Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Sharing your information Your information will only be disclosed to those who have a genuine need to know and who agree to keep your information confidential. For your direct care we often share information with: NHS hospitals and clinics GPs Social care Who to contact Heart failure service t: 01634 382840 f: 01634 382836 Unit 7-8 Ambley Green Gillingham Business Park Kent, ME8 0NJ [email protected] Medway Community Healthcare provides a wide range of high quality community health services for Medway residents; from community nurses and health visitors to speech and language therapists and out of hours urgent care. _________ Medication booklet Heart failure service Customer care Please send any comments about Medway Community Healthcare services to: Customer care coordinator Medway Community Healthcare MCH House, Bailey Drive, Gillingham, Kent, ME8 0PZ t: 01634 334650 [email protected] All contact will be treated confidentially _________ This information can be made available in other formats and languages. Please contact: [email protected] MCH 152.3 Medway Community Healthcare CIC providing services on behalf of the NHS Registered office: MCH House, Bailey Drive, Gillingham, Kent ME8 0PZ Tel: 01634 337593 Registered in England and Wales, Company number: 07275637 www.medwaycommunityhealthcare.nhs.uk Information Heart failure medication booklet This booklet has been designed to discuss aspects of heart medication and answers questions commonly asked by patients. Symptoms of heart failure usually respond to medication. Drugs used include Diuretics (water tablets), ACE inhibitors, Beta blockers, Digoxin and Anticoagulants. Please note the following rules about medication store medication as instructed on the box or bottle dispose of unwanted medication by returning them to a pharmacist take your medication (dose and frequency) as directed on the label – if this differs from your usual directions please seek advice from your GP or the heart failure team read the information leaflet which comes with your medication for a full list of possible side effects Cardiac Glycosides if you experience any side effects please inform your GP or the heart failure What is a cardiac glycoside? ensure you do not run out of tablets by ordering repeat prescriptions from your surgery please inform the heart failure nurse if you are taking complementary medicines or alternative therapies. Digoxin Cardiac glycosides are a group of drugs derived from digitalis, a substance that occurs naturally in foxglove plants. The most frequently used cardiac glycoside is Digoxin. Why do I need to take Digoxin? Digoxin is given to patients with heart failure and irregular heart beats (atrial fibrillation) to control their heart rate. It will slow the heart but does not restore its regularity. Digoxin is also sometimes used for heart failure patients with a normal heart rhythm who suffer with on-going symptoms despite diuretics, ACE Inhibitor and betablocker medication. When do I take my Digoxin tablets? What dose? For how long? When starting Digoxin larger doses are sometimes given initially. Then a regular daily dose is taken in the morning. Digoxin is taken in the long term unless indicated otherwise. What are the side effects of Digoxin? Digoxin may cause loss of appetite and nausea. It can also cause abdominal pain, vomiting, painful or enlarged breasts, headaches, rash, palpitations fainting, drowsiness, blurred vision and confusion. You should inform your doctor or nurse specialist if you experience any of these symptoms, as you may need a different dose. Many drugs can interact with Digoxin and therefore it is vital that you inform your GP or heart failure nurse of all your medications. Anticoagulants Warfarin advise you when your next INR blood test is due. Your Warfarin dose should be documented in your yellow anticoagulation treatment booklet. What is an anticoagulant? Anticoagulants thin the blood and helps to prevent blood clots from forming in the blood vessels. Warfarin is a drug prescribed to achieve this. Why do I need to take Warfarin? You may be at risk of developing blood clots that lead to heart attacks and strokes, or you have an artificial heart valve or an irregular heart rhythm (atrial fibrillation). What dose of Warfarin do I take? The dose of Warfarin will vary and change depending on you INR (this is the blood test taken to measure the thickness of your blood). Your Warfarin clinic will monitor and advise you regarding this. They will also What are the side effects from taking Warfarin? Cardiac medication you are already taking: ...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ..................................................................................................... ..................................................................................................... The main side effect to an anticoagulant is the risk of bleeding. Other side effects include rash, alopecia (loss of hair), diarrhoea, liver dysfunction, nausea and vomiting. Cardiac medication that has been started today (with date): ...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ..................................................................................................... ..................................................................................................... Are there any drugs I should avoid when taking Warfarin? Cardiac medication tha has been stopped (with date): ...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ...................................................................................................... ..................................................................................................... ..................................................................................................... Yes, possibly. Many drugs increase the effects of Warfarin, resulting in an increased risk of bleeding. It is very important that you inform your GP or heart failure nurse of all your medications including alternative or herbal remedies and fruit juices. If you have any questions about your medication please speak to your GP or heart failure nurse. Heart failure service: telephone 01634 382840 Diuretics What is the dose? Diuretics (water tablets) – examples: Furosemide, Bumetanide (loop diuretics) and Bendroflumethiazide (Thiazide Diuretics) and Spironolactone or Eplerenone. The dose of diuretics will depend on which drug you are taking. The dose may often change depending on your condition. This will be assessed by your GP or heart failure nurse. What is a diuretic? A diuretic is a drug that increases the amount of water that you pass through your kidneys increasing your urine output. They are sometimes called ‘water tablets’. Several types of diuretics are available and you may be prescribed more than one. Why are diuretics necessary? Heart failure may cause fluid to accumulate in your body due to the heart not pumping blood around the body as well as normal. You may become breathless (as fluid accumulates in the lungs) and your ankles and legs may swell with extra fluid in the tissues (oedema). Diuretics help clear excess body fluid and are also effective in lowering blood pressure. How often do I take diuretics? Diuretic tablets are normally taken in the morning, ensuring the extra trips to the toilet are during the day and not at night. The drug (loop diuretics) will start to take effect within half an hour and lasts about six hours. Diuretics are often taken at other times of the day. A dose taken at lunchtime should be taken between 12 -2pm. Thiazide diuretics are taken once a day generally in the morning. some people can develop cold hands or feet. other less common side effects may include tiredness, depression, erectile dysfunction, vivid dreams and other sleeping problems. Are there any other considerations when taking beta-blockers? Do not stop beta-blockers suddenly without first consulting a doctor or heart failure nurse. When you take beta-blockers regularly, the body becomes used to them. So, suddenly stopping them can sometimes cause problems, such as palpitations, a rise in blood pressure, or a recurrence of angina pains. If they need to be stopped your GP or heart failure nurse may advise a gradual reduction in dose. Do all patients with heart failure have to take betablockers? No. If you have asthma you should not take betablockers. This is because beta-blockers can narrow the airways and make breathing symptoms worse (there are some exceptions – when a beta-blocker is prescribed under careful supervision). Beta-Blockers less likely to be admitted to hospital Carvedilol, Bisoprolol and Nebivolol less likely to have episodes of worsening heart failure in the long term. What is a beta-blocker? Beta-blocker is the name given to a group of drugs, which have been shown through a number of medical studies, to be beneficial to people with poor heart function. How do beta-blockers work? They slow your heart rate and lower the blood pressure and improve the heart’s ability to pump blood around the body. Why do I need to take them? Studies have shown that if these drugs are taken in combination with other medications then people are: more likely to live longer than those who do not take them What dose and for what period should I take beta-blockers? The dose of your beta-blocker medication may change. The aim will be to start you on a small dose and increase it slowly until the best dose is achieved for you. Generally, you will stay on betablockers long term. Are there any side effects with taking beta-blockers? Most people who take betablockers have no side effects or only minor ones. Examples of side effects are: you may feel dizzy or feel faint if you have diabetes you need to be aware that beta-blockers may dull the warning signs of a low blood sugar level (hypo) Can I miss doses of diuretics to suit my lifestyle? It is important to take the correct dose regularly as prescribed. However, you could take the drug at a flexible time during the day to suit you, for example, if you want to go out early in the morning for a few hours and don’t want to have to find a toilet, you may be able to postpone the dose until later in the day when it may be more convenient. Discuss this with your GP or nurse. Are there any side effects with diuretics? When routine low doses of loop diuretics are used, side effects are uncommon. The risk of side effects increases with a higher dose. Sometimes the salt balance in the blood stream is upset which can cause low blood levels of potassium and sodium. These effects may cause weakness, confusion and, rarely, abnormal heart rhythms to develop. If you have diabetes or gout, these conditions may be made worse by diuretics as the blood sugar level may rise and uric acid levels may increase. Other possible side effects include an upset stomach, dizziness on standing (due to low blood pressure) and nausea. Side effects of taking Spironolactone may also include erectile dysfunction, painful breasts in men, high potassium levels and lethargy. Will I need any specific monitoring whilst on diuretic therapy? Yes. In view of the potential for abnormal blood salts, you will need your kidney function checked periodically by a blood test. ACE Inhibitor Enalapril, Lisinopril, Ramipril and Perindopril What is an ACE inhibitor? Angiotensin Converting Enzyme (ACE) Inhibitor is the technical term given to the ‘science’ part of how the drug works. ACE Inhibitors have several effects on the blood circulation including a relaxing effect on the arteries. It helps the heart to pump the blood around the body. Why do I need to take ACE Inhibitors? ACE Inhibitors usually lead to a substantial improvement in your quality of life, and improve your outlook. They have a valuable role in the treatment for heart failure. What dose do I take? The dose will differ depending on which brand you are taking. Your GP or heart failure nurse will start you on a low dose to maintain blood pressure and consider increasing this to the next dose at fortnightly intervals. It may take several weeks to fully optimise this medication. Are there any side effects with ACE Inhibitors? You may experience the following side effects: headache, fatigue, dry persistent cough, anglooedema (swelling of lips and other parts of the mouth and throat, eyelids, genitals and the hands and feet), sore throat, rash, sickness, vomiting, and increased blood potassium levels. Please talk to your GP or heart failure nurse if you experience side effects. Is there any special monitoring that I should have whilst taking ACE Inhibitors? Your GP or heart failure nurse will regularly check your blood pressure. You will need regular blood tests to check your blood salt levels. How long do I need to take this medication for? It is likely that you will need to take it long term but the dose may change as your GP or heart failure nurse tries to get the ACE Inhibitor to the maximum dose appropriate for you. Do all patients with heart failure receive ACE Inhibitor medication? No. As with all medications there are exceptions. Patients who are not advised to have this treatment may be considered for alternatives. Angiotensin II receptor antagonists Candesartan, Vlasartan, Irbesartan, Losartan What is an angiotensin II receptor antagonist? These medication work in a similar way to ACE Inhibitors. They also have similar side effects but do not cause a dry persistent cough.