A cardiologist speaks: How to think about heart medications

April 13, 2018 Providence Health Team

 

There are many types of heart medications, and many factors go into choosing which one is right for you

The same medicine can be used to help in different ways for different diseases

Don’t stop or change your prescribed dosage without consulting with your physician

 

If you’re a candidate for a heart medication, the number of options out there can be daunting: statins, aspirin, warfarin, beta-blockers, ace inhibitors, clopidogrel bisulfate and more. That’s why knowing some of the finer points of heart medication can help you successfully integrate any prescribed drugs into your cardiovascular treatment plan. Deirdre Mooney, MD, a cardiovascular disease specialist at Providence Spokane Heart Institute, shares some key points to keep in mind if you’ll be taking heart meds.

 

Different medicines serve different purposes

“A medicine may be used with the goal of curing a disease, stabilizing a disease and/or improving quality of life, and not all medicines do the same type of thing,” Dr. Mooney says. “For instance, if you have hypertension you may take medication to stabilize or control your blood pressure, but it won’t cure hypertension. However, if you’ve had a heart attack you may be put on a high-potency statin as well as a beta-blocker, so your heart might recover better than someone who doesn’t get put on those medicines or you might have fewer recurrences of heart attacks in the future — that’s a situation where the goal of medicine is to cure or improve.”

 

Medicines are prescribed with your specific needs in mind

“I often choose controller medicines that will help patients in as many ways as possible,” Dr. Mooney says. “For instance, for high blood pressure I might choose a controller agent that also protects the kidneys, especially if you have certain risk factors such as diabetes or heart failure. Or if you had a heart attack, I might choose to start a medicine that’s known to prevent repeat heart attacks and arrhythmias and to decrease mortality.”

 

You can’t just stop following the prescribed dosage

Taking medication sporadically, changing your dosage amount or otherwise modifying the prescribed course of treatment can have adverse effects on the body. “If you want to do that, it’s best to find a provider with whom you can connect and then you can communicate effectively,” Dr. Mooney says. “We can often understand your goal and help you reach it in the safest possible way, but if you’re tinkering with something we need to know why. Is it the pill burden or how many times a day you take medicines? Let us help you figure out how to address your goal.”

This also allows your doctor to keep better tabs on your health. “If you want to change your medications, we need to know so we can help you do it safely,” Dr. Mooney says. “That way, if I see something, such as the potassium levels are too high or low or the kidney function is worsening, then I can know why that is happening with respect to the medication changes and what we can do to fix it.”

 

Get involved with the process

Dr. Mooney welcomes patients who come to her with an idea they’ve seen in a news article or on the internet. “We can work with that — we can go through the literature to see if it’s been studied. As doctors, we are always trying to stay abreast of the basic science literature and reading primary data, while patients are reading coverage in the lay press, so we’re not always on the same page. It’s helpful if patients bring in an article so we can look at it together. We’re always happy to work with people, and doing this is generally a sign of engagement – patients  are trying to think of creative ways to help themselves. But, as doctors, we also want to make sure it’s not a sign of denial - that they’re trying to pretend they don’t have a disease.”

 

Don’t panic about potential side effects

“It’s an interesting scenario when you warn patients about common side effects, because you’re worried you’re going to prime them to feel or experience the effects. On the other hand,  you don’t want them to not know about the side effects and risk suffering from a symptom like a cough if they don’t realize the medicine can cause a cough and we can use a different medicine instead,” Dr. Mooney says. She strives to explain to patients how each medication she recommends helps with particular health issues.

“In a hospital where someone is starting many new medicines, I try to let them know the importance of each one. I’ll say things like: ‘This is the lifesaving medicine that keeps blood flowing through your coronary stents and prevents you from having another emergency heart attack;’ or ‘These are the medicines that, if you miss a dose, it won’t be life-threatening, but they are crucial in helping your heart heal.’ If it’s a patient just starting one new medication, I will often go over all the side effects and whether there’s an acceptable alternative, but that can be overwhelming when many medications are being started at once.”

 

Don’t be afraid to take a lead role

Dr. Mooney says she often tells people to “ask why” in order to understand certain medications — what they do, how they help, why they’ve been prescribed. Patients who are engaged in their care can save a lot of resources, she adds.

“We are expanding our use of technology and resources such as telehealth, offering patients convenience and access. If you agree to call in and put on your smart phone calendar that you will call me in two weeks and tell me how you’re feeling, then you don’t have to see me in two weeks; you can see me in a month and you don’t have to see my nurse practitioner - you can see me. My nurse practitioner can spend more time with someone else in the meantime. You avoid having to take a whole morning off to come in, find parking, check in and see a physician for a blood pressure check and some blood work. Instead, you can go after hours and get your lab work done and call in the morning from the privacy of your office or home, or you can update us with the blood pressure checks you do at home.”

See a Providence health care provider via phone or tablet by signing up for Express Care Virtual. And subscribe to our blog for more expert advice on heart and vascular health.

 

Alaska: Providence Heart & Vascular Center

California: Providence Saint John’s Health Center

Washington: Providence Regional Medical Center Everett

Oregon: Providence Heart & Vascular Institute

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