Common Challenges with Multiple Medications

Sara Paul DNP, FNPCatawba Valley Cardiology

Conover, NC

Heart Failure Medications1. ACE inhibitor/ARB– Iisinopril– enalapril– quinapril– benazapril– losartan– valsartan– Entresto (new)

2. Beta blocker– carvedilol or metoprolol

3. Aldosterone blocker– spironolactone or

eplerenone

4,5. Hydralazine/isosorbide6. Digoxin7. Diuretic (“water pill”)– furosemide, bumetanide,

torsemide, metolazone

8. Corlanor (new)

Other common medicines heart patients take:

• Blood pressure pill(s)• Cholesterol lowering pill• Blood thinner– warfarin, Eliquis, Xarelto,

Pradaxa, etc

• If stents– clopidogrel, Brillinta

• Aspirin

• Diabetes medicine– Pills, injections

• Arthritis/pain medicine• Allergy pill• Chronic pain pill

• Your chance of having a medication problem is increased if: – You take 5 or more drugs. – You take drugs for 3 or more health problems. – You get prescriptions from more than one provider. – You got prescriptions during a recent stay in the

hospital. • The word for taking multiple medications is

“polypharmacy”

• It is important to know the name and purpose of each medication that you are prescribed Always carry a list of your medications or bring your

medicines with you to appointmentsSometimes the instructions on the bottle are not the same as your

provider has instructed, ie sometimes when changing dosage of medicine

Ask your provider the PURPOSE of medications Ask your provider HOW to take your medications Tell your provider if you are taking any non-prescription

medicines Many medications have more than one effect All medications have a brand name and a generic name

• Know what your medications look like– Pharmacies buy medications in bulk– The same medication may be different colors if they

are made by a different manufacturer

• VERY IMPORTANT POINT:– Do not expect your doctor or nurse to know what

color your pills are!!– Always use the name of the pill, even if you have to

spell it

• How should you schedule your medications throughout the day?Taking too many medications at one time can sometimes

cause fatigue, dizziness or stomach upsetSome medications must be taken with food or on an

empty stomach. The pill bottle should state that.Some medicines have a timed release, usually 12 or 24

hoursOnce-a-day medicines can often be taken any time of day,

just take at the same time each day

• What is the best way to make sure medications are taken correctly?– Bring your pills with you to appointments– Weekly pill box with morning, afternoon & night

slots– ? Turn pill bottle upside down after taking pill– Pill reminder apps on mobile phone or iPad– Medication tracking sheets

• What should you do if you suspect a side effect?– Try to identify which pill you think is causing the

problem– Set the medication aside and contact your

provider right away– Do not wait until your next appointment– Do not stop the medication without instructions

from your provider

• What should you do if you are having difficulty affording all of your medications?– TALK TO YOUR HEALTHCARE PROVIDER!!• May be able to change to a less expensive drug• May help with samples (not long term)• Pharmaceutical assistance programs• May be able to discontinue a drug

• How can I get more information about taking my medications?– https://www.consumerreports.org/health/resources/pdf– http://www.mustforseniors.org/documents/must_juggling.pdf– http://www.webmd.com/interaction-checker/