Patient Education & Resources

Patient Education Module 4 - Medications

Your doctor has prescribed medications for you that must be taken exactly according to instructions. The medications will be effective only if you take them exactly as prescribed and this will also help your doctor develop a dosage regimen that will give you the most benefits with the least side effects.

Do not hesitate to ask questions or discuss side effects about your medication with your doctor or pharmacist and make sure you give and receive clear information.

How do medications work?

Medications are intended to relieve symptoms or to cure, control, prevent or diagnose disease. After they have been at work in the body for a certain period of time they are gradually eliminated in different ways (through the lungs, urine, bowel for example). The same drug may act differently in different people especially if they are very young, old or ill. When, how, and in what period of time a drug is eliminated from the body depends both upon the drug itself and the individual taking it.

This is why dosage schedules are different for each drug and sometimes vary between individuals taking the same drug.

All medications have desirable and undesirable effects and many do not mix with each other or with certain foods. The potential for unwanted effects can be minimized if you have reliable information. Your doctor and pharmacist are the best sources. Information received from friends, relatives, newspaper or magazine articles and other non-medical sources should not be used to alter your regimen without checking with your doctor.

What you need to know about any medication you take:

• its name
• what it is for
• what it looks like (shape, colour)
• how much to take
• when to take it (before, after or with meals)
• how often to take it (once a day, three times a day)
• how to take it (with or without food, on an empty stomach)
• side effects

It may often be difficult to remember exactly when to take medication & how much to take, especially if you are taking more than one drug.

Organize a system to help you remember with the use of memory aids, for example:

• a calendar
• chart method
• lists
• sectioned pill boxes
• special vials®colour coded

Ask your pharmacist to assist you in developing a system.

Points to Note about Your Medication:

1. Ask what to do if you happen to miss taking the medication at the required time
2. Know how long you are supposed to take the drug and when your prescription should be filled (give proper notice if you need refills)
3. Know where and how the drug should be stored (usually in a cool, dry place)
4. Do not adjust the dose without directions to do so
5. Check with your doctor or pharmacist before taking non-prescribed drugs
6. Don't share or borrow prescriptions. Your prescription is designed for you
7. Shop at one pharmacy, get to know your pharmacist; this way continuity of your therapy can be maintained
8. Take your medication with you on outings, when traveling make sure you have a sufficient quantity
9. Always have a list of your medications with you with proper identification, & dosages. Show the list to any medical personnel who will be treating you (i.e.: doctors, dentists, pharmacists, nurse)
10. Side effects may occur from certain drugs. Most of these will subside within a short period of time. Discuss these side effects with your doctor or pharmacist
11. Certain medications can cause sexual dysfunction. If you are experiencing this, speak to your doctor, as there are alternative medications that may be prescribed

How to Take Nitroglycerin

Nitroglycerin relieves anginal pain by temporarily dilating veins and arteries. This brings more blood and oxygen to the heart so it does not have to work as hard.

When you have anginal pain:

• sit or lie down, and place one tablet (or give one spray) under tongue. Let this dissolve completely
• hold the saliva in your mouth for 1 or 2 minutes before swallowing
• don't stand up for a few minutes, you may become dizzy
• you may feel a headache or become flushed, don't worry, these effects are only temporary
• take up to 3 tablets (or sprays) - one every 5 minutes if necessary
• if pain remains after 3 doses, call 911, get emergency assistance
• nitro is not habit-forming
• keep tablets in original container (dark), they will lose their strength if exposed to light, moisture, heat or if older than 3 months, replace outdated tablets
• fresh tablets and spray produce a slight burning sensation under your tongue

Always have a supply of tablets with you when you go out. Keep a bottle (or spray) in you car, at work or home.

Nitroglycerin is available in different strengths. If you are in a situation where you have forgotten your supply, you may use the supply of another person, but realize that the effect may vary if the strength is different. Likewise you may find that you need to lend your supply to someone else in an emergency. Caution the other person that the effect may be different and stay nearby to help them summon help if the medication is ineffective.

Have You Taken Your Lifesavers Today?

Certain kinds of medication should be used for all patients with vascular disease. These types of medications are used to prevent worsening of disease that is already present, or progression of disease not yet detected. The drugs listed below are known as the "Lifesavers" because all of these types of drugs have been proven to save lives.

1. Blood "Thinners":
   ASA (aspirin), clopidogrel (Plavix), aggrenox (ASA & dipyridamole) and warfarin (Coumadin) are drugs used to "thin" the blood. Aspirin is most often used. Platelets are a kind of blood cell that make your blood clot. Aspirin works by making the platelets less likely to clot. As a result, there is less chance that you will form a clot in your arteries. This reduces the chance of unstable angina, heart attack, stroke, and sudden death. Coumadin is a more powerful blood thinner, and may be used in special circumstances. Usually, you will not be on both Coumadin and another blood "thinner" together, but occasionally they are used in combination.


2. Beta Blockers:
   There are many kinds of Beta Blockers, but all of the names end in "lol". A few examples are metoprolol (Betaloc,Lopresor), sotalol (Sotacor), bisoprolol (monocor) atenolol (Tenormin), and carvedilol (Coreg). It is very important to know if you are on a beta blocker. These drugs help prevent another heart attack, reduce or prevent angina (chest pain), and some also help to prevent abnormal heart rhythms. Almost all heart attack patients should be on a beta blocker. Patients with heart failure or damaged heart muscle also benefit from beta blockers. People with asthma or diabetes may not be able to take beta blockers.


3. ACE Inhibitors and ARBs:
   There are many kinds of ACE Inhibitors, but all of the names end in "PRIL". A few examples are ramipril (Altace), perindopril (Coversyl), lisinopril (Zestril, Prinivil), and enalapril (Vasotec).In the past, these drugs were mostly used to lower blood pressure. Today, ACE Inhibitors also appear to save lives in people who have any kind of vascular disease and especially in patients who also have diabetes. They help to protect the walls of all of the blood vessels in your body, and in doing that, they protect against heart attack, stroke and death. They are used extensively in heart failure. A related class of drugs, ARB’s, (drugs that end in "SARTAN") appear to have similar benefit. Examples of these are candesartan (Atacand), valsartan (Diovan), eprosartan (Teveten), irbesartan (Avapro), telmisartan (Micardis), and the original in the class, losartan (Cozaar).


4. Cholesterol/Triglyceride Drugs:
   Most common are STATINS. A few examples are rosuvastatin (Crestor), atorvastatin (Lipitor), simvastatin (Zocor). There are other statins available, but it is uncommon to achieve the current cholesterol goals with these agents. They lower cholesterol very well and are extremely well tolerated. Alternatives (especially for those patients with high triglycerides) are a class of drugs known as FIBRATES. Examples are fenofibrate (Lipidil), bezafibrate (Bezalip) and gemfibrozil (Lopid). Diet plays an important role but the drugs are essential in most patients - even those with "normal" cholesterol.