2. Heart Failure Medicines ACE (angiotensin- converting enzyme) inhibitors ARBs (angiotensin receptor blockers) Beta-blockers Spironolactone Diuretics (water pills) Potassium Digoxin

3. ACE INHIBITORS Examples of these are: –Lisinopril –Fosinopril –Enalapril –Captopril

4. ACE inhibitors Block the effects of harmful hormones on your heart muscle. This prevents the heart from getting larger Lower the blood pressure Have benefits even if you do not have high blood pressure Helps to keep you out of the hospital and you may live longer

5. Side effects of ACE Inhibitors Cough Dizziness Skin rash High potassium levels in your blood **** If you develop swelling of the face, tongue, or mouth, stop taking the medicine and call your doctor ****

6. Angiotensin Receptor Blockers Examples of these are: –Losartan (Cozaar®) –Candesartan (Atacand®) Effects similar to ACE inhibitors –Keeps you out of the hospital –You may live a longer and healthier life

7. Beta-Blockers Examples of these are: –Carvedilol (Coreg  ) –Metoprolol (Lopressor, Toprol XL  ) –Atenolol –Propranolol

8. Beta-Blockers Block the effects of harmful hormones on your heart muscle. This prevents the heart from getting larger Lower your blood pressure Slow the heart rate  lessen the work your heart has to do Prevent heart attacks in patients who have coronary artery disease

9. By regularly taking these types of medications: The pumping action of the heart may improve over time Helps to keep you out of the hospital You may live a longer and healthier life

10. Side effects of Beta-Blockers Initially you may feel tired or dizzy. This usually gets better your body adjusts. It may take anywhere from 1 to 3 months to feel better. Stick with the regimen because the benefits are tremendous. If you have more shortness of breath or weight gain from fluid build-up, notify your provider

11. Target Dose Usually ACE-Inhibitors and Beta- blockers are started in low doses and increased gradually to the “target doses” If you cannot tolerate the higher doses your provider will get to a dose that is best for you.

12. What is meant by target dose? The target dose is the dose which has been shown in clinical research to give the most benefit

13. For example…. You may be started on Carvedilol 3.125 mg twice daily On your next appointment the dose may be increased to 6.25 mg twice daily Would continue doing this till you reach the target dose 25 mg twice daily

14. Spironolactone Given to some patients with advanced heart failure A low dose reduces symptoms of heart failure Helps to keep you out of the hospital May increase the potassium level

15. Diuretics (“Water Pills”) Examples of these are: –Furosemide (Lasix  ) –Hydrochlorothiazide –Metolazone –Bumetanide

16. Diuretics (“Water Pills”) Help your body get rid of excess water. You will feel better and breathe better. Try to take these medications in the daytime no later than 4pm Your blood will be checked periodically to make sure your potassium level is normal.

17. Potassium Supplements When you take a water pill, your body may lose potassium. If your blood potassium level is low, then a supplement is prescribed.

18. Reminder….. You may be taking different types of medicines which may increase or decrease your potassium level. It is very important to go to your doctor’s appointments to have have your labs checked and medications adjusted.

19. Digoxin Helps reduces symptoms of heart failure Helps the heart to pump stronger Helps to keep you out of the hospital. Not given to all heart failure patients.

20. Digoxin Your provider may check your blood digoxin level Notify your provider if you experience any of the following: –Loss of appetite –Blurry vision –Stomach pain, nausea, vomiting –Confusion or extreme tiredness

21. Cholesterol Medicines Many of you may be taking: –Simvastatin (Zocor®), Atorvastatin (Lipitor®), Lovastatin or Fluvastatin Some other types include: Niacin (Niaspan ® ) Gemfibrozil (Lopid ® )

22. Tips to remember You should always take your morning medicines before your doctor’s appointment. If you miss a dose of a medication, it is important not to double up on the dose. Please do not to run out of your medicines

23. VA automated refill system Mail in slips Drop slips in box outside outpatient pharmacy Touch-tone phone