, either full strength (325 mg), ½ strength, or “baby” aspirin strength (81 mg). All strengths are effective. Aspirin should be taken with food. Coated aspirin is available if needed to protect the stomach. Notify your doctor for any signs of bleeding (blood in the stool, not stopping bleeding from a cut, frequent large bruises) or stomach irritation.
Beta Blockers
( Tenormin, Atenolol, Lopressor, Metoprolol, Inderal, Propranolol, Corgard, Nadolol, etc)
Beta blockers are used for treatment of high blood pressure or to prevent angina or heart attacks. These medications may slow your heart rate and lower your blood pressure. Take this medication as directed; do no stop taking it without discussing with your doctor. Side effects may include fatigue, tiredness, cold feet or hands, dizziness when standing up. If you should notice any new shortness or breath or wheezing, swelling of the feet and lower legs, sudden weigh gain or chest pain after starting this medication, call your doctor. Beta blockers may be taken with or without food.
Coumadin (Warfarin)
Coumadin is a “blood thinner”, given to prevent the risk of harmful blood clots. It does not dissolve clots, but prevents them from worsening or recurring. It is very important to take this as directed and not to stop taking without discussing with your doctor. Laboratory testing of your blood clotting times (PT, or protime) is necessary while taking this medicine; keep appointments with your doctor and with the laboratory. Interactions with other drugs are possible while taking Coumadin, so do not start or stop any other medicine without discussing with your doctor or pharmacist. Do not take aspirin, or other non-steroidal anti-inflammatory medication (Motrin, Advil, Nuprin, Naprosyn, Orudis, Aleve) unless directed by your physician. Possible side effects include bleeding, so notify your doctor for any signs of bleeding (nosebleeds, blood in the stool or urine or other unusual bleeding). The effectiveness of Coumadin may be affected by foods that you eat. This is especially true of foods that are high in Vitamin K. If you do not know what foods these are, ask your nurse or pharmacist for a booklet about Coumadin and food interactions.

Diuretics are prescribed to help reduce water in the body.  In so doing, they lower blood pressure, reduce the workload of the heart, and reduce its need for blood and oxygen.  The various types of diuretics include bumetanide (Bumex), furosemide (Lasiz), amiloride (Midamor), amiloride with hydrochlorothiaxide (HCTZ) (Moduretic), and  spironolactone.

Lovenox (Enoxaparin)
Lovenox injection is a blood thinner given in combination with one or more of the above to help in preventing blood clots from forming or worsening. It is given by subcutaneous injection twice a day. You will be taught exactly how to administer this and how to dispose of the syringes; be sure to ask any questions about how to take this medication. Let your doctor know right away if you have any unusual bleeding; (black or bloody stools, blood in the urine, nosebleeds) or swollen ankles or feet.

Plavix (Clopidogrel)
Plavix is another anti-platelet medication. It is prescribed to prevent the risk of harmful blood clots. Please take it as directed, and do not stop taking it without discussing with your doctor. It may be taken without regard to meals.

Ticlid (Ticlodipine)
Ticlid is an anti-platelet drug. This medicine is used to prevent the risk of harmful blood clots. Please take it as directed and do not stop taking it without discussing with your doctor. Take it with or after a meal for less chance of stomach upset. Long-term use in some people may cause a decrease in white blood cells.  Keep appointments with your doctor and with the laboratory for monitoring.

Calcium Channel Blockers
Calcium channel blockers are used to relieve and control angina, reduce blood pressure, and, in the case of verapamil, treat rapid heart rates.  These medications work by slowing the flow of calcium  into the muscle cells of the heart and blood vessels.  These muscle cells need calcium to contract.  Therefore, the blood vessels are relaxed, thereby lowering blood pressure, reducing the workload of the heart, and reducing its need for blood and oxygen.  Calcium channel blockers include diltiazem (Cardizen, Cardizem SR), mifedipine (Procardia, Procardia XL), verapamil (Calan, Calan SR, Verelan, Isoptin, Isoptin SR), nicardipine (Cardene), and isradipine (DynaCirc).  Take the calcium channel blocker as directed by your doctor, even if you are feeling well and not experiencing angina.  If you are taking an extended-release form of this medication (sustained-release, or SR), do not break, crush, or chew it.  Swallow it whole.  Take it with food or milk.  If you are taking the medication for high blood pressure, it does not replace the need for a low salt diet and weight loss when indicated.  Check with your doctor for diet recommendations.  A calcium channel blocker will not cure high blood pressure, but it does control it.  Continue to take it as prescribed.  If you miss a dose of the medication, take it as soon as possible.  If it is close to your next scheduled dose, skip the dose and resume your regular schedule.  Do not double the doses.  Do not stop the medication suddenly, as it could bring on symptoms of angina.  Check with your doctor for a schedule to wean off gradually.  Some people become dizzy or light-headed when rising from a lying or sitting position.  Getting up slowly might help.  Drinking alcohol can make these effects worse.  If you are taking diltiazem or verapamil, ask your doctor about checking your pulse rate before and after your medication.  While you are taking this medicine, check your pulse rate regularly.  If it is much slower than your usual rate of often below the rate recommended by your doctor, report the occurrence. Along with the desired effects, calcium channel blockers can produce some unwanted effects.  Check with your doctor if any of the following occur:
  • breathing difficulty, coughing, or, wheezing
  • irregular of fast heartbeat
  • skin rash
  • slow heartbeat
  • swelling of ankles, feet, or lower legs
Digitallis & Digoxin
Digitalis or digoxin in prescribed to improve the strength and efficiency of the heart or to control its rate and rhythm.  The medication should be taken as directed, even though you feel well.  Brand names of digoxin include Lanoxin Lanoxicaps.  Ask your doctor about checking your pulse rate.  While you are taking this medication, check your pulse regularly.  If your pulse is suddenly higher or lower than usual, if it is irregular, or if it is often below the rate suggested by your doctor, report the occurrence.  If you forget a dose of this medication and remember within 12 hours, take it immediately.  If it is more than 12 hours, skip that dose and resume your regular schedule.  Do not double the next dose.  Some of the early warning signs of overdose are loss of appetite, nausea, vomiting, diarrhea, or extremely slow heartbeat.

Integrelin (Eptifibatide) or Rheo-pro (Abciximab)
These are injectable blood thinners called IIb/IIIa inhibitors that are used during and sometimes after a cardiac catheterization or coronary intervention to help prevent blood clots from forming in the coronary arteries. They are given by continuous IV infusion.

Sublingual (under the tongue.)  Nitroglycerin tablets or spray are used to treat chest pain and are used by placing a table under the tongue or one spray in the mouth. If the pain or pressure remains after 5 minutes, use a second tablet or spray. Wait 5 more minutes, and if the pain or pressure is still present, even if it is less, repeat a third tablet or spray and CALL 911. Keep these tablets in the original bottle or in a specially made carrying case to protect them from light and air. Always carry your Nitroglycerin with you. Pay close attention to the expiration date on the bottle or spray canister. If you have opened your nitroglycerin tablets, you may want to replace them in 6 months, as once air gets to them they start to lose their effectiveness. When using the nitroglycerin tablets or spray, be sure that you are sitting or laying down, because they will lower your blood pressure, and may make you dizzy or cause a headache.