Coronary Artery Disease: Medications
Coronary Artery Disease: Medications
Lynn Yang, a clinical pharmacist at the Ottawa Heart Institute discusses medications as it relates to coronary artery disease for those who have been diagnosed with coronary artery disease or who want to learn more about the condition.
Content
1.467 -> My name is Lynn Yang.
3.467 -> I am one of the
Clinical Pharmacists
5.033 -> at the Heart Institute.
7.2 -> Please turn to page 50 in
your booklet as we discuss
10.533 -> some of the new medications
you have been prescribed.
16.7 -> The objectives of this section
are to review the 5 main
20.533 -> medications prescribed after
heart attacks and angina,
24.333 -> review the use of nitroglycerin
spray or sublingual tablets
28.8 -> and review tips that may help
you manage your medications.
36.867 -> Patients who have a heart
attacks or angina usually
39.934 -> go home on 5 medications.
42.667 -> Those being ASA, an
Antiplatelet, an ACE Inhibitor,
47.3 -> a Beta Blocker and a Cholesterol
Lowering Medication.
52.867 -> There are many different
medications in each class so
55.867 -> you may be on a different drug
and dose than someone else.
60.3 -> All you need to know is that
your doctor specifically
62.9 -> chose that drug and dose
based on your blood pressure,
65.9 -> heart rate and various other
conditions that you may have.
70.767 -> You may also be on other heart
medications based on other heart
73.633 -> conditions that you may have.
76.967 -> These other drug classes
are listed in your book.
80.4 -> If you have any questions
about those drugs,
82.6 -> you can feel free to
contact your doctor or
84.633 -> your community pharmacist.
90.5 -> ASA or Acetylsalicylic Acid
is commonly referred to
94.6 -> by its brand name, Aspirin.
98.367 -> You will likely be taking
a dose between 80 mg
100.734 -> and 325 mg once per day.
104.9 -> ASA helps to prevent excess
clotting and has been shown to
108.8 -> decrease the risk of
future heart attacks.
112.533 -> Because it is considered
a type of blood thinner,
115.066 -> there is an increased risk
of bleeding or bruising.
118.5 -> Signs of bleeding include
throwing up what looks like
121.233 -> black coffee grounds, blood in
your urine or your stool
125.5 -> or black tarry stool.
128.2 -> If you experience any of this,
or if you find that you are
131 -> bruising for no reason,
call your doctor.
135.7 -> You may also experience stomach
upset with non-coated ASA.
143.266 -> If you've had a heart
attack or unstable angina,
146.5 -> you will most likely have
been prescribed one of
149.066 -> the antiplatelets listed here.
151.867 -> These antiplatelets have
been shown to prevent
154.4 -> future heart attacks.
156.934 -> Also, if you had a stent
placed in one of your coronary
159.967 -> arteries, your body will see
the stent as a foreign object
163.533 -> and will want to clot around it.
166.1 -> So taking your antiplatelet
will prevent your stent
168.467 -> from blocking with a clot until
a layer of skin grows over
171.867 -> and covers the stent.
175.066 -> The amount of time you will need
to be on this medication will
177.667 -> depend on various factors such
as any pending surgeries and the
182.133 -> type of stent that was inserted.
185.033 -> Your cardiologist will be able
to tell you how long you will
187.2 -> be taking this medication.
190.7 -> If any other health professional
tells you to stop taking your
193.5 -> antiplatelet medication, it
is very important that you
196.767 -> contact your cardiologist
first to make sure it is
199.333 -> okay to stop this drug.
202.533 -> Side effects include:
rash, hives and an
205.6 -> increased risk of bleeding.
214.2 -> Angiotensin Converting Enzyme
Inhibitors or ACE Inhibitors
218.233 -> have been shown to help
prevent future heart attacks
220.8 -> and lower blood pressure.
223.967 -> ACE Inhibitors also help to
maintain the normal shape of the
226.734 -> heart after a heart attack
so that you don't end up
229.633 -> with a baggy heart that
doesn't pump very well.
233.9 -> For heart failure patients, ACE
inhibitors make it easier for
237.3 -> the heart to pump blood
to the rest of the body.
240.433 -> Finally, ACE Inhibitors have
been shown to protect the
243.834 -> kidneys in patients where the
kidneys don't work very well.
248.166 -> ACE inhibitors can increase
potassium levels so your
251.6 -> doctor will do blood tests
once in a while to check this.
255.333 -> Because ACE Inhibitors can
lower you blood pressure,
258.3 -> you may get light-headed or
dizzy when moving from a lying
261.233 -> position to a standing position.
264.133 -> If this occurs, try
sitting at the edge of
266.734 -> your bed before standing.
269.4 -> This will give your body
a chance to adjust to the
271.7 -> change in position and pump
more blood to your head.
276.433 -> You may also
experience a dry cough.
279.2 -> If it becomes bothersome,
speak to your doctor.
281.867 -> They may change the
drug to something else.
285.967 -> If you get swelling of
the lips, face or throat,
288.533 -> call 911 immediately.
293.567 -> Beta Blockers can be used
to lower blood pressure.
296.433 -> They also slow the heart rate
which helps prevent angina.
301.467 -> Beta blockers have been
shown to prevent future
303.567 -> heart attacks and in heart
failure patients can improve
306.5 -> the pumping of the heart.
309.3 -> Since Beta Blockers can
lower blood pressure,
311.734 -> you may experience
light-headedness
314.066 -> when you stand up.
316.033 -> If this occurs, try to get up a
little more slowly so that your
319.2 -> body gets a chance to adjust and
pump more blood to your brain.
324.433 -> Because Beta Blockers
slow your heart rate,
326.867 -> you may find that you are
more tired than usual.
330.333 -> Be patient as it may take a few
weeks for your body to get used
333.867 -> to being on Beta Blocker.
336.7 -> If you have diabetes, be aware
that Beta Blockers may hide the
340.333 -> signs of low blood sugars,
except for sweating.
345.567 -> Beta Blockers can
also aggravate asthma,
348 -> but because Beta Blockers
are so beneficial,
350.7 -> your cardiologist will
continue the Beta Blocker
353.333 -> as long as your asthma can
be controlled with puffers.
359.533 -> The final drug that you will
likely be taking is class
362.333 -> of cholesterol lowering
medication called Statins.
365.934 -> Statins lower LDL which is the
bad cholesterol that forms
369.533 -> plaques in your arteries.
372.934 -> Statins have been shown to
prevent future heart attacks,
375.467 -> decrease the likelihood
of needing future
378 -> procedures to open the
coronary arteries and it can
381.233 -> also help to prevent strokes.
384.8 -> Its also been thought that
Statins have anti-inflammatory
387.367 -> properties and can stabilize
plaques in the arteries making
390.7 -> them more difficult to rupture
and to cause a heart attack.
395.767 -> The current cholesterol targets
are total cholesterol less than
399.6 -> 5.2, HDL, which is your good
cholesterol, greater than 1,
404.9 -> triglycerides less than 1.7,
LDL less than 2 and total
409.533 -> cholesterol to HDL
ratio less than 4.
413.667 -> Other cholesterol lowering
medications may be added to
416.467 -> your Statin if the cholesterol
targets are not reached
419.4 -> with Statins alone.
422.767 -> Side effects include
muscle or joint pain.
425.6 -> If it becomes bothersome
let your doctor know.
429 -> Your doctor will also do
blood tests once in a while
431.1 -> to check how well your
liver is functioning.
437.066 -> Nitroglycerin comes
in many forms.
440.233 -> If you are using a patch or
tablets that you are using
442.667 -> regularly every day, these
are to help prevent angina.
447.3 -> These agents may
cause headaches.
450.533 -> You can use Tylenol to help
with the headaches but if the
453.2 -> headaches become unbearable,
let your doctor know.
456.8 -> Nitroglycerin spray or
tablets that dissolve under
459.2 -> your tongue stop angina when
you have an angina attack.
466.967 -> Before you use your
Nitroglycerin Spray,
469.533 -> make sure you sit down
or lean against a wall.
473.033 -> Nitroglycerin can make you
lightheaded and we don't need to
476.1 -> fall down and break a hip while
you're dealing with your angina.
481.1 -> If it is a new bottle or you
haven't used the spray in more
484.033 -> than fourteen days, you
need to prime the container.
487.8 -> You do this by facing the spray
away from you and pumping the
491.233 -> actuator until four sprays
of nitroglycerin come out.
495.767 -> Then use one spray on
or under your tongue.
499.9 -> If you're using tablets instead
of the spray to stop angina,
503.166 -> the tablets must be dissolved
under the tongue to be absorbed.
507.033 -> Wait five minutes.
509.567 -> If you still have angina,
use a second spray and
512.467 -> wait five minutes.
514.567 -> If you still have angina,
you can take a third spray
517.7 -> while you are calling 911.
521.934 -> Nitroglycerin is not
addictive so you can use it
524.967 -> as often as you need to.
527.9 -> If you know an activity
will cause angina,
530.433 -> you can take a spray before
you exert yourself to prevent
532.967 -> the angina from occurring.
539.033 -> Here are some tips to help
you manage your medications.
542.834 -> Circle the drugs you are taking
in your book so that you can
545.8 -> easily figure out which
drugs you are taking.
549.9 -> You are getting a lot of
information at one time so it's
553.033 -> a good idea to review your
discharge book regularly so it
556.633 -> helps you remember why you
are taking these medications.
560.734 -> You are more likely to continue
to take your medications if you
563.367 -> understand why you
are taking them.
567.1 -> Use the same pharmacy for all
your medications so that your
570.467 -> pharmacist has a complete list
of your prescription medications
574 -> and they can tell you and
your doctor if any of your
577.133 -> medications should
not be taken together.
580.967 -> When you go home, your
medications may not be the
583.166 -> same drug or dose as you
were on previously.
588.6 -> Get your new prescription filled
right away and take all your
591.4 -> old mediations to the pharmacy.
594.2 -> Your pharmacist will be able to
tell you which ones to continue.
597.667 -> The pharmacist can also take the
medications you don't need any
600.6 -> more and discard them for you.
604.333 -> Never stop a medication without
letting your doctor know.
607.7 -> Remember, they put you on the
drug for a reason so they might
611.8 -> want to give you an alternative
drug if you are having
614.467 -> problems taking the ones
you have been prescribed.
618.8 -> Carry a current list of your
medications with you so that you
621.867 -> have a quick reference for
medical appointments or if
624.867 -> you ever end up in the
emergency department.
630.066 -> If you have trouble remembering
to take your medications,
632.834 -> try to time it around
daily events such as
635.4 -> mealtimes or bed time.
638.467 -> You can purchase a pill
organizer such as a dosette
641.1 -> or have pharmacy blister pack
your medications for you.
645.166 -> It is a good idea to keep a
small supply of your medications
647.9 -> in your handbag or office
just in case you forget to
651.734 -> take your medications
before you go to work.
655.166 -> You can also talk to your doctor
if you find that the dosing
657.867 -> schedule too difficult.
660.266 -> Your doctor may be
able to simplify your
662.1 -> medications for you.
665.3 -> Don't store your medications in
hot or humid areas such as the
668.834 -> medicine cabinet in your
bathroom or the glove
671.633 -> compartment in your car.
674 -> These type of conditions
will shorten the
675.7 -> expiry of your medications.
680.133 -> If you ever have any
questions, speak to your
682.6 -> doctor or pharmacist.
Source: https://www.youtube.com/watch?v=TLGttocSsJA