Coronary Artery Disease: Medications

Coronary Artery Disease: Medications


My name is Lynn Yang. I am one of the
Clinical Pharmacists at the Heart Institute. Please turn to page 50 in
your booklet as we discuss some of the new medications
you have been prescribed. The objectives of this section
are to review the 5 main medications prescribed after
heart attacks and angina, review the use of nitroglycerin
spray or sublingual tablets and review tips that may help
you manage your medications. Patients who have a heart
attacks or angina usually go home on 5 medications. Those being ASA, an
Antiplatelet, an ACE Inhibitor, a Beta Blocker and a Cholesterol
Lowering Medication. There are many different
medications in each class so you may be on a different drug
and dose than someone else. All you need to know is that
your doctor specifically chose that drug and dose
based on your blood pressure, heart rate and various other
conditions that you may have. You may also be on other heart
medications based on other heart conditions that you may have. These other drug classes
are listed in your book. If you have any questions
about those drugs, you can feel free to
contact your doctor or your community pharmacist. ASA or Acetylsalicylic Acid
is commonly referred to by its brand name, Aspirin. You will likely be taking
a dose between 80 mg and 325 mg once per day. ASA helps to prevent excess
clotting and has been shown to decrease the risk of
future heart attacks. Because it is considered
a type of blood thinner, there is an increased risk
of bleeding or bruising. Signs of bleeding include
throwing up what looks like black coffee grounds, blood in
your urine or your stool or black tarry stool. If you experience any of this,
or if you find that you are bruising for no reason,
call your doctor. You may also experience stomach
upset with non-coated ASA. If you’ve had a heart
attack or unstable angina, you will most likely have
been prescribed one of the antiplatelets listed here. These antiplatelets have
been shown to prevent future heart attacks. Also, if you had a stent
placed in one of your coronary arteries, your body will see
the stent as a foreign object and will want to clot around it. So taking your antiplatelet
will prevent your stent from blocking with a clot until
a layer of skin grows over and covers the stent. The amount of time you will need
to be on this medication will depend on various factors such
as any pending surgeries and the type of stent that was inserted. Your cardiologist will be able
to tell you how long you will be taking this medication. If any other health professional
tells you to stop taking your antiplatelet medication, it
is very important that you contact your cardiologist
first to make sure it is okay to stop this drug. Side effects include:
rash, hives and an increased risk of bleeding. Angiotensin Converting Enzyme
Inhibitors or ACE Inhibitors have been shown to help
prevent future heart attacks and lower blood pressure. ACE Inhibitors also help to
maintain the normal shape of the heart after a heart attack
so that you don’t end up with a baggy heart that
doesn’t pump very well. For heart failure patients, ACE
inhibitors make it easier for the heart to pump blood
to the rest of the body. Finally, ACE Inhibitors have
been shown to protect the kidneys in patients where the
kidneys don’t work very well. ACE inhibitors can increase
potassium levels so your doctor will do blood tests
once in a while to check this. Because ACE Inhibitors can
lower you blood pressure, you may get light-headed or
dizzy when moving from a lying position to a standing position. If this occurs, try
sitting at the edge of your bed before standing. This will give your body
a chance to adjust to the change in position and pump
more blood to your head. You may also
experience a dry cough. If it becomes bothersome,
speak to your doctor. They may change the
drug to something else. If you get swelling of
the lips, face or throat, call 911 immediately. Beta Blockers can be used
to lower blood pressure. They also slow the heart rate
which helps prevent angina. Beta blockers have been
shown to prevent future heart attacks and in heart
failure patients can improve the pumping of the heart. Since Beta Blockers can
lower blood pressure, you may experience
light-headedness when you stand up. If this occurs, try to get up a
little more slowly so that your body gets a chance to adjust and
pump more blood to your brain. Because Beta Blockers
slow your heart rate, you may find that you are
more tired than usual. Be patient as it may take a few
weeks for your body to get used to being on Beta Blocker. If you have diabetes, be aware
that Beta Blockers may hide the signs of low blood sugars,
except for sweating. Beta Blockers can
also aggravate asthma, but because Beta Blockers
are so beneficial, your cardiologist will
continue the Beta Blocker as long as your asthma can
be controlled with puffers. The final drug that you will
likely be taking is class of cholesterol lowering
medication called Statins. Statins lower LDL which is the
bad cholesterol that forms plaques in your arteries. Statins have been shown to
prevent future heart attacks, decrease the likelihood
of needing future procedures to open the
coronary arteries and it can also help to prevent strokes. Its also been thought that
Statins have anti-inflammatory properties and can stabilize
plaques in the arteries making them more difficult to rupture
and to cause a heart attack. The current cholesterol targets
are total cholesterol less than 5.2, HDL, which is your good
cholesterol, greater than 1, triglycerides less than 1.7,
LDL less than 2 and total cholesterol to HDL
ratio less than 4. Other cholesterol lowering
medications may be added to your Statin if the cholesterol
targets are not reached with Statins alone. Side effects include
muscle or joint pain. If it becomes bothersome
let your doctor know. Your doctor will also do
blood tests once in a while to check how well your
liver is functioning. Nitroglycerin comes
in many forms. If you are using a patch or
tablets that you are using regularly every day, these
are to help prevent angina. These agents may
cause headaches. You can use Tylenol to help
with the headaches but if the headaches become unbearable,
let your doctor know. Nitroglycerin spray or
tablets that dissolve under your tongue stop angina when
you have an angina attack. Before you use your
Nitroglycerin Spray, make sure you sit down
or lean against a wall. Nitroglycerin can make you
lightheaded and we don’t need to fall down and break a hip while
you’re dealing with your angina. If it is a new bottle or you
haven’t used the spray in more than fourteen days, you
need to prime the container. You do this by facing the spray
away from you and pumping the actuator until four sprays
of nitroglycerin come out. Then use one spray on
or under your tongue. If you’re using tablets instead
of the spray to stop angina, the tablets must be dissolved
under the tongue to be absorbed. Wait five minutes. If you still have angina,
use a second spray and wait five minutes. If you still have angina,
you can take a third spray while you are calling 911. Nitroglycerin is not
addictive so you can use it as often as you need to. If you know an activity
will cause angina, you can take a spray before
you exert yourself to prevent the angina from occurring. Here are some tips to help
you manage your medications. Circle the drugs you are taking
in your book so that you can easily figure out which
drugs you are taking. You are getting a lot of
information at one time so it’s a good idea to review your
discharge book regularly so it helps you remember why you
are taking these medications. You are more likely to continue
to take your medications if you understand why you
are taking them. Use the same pharmacy for all
your medications so that your pharmacist has a complete list
of your prescription medications and they can tell you and
your doctor if any of your medications should
not be taken together. When you go home, your
medications may not be the same drug or dose as you
were on previously. Get your new prescription filled
right away and take all your old mediations to the pharmacy. Your pharmacist will be able to
tell you which ones to continue. The pharmacist can also take the
medications you don’t need any more and discard them for you. Never stop a medication without
letting your doctor know. Remember, they put you on the
drug for a reason so they might want to give you an alternative
drug if you are having problems taking the ones
you have been prescribed. Carry a current list of your
medications with you so that you have a quick reference for
medical appointments or if you ever end up in the
emergency department. If you have trouble remembering
to take your medications, try to time it around
daily events such as mealtimes or bed time. You can purchase a pill
organizer such as a dosette or have pharmacy blister pack
your medications for you. It is a good idea to keep a
small supply of your medications in your handbag or office
just in case you forget to take your medications
before you go to work. You can also talk to your doctor
if you find that the dosing schedule too difficult. Your doctor may be
able to simplify your medications for you. Don’t store your medications in
hot or humid areas such as the medicine cabinet in your
bathroom or the glove compartment in your car. These type of conditions
will shorten the expiry of your medications. If you ever have any
questions, speak to your doctor or pharmacist.

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