Ишемическая болезнь сердца-Ischemic heart disease

It’s almost certain that your doctor has prescribed special medications for you as a heart patient. Some will be taken on a temporary basis, while you might need to take others for the rest of your life. And it’s just as certain that you’re more than a bit confused about those pills, capsules, tablets and whatnot.

Cardiac medications comprise a major segment of the entire pharmaceutical industry. There are hundreds of choices for your doctor to make in prescribing just the right drugs to put you on the road to recovery. What do the drugs do? How do they work? Why do you need this particular dosage? What about potential side effects? Will the medications interact with other drugs? How about with foods? Is it really important to take each and every dose? And if you miss a dose, should you take two the next time?

I took these and other questions to a man with the answers, a man who could help me sort through the vast amount of information available on each and every drug. Hiro Nishi, Pharm.D., is Senior Pharmacist at Daniel Freeman Memorial Hospital in Inglewood, California. When I told him what I wanted for my readers, his first reaction was, «Bob, you could write a whole book on that! It could be huge!»

The problem, indeed, was to limit the amount of information in this chapter. I want to simplify your life, not make it more complicated. So Dr Nishi and I worked together to provide general guidelines on cardiac medications and specific information on the drugs you’re taking. He designed the charts at the end of the chapter so that you can easily find the information you need about your own medications in a moment.

First let me say that no one likes the idea of taking medicine. Just the notion of swallowing this pill or that nostrum makes one feel like a sick person. I understand that feeling entirely, even though my own father was a pharmacist. But there ate two things you must keep in mind at all times.

One is that those medications are vital to your recovery and long-term wellness. Many have been introduced only during recent years and are directly responsible for the improved outlook for the heart patient. And the other thing is that by following the steps outlined in this book, you can gradually but dramatically cut back the amount of medication you must take.

So, if you really hate taking those heart medications, the best thing you can do is follow your doctor’s prescription to the letter and do e very thing in your power to convert yourself into a former heart patient.

But just keeping track of your medications can be difficult, especially with so many other things on your mind. To help you with that aspect I’d like to share a trick I learned at the Heart Institute of the Desert in Rancho Mirage, California. The nurses there help patients make their own, individualised medication charts. You can do the same for yourself.

Find a piece of stiff cardboard about the size of a sheet of typing paper. At the top write your name and «heart medications». Tape one of each of the tablets, capsules and pills you’ve been prescribed to the cardboard and write the following information alongside each one with the help of your doctor or nurse.

Drug (brand name)

(generic name)

Take

Purpose

Precautions

Doctor’s Comments

As an example, you might write that the brand name of your drug is Inderal; its generic name is propranolol. Your doctor might tell you to take the table twice daily, once in the morning and once in the evening. The purpose of the drug is to help control blood pressure, to ease arrhythmias, and to slow down the rate of the heart so it won’t have to work so hard. Precautions might include a warning not to stop taking the medication abruptly. Your doctor’s comments may remind you that this drug might lead to drowsiness. Finally, you may wish to add something you’ve learned in this chapter to keep it close at hand.

By glancing at your heart medication chart now and then you’ll be able to easily keep track of your prescriptions. But, if you’re like most patients, you’re likely to be taking other medications as well. Another doctor may have prescribed tablets for arthritis, diabetes or other chronic, long-term conditions. Be certain to tell your cardiologist, and later your personal physician, about all the vitamins and medications you take, including those you can buy without a prescription.

On the other side of your heart medication chart, make a daily medication dosage plan. List the drugs you are to take in the morning, those to be taken with lunch, those for the evening, and at whatever special times your doctor might advise. On that dosage plan, include all the medications for the day, including both your heart prescriptions, those for other conditions and those you buy across the counter.

Each time you have a doctor’s appointment, be certain to take your chart in with you. You may have questions about a certain drug. Or your physician may wish to make an alteration in the type or dosage of a particular pill.

Now, certainly you’re not going to carry this chart along with you wherever you go throughout the day. But the chart will help you keep them organised in your mind and, after a while, you’ll probably rely on it less and less.

Dr Nishi offers the following 10 guidelines for all medications. Following these rules will help facilitate your recovery by providing your medications’ full benefit, with the least chance of complications.

Take medications specifically as directed. This will provide maximum effectiveness with a minimum of side effects.

Understand what your medications should do for you. This is the best way to avoid possible adverse reactions.

Plan medication taking around your regular routine so that it will become part of your lifestyle.

Leave reminders in conspicuous places, such as bathroom, mirror, television set, refrigerator, etc.

Keep all medications in their original containers labelled with specific directions even if hen travelling. (If you need another bottle to keep, say, at the office, ask the pharmacist to divide the prescription into two identically labelled bottles.)

If you consider taking any over-the-counter medication, consult your doctor first. Some medications may alter the effectiveness of your prescribed medications.

Never take anyone else’s medications, even if they have the same medical condition that you have. And never let anyone take your medications.

If you have questions about your medications, talk with your doctor and pharmacist. The more you understand, the more comfortable you’ll feel.

Be careful not to run out of your medication. Obtain refills before you run out. Plan for weekends and holidays.

Never take more than prescribed, even if you skip a dose. And never stop taking your medications without consulting your doctor first.

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Cardio & Blood/ Cholesterol

The benefits of all the non-drug methods of controlling blood pressure we’ve discussed cannot be disputed. All contribute to substantial improvement and should be included in your complete program of recovery. But some patients, despite their best efforts and intentions, are unable to bring their blood pressures to a safe level without the aid of prescription drugs.

Your first reaction may be quite negative, since antihypertensive drugs have received a lot of bad publicity owing to adverse reactions such as fatigue, irritability and, most notorious, impotence. Rest assured that tremendous progress has been made since the early days of treating high blood pressure with drugs.

No doubt the most important factor is having a good doctor-patient relationship so you can work out the best possible drug treatment as part of a complete blood pressure control program. While one patient may do very well with a given drug, another will respond negatively. Some simply give up, refusing to take medications at all. That’s the wrong approach. Instead, you’ll have to find a drug or drugs tailored to your specific needs.

At the risk of being redundant, it’s vital to remember that there are no symptoms of hypertension. Just because you feel fine doesn’t mean that you can stop taking your medications. In fact, that’s the single biggest problem facing doctors and their patients. It’s vital, literally in many cases a matter of life and death, to remain on the drugs your doctor has prescribed.

By all means you’ll want to do everything in your power to keep the drugs needed to a minimum. You can do that by controlling your weight, getting plenty of exercise, quitting the cigarettes, curbing stress and limiting your alcohol and salt intake. But the drugs may give you the edge in keeping hypertension at bay.

You’ll find a complete listing of antihypertensive drugs used in medical treatment today in chapter 16. But I’d like to provide a brief overview of just how the drugs work and the various categories your doctor may prescribe for you.

First, you might ask, is taking antihypertensive drugs really worthwhile? Since you don’t feel any different, can you expect real benefits? The answer is an unequivocal yes.

Drug therapy to reduce blood pressure definitely decreases cardiovascular morbidity and mortality in those with diastolic blood pressures of more than 104. Studies of patients with mild hypertension, from 90 to 104, have shown that antihypertensive drugs protect against stroke, congestive heart failure, increases in hypertension severity, and all-cause mortality. And a 30- to 50-per cent reduction in both fatal and non-fatal strokes has been demonstrated in those taking medications. Needless to say, if one can prove the benefits of drugs so clearly in even mild cases of hypertension, the health advantages for patients with moderate and severe hypertension are even greater.

Be patient. Expect a period of trial and error as you and your doctor work together to find the winning combination of drug and non-drug therapy. Don’t be discouraged. Ask all the questions you want, make sure you understand the dosages and the schedules your doctor wants you to try. Find out if there are certain side effects or adverse reactions that you should be aware of. Let your doctor know if you’re taking any other drugs, since one drug may interact with another. Find out whether taking the drug while driving a car, working on hazardous equipment, or drinking alcohol is OK. In other words, become an active participant in your treatment.

Doctors most often initiate antihypertensive drug therapy with diuretics. These «water pills» lower your blood pressure by eliminating excess sodium and fluid the body would otherwise retain. By cutting down on the amount of fluid in the bloodstream, pressure in the arteries decreases.

At least for the first few days you’ll find yourself needing to urinate frequently. That’s because there’s been a build-up of fluid in your tissues. This will lessen over time. To avoid the need to wake up with a «bathroom call» in the middle of the night, don’t take your diuretic after about six in the evening.

For the most part, diuretics don’t pose significant problems, but the right dosage schedule is important. In the summer, for example, you may find that you lose more fluid than desired. This could lead to feeling light-headed or faint.

Because diuretics sometimes wash away potassium, you may be asked to eat more potassium-rich foods such as bananas, oranges and potatoes. Your doctor may even prescribe a potassium supplement. Again, each patient is different, and it’s important to keep your doctor informed on your progress and any difficulties you’re experiencing.

One distinct disadvantage of the diuretics is that they tend to elevate cholesterol levels in the blood. You’ll want to have your cholesterol count measured regularly to make sure this does not get out of control.

Diuretics are often prescribed in combination with other drugs. That’s because they help those other drugs work more effectively, and thus they keep the necessary dosage to a minimum.

Drugs in the category of sympatholytics act on the sympathetic nervous system. They lower blood pressure by reducing the amount of blood the heart pumps and decreasing the heart rate so your heart doesn’t work so hard. Other drugs in this classification work by relaxing the blood vessels indirectly by blocking nervous system signals that cause them to contract.

Drugs known as vasodilators relax blood vessels directly, causing a widening of the lumen and allowing blood to flow mote easily. They have a particular advantage for patients whose arteries are blocked by cholesterol build-up.

ACE inhibitors ate the newest drugs in the antihypertension atsenal. ACE stands for angiotensin converting enzyme. By reducing the production of angiotensin, a chemical produced in the kidney which controls blood pressure, one can regulate hypertension.

Here’s another incentive for you to work as hard as possible to get that blood pressure down: for patients with mild hypertension who have controlled their blood pressure for at least one year, doctors are now advising a stepwise reduction in drugs. This will be particularly effective if you’ve made some of those lifestyle modifications we’ve discussed. Conversely, if you don’t keep up the good work with those non-drug approaches, you may find that you’ll have to return to medications.

The progress made in controlling hypertension during the past 20 years has been nothing short of spectacular. Blood pressure reduction has resulted in a substantial reduction in the incidence of and deaths from strokes. While it has had much less effect on coronary heart disease when viewed alone, together with cholesterol reduction and other lifestyle modifications, controlling hypertension can significantly improve your chances for cutting your risks. This is definitely a risk factor that you can take charge of in a very positive way. It’s a major step forward in your complete recovery from heart disease.

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Cardio & Blood/ Cholesterol