What the nurse needs to know:
Some of the most common medications used to treat heart failure include:
- Diuretics (water pills) – also known as: hydrochlorothiazide, chlorothiazide, furosemide (Lasix®), bumetanide, spironolactone (Aldactone®), triamterene, metolazone , torsemide, indapamide, polythiazide,amiloride, combination agents work by causing the kidneys to remove more sodium and water from the bloodstream than usual for elimination by the kidneys. less circulating volume, or preload, decreases the workload on the heart. they literally work by helping the body to get rid of excess fluid that can accumulate in the lungs or the periphery. sometime these medications cause the potassiumlevel to drop, so this should be checked periodically. they may also cause dehydration. advise the patient to take these at the same time every morning.
- ACE (Angiotensin Converting Enzyme) Inhibitors – also known as: captopril, enalapril, ramipril , lisinopril , quinapril, fosinopril block the body from converting angiotensin I to angiotensin II, which is a powerful vasoconstrictor. increased vasoconstriction, or afterload, increases the workload on the heart ACE Inhibitors block the effect of stress hormones that make the heart work harder and cause high blood pressure. Side effects include dizziness from low blood pressure, dry cough and less commonly angioedema or swelling of the lips,tongue or throat.
- Digitalis preparations – also known as: digoxin (Lanoxin®), digitoxin, as a positive inotrope, increases the force of the heart’s contractions while simultaneously slowing the heart rate. they make the heart beat stronger thereby alleviating heart failure symptoms. Side effects include nausea, vomiting, blurred or abnormally colored vision, palpitations, or a markedly slow heart rate that may lead to dizziness or blackouts.
- Beta-blockers – also known as: carvedilol , metoprolol , atenolol, bisoprolol, labetalol, propranolol, sotalol, pindolol, penbutolol, acebutolol, timolol, nadolol, and betaxolol block the beta-receptors on heart cells, which when stimulated make the heart rate increase. this increase in heart rate is the body’s way to compensate for a failing heart, but increases the heart’s workload and subsequently can worsen heart failure. most common side effects include feeling tired or dizzy.
- Angiotensin II receptor blockers (ARBs) – also known as: losartan , valsartan , irbesartan, candesartan, eprosartan, telmisartan, olmesartan actually block the effects of angiotensin II on the cardiovascular system, there by reducing vasoconstriction. the actions of ARBs are almost the same as ACEI. they block the effects of stress hormones on the cardiovascular system, and have similar side effects as ACE inhibitors. ARBs generally do not cause a dry cough.
- Vasodilators – also known as: isosorbide dinitrate, nitrates, minoxidil cause the blood vessels to relax to decrease afterload, this improves blood flow and decreases the workload on the heart.
- Anticoagulants – also known as: warfarin , heparin. interfere with the body’s clotting mechanisms to prevent clots in patients at risk, particularly those with atrial fibrillation. patients should avoid activities where injury is possible since blood thinners can cause bleeding. they should ask their healthcare provider how often they should have labwork to check the effects of these medications. they should also avoid dark leafy green vegetables as these are high in Vitamin K which contributes to clotting.
- Cholesterol Lowering Agents – the drugs of first choice for elevated LDL cholesterol are the HMG CoA reductase inhibitors, e.g., atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin and simvastatin. Statin drugs are very effective for lowering LDL cholesterol levels and have few immediate short-term side effects. another class of drugs for lowering LDL is the bile acid sequestrants—colesevelam, cholestyramine and colestipol—and nicotinic acid (niacin). these have been shown to reduce the risk for coronary heart disease in controlled clinical trials. both classes of drugs appear to be free of serious side effects, but both can have troublesome side effects and require considerable patient education to achieve adherence. nicotinic acid is preferred in patients with triglyceride levels that exceed 250 mg/dL because bile acid sequestrants tend to raise triglyceride levels.
What the patient needs to know
key points about medications medications
- medications are an extremely important part of your therapy for heart failure.
- most patients will require multiple medications to manage the disease.
- medications started in the hospital may have to be changed according to how you respond to them.
- never change or skip doses without consulting your healthcare provider.
- at your follow-up appointments, let your healthcare provider know if you think there are any problems with your medicines, even if they seem simple or minor.
- using a pillbox is one of the best ways to remember to take all medicines everyday – they are available at most pharmacies.
- a medication chart is also a helpful way to remember to take your medications.
- taking all prescribed medicines as directed will help you to stay well and out of the hospital.
- if you are taking all medications as directed and feel worse, you need to contact your healthcare provider as soon as possible.
- you should contact your healthcare provider if you think you are experiencing side effects (such as dizziness – could be due to low blood pressure).