Simple tips for Patient Counseling of Anti-Ischemic drugs to provide best use of medications.

1. Ischemic Heart Disease (IHD)
Patient Counseling

2. Antiplatelet Agents
 Members : Aspirin and Clopidogrel
 Doses : Aspirin: 75-162 mg daily
Clopidogrel (Plavix): 75 mg daily
 This medication helps prevent platelets from sticking together and forming a
clot that can block an artery.
 Do not stop taking it without talking to your healthcare provider as you could
be at risk of developing a clot which can be life-threatening.
 If you miss a dose, take it as soon as you remember. If it is almost time for your
next dose, skip the missed dose and take the next dose at your regularly
scheduled time.
 Do not take two doses at the same time unless instructed by your healthcare
provider.
 You may bleed and bruise more easily while taking this medication, even from
a minor scrape. It may take longer to stop bleeding.

3.  Call your healthcare provider at once if you have black or bloody stools, or if
you cough up blood or vomit that looks like coffee grounds.
 These could be signs of serious bleeding in the stomach or intestines.
 Your risk of bleeding in the stomach or intestines may be increased if you drink
alcohol, have a history of stomach ulcers or take other medications that
increase the risk of bleeding (e.g., blood thinners or ibuprofen).
 Do not take other over-the-counter pain relievers without consulting your
healthcare provider.
 Most drug interactions are due to additive effects with other agents that can
increase bleeding risk.
 Aspirin: use caution in combination with other ototoxic.
 Clopidogrel: avoid in combination with omeprazole and esomeprazole (other
PPIs interact less) and use caution with other CYP2C19 inhibitors.

5. Aspirin
 Stop taking this medication and tell your healthcare provider right away if you
develop signs of an allergic reaction (e.g., hives, swelling in the face, wheezing),
ringing in the ears or loss of hearing.

6. Clopidogrel
1. Thrombotic thrombocytopenic purpura (TTP) is a rare, but serious, side effect of this medication.
2. Seek prompt medical attention if you experience any of these symptoms: fever,
weakness, extreme skin paleness, purplish spots or skin patches (called purpura),
yellowing of the skin or eyes ( jaundice) or mental status changes.
3. If you need to have any type of surgery or dental work, tell the surgeon or dentist
ahead of time that you are using clopidogrel.
4. You may need to stop using the medication for at least five days before having major
surgery, to prevent excessive bleeding.
5. Some acid-reducing medications can decrease the beneficial effects of clopidogrel.
6. Do not take heartburn medications without consulting your healthcare provider.

7. All Nitroglycerin Products
 Do not use this medication with:sildenafil (Viagra, Revatio),
tadalafil (Cialis, Adcirca), vardenafil ( Levitra, Staxyn), avanafil (Stendra)
and riociguat (Adempas).
 A dangerous drop in blood pressure could occur.
 Side effects of this medication can include headache, dizziness,
lightheadedness, redness/mild warmth (flushing) or nausea.
 Headache is often a sign that this medication is working.
 Flushing and headache should become less bothersome as your body gets
used to the medication.
 Your healthcare provider may recommend treating headaches with
acetaminophen.
 If headaches continue or become severe, tell your healthcare provider.
 To reduce the risk of dizziness and lightheadedness with this medication,
get up slowly when rising from a sitting or lying position.
 Hold onto the side of the bed or chair to avoid falling.
 Limit alcoholic beverages.

9. Nitroglycerin Sublingual Tablets,powder And Translingual Spray
 At the first sign of chest pain: take one dose immediately
(one SL tablet, one SL powder packet or one TL spray).
 Call 911 immediately if chest pain persists after the first dose.
 Continue to take two additional doses at five minute intervals while waiting for
the ambulance to arrive.
 Do not take more than three doses within 15 minutes.
 This medication may be taken 5 - 1 0 minutes before activities that bring on
chest pain.

10. Nitroglycerin SL Tablets
 Nitroglycerin SL tablets should not be chewed, crushed or swallowed.
 Place the tablet under the tongue, or in the area between the inside of the
cheek and the gums/teeth, and let it dissolve.
 You may feel a slight burning or tingling sensation with SL tablets.
 This is not a sign of how well the medication is working.
 Do not use more medication because you do not feel these sensations.
 Keep nitroglycerin SL tablets tightly capped in the original amber glass bottle,
and store at room temperature.
 Shake out one tablet only; do not let the other tablets get wet.
Nitroglycerin SL Powder
 Empty the contents of a packet under the tongue, close your mouth and
breath normally through your nose.
 Let the powder dissolve without swallowing.
 Do not rinse the mouth or spit for five minutes after the dose.

12. Nitroglycerin TL Spray
 The pump must be primed before first use (five sprays for Nitrolingual Pump
Spray and ten sprays for NitroMist).
 If not used within six weeks, prime the pump with one spray ( Nitrolingual Pump
Spray) or two sprays ( NitroMist) before use.
 Do not shake. Press the button firmly with the forefinger to release the spray
onto or under the tongue.
 Close your mouth after the spray.
 Do not inhale the spray and try not to swallow too quickly afterwards.
 Do not spit or rinse the mouth for 5-10 minutes after the dose.

13. Nitroglycerin Ointment
 Measure the dose of ointment with the dose measuring applicator supplied
with the tube.
 Place the applicator on a flat surface, printed side down.
 Squeeze the needed amount of ointment onto the applicator, and place the
applicator (ointment side down) on the chest or other desired area of the skin.
 Spread the ointment, using the dose measuring applicator, lightly onto the skin.
 Do not rub into the skin.
 Tape the applicator into place.
 This medication can stain clothing.
 Care should be taken to completely cover the dose measuring applicator.

14. Nitroglycerin Patches
 Remove the patch from its pouch and remove the protective clear liner.
 Apply the patch to a clean, dry, and hairless area of the skin and press it firmly
in place with the palm of your hand.
 Any area may be selected except the extremities below the knees or elbows;
the chest is the preferred site.
 Hair in the area may be clipped, but not shaved.
 Avoid areas with cuts or irritation.

15.  Do not apply the patch immediately after bathing or showering; wait until
your skin is completely dry.
 You may bathe, shower, and swim while wearing the patch.
Apply one new patch each morning and wear for 12 – 14 hours.
 For the medication to work well, there must be a 10 -12 hour "patch free
"interval where the patch is left off.
 To reduce skin irritation, apply each new patch to a different area of skin.
After removing the old patch, fold it in half with the sticky sides together, and
discard out of the reach of children and pets.

16. Ranolazine
 Ranolazine is used to decrease the number of times you get chest pain.
 It works differently than other drugs for chest pain, so it can be used with your
other medications (beta blockers, nitrates and calcium channel blockers).
 Take this medication by mouth twice daily with or without food.
 Swallow the tablet whole.
 Do not crush or chew the tablets.
 Use this medication regularly to get the most benefit from it.
 Take it at the same times each day.
 It should not be used to treat chest pain when it occurs.
 Use other medications (e.g., SL nitroglycerin) to relieve chest pain, as directed
by your healthcare provider.

17.  Dizziness, headache, lightheadedness, nausea and constipation can occur. If
any of these effects persist or worsen, notify your healthcare provider promptly.
 Ranolazine can cause a condition that affects the heart rhythm (QT
prolongation).
 This heart rhythm can infrequently result in serious fast/irregular heartbeat and
other symptoms (such as severe dizziness, fainting) that require immediate
medical attention.

18.  The risk is increased if you are taking other drugs that can affect the heart
rhythm.
 Check with your healthcare provider before using any herbal or OTC
medications.
 Other drugs may interfere with this medication.
 Avoid grapefruit and grapefruit juice.
 Inform your healthcare provider and pharmacist that you are taking this
medication before starting new drugs.