The day you are discharged you will be given a list of medications to take and the necessary prescriptions. TAKE ONLY WHAT WE, PRESCRIBE. Do not take other medications that you were on before your operation.

General Instructions

Learn your medications' names, dosages and purposes. You should always carry an updated list of any medicines with the dosages and frequency on a card in your wallet.

Do not skip a dose or take an extra dose without consulting your physician first.

DO NOT stop any medicine without checking with your doctor. If the prescription is running low, call to see if you should get a refill.

Common Medications After Heart Surgery

The following pages discuss some of the common medications that patients may be required to take after a heart operation. If one of your medications is not found here, one of the members of the cardiac surgical team will explain it to you.

Medications are prescribed on an individual basis. Some may be necessary just throughout the recovery period, while others may be needed indefinitely. Your surgeon will discuss this with your family doctor and cardiologist and you can discuss the medicines with him when you return for your postoperative visit.

Nitroglycerin
If you experience any chest pain that you know is angina you may take nitroglycerin. If you find it necessary to take any nitroglycerin within the first month after discharge, PLEASE let us know by calling the surgeon's office. Remember, nitroglycerin only stays fresh in the bottle approximately 3-4 months.

Ascriptin, Ecotrin
This is prescribed as a mild dose of a blood thinner to prevent small clots in the new grafts. It works by preventing platelets which are part of our normal blood clotting factors from sticking on the new grafts. It is a combination of an aspirin tablet and the antacid Maalox to protect the stomach. Many people use Ascriptin like aspirin for arthritis and minor aches and pains because it can be purchased over the counter. DO NOT increase the dose of Ascriptin. If you need something additional for a headache or minor discomfort it is better to use a non-aspirin pain reliever.

Persantine (Dipyridamole)
Persantine works similiarly to Ascriptin by helping to prevent the platelets from sticking together and clumping on the new vein grafts. Persantine is usuallv taken two-three times a day with meals. Notify your surgeon's office if.
1. You have persistent headaches.
2. You have nausea, vomiting or continued loss of appetite.

Digoxin, Lanoxin (Digitalis)
Digoxin strengthens the contraction of the heart muscle. This improves the pumping action of the heart. It is also used to help the heart beat regularly. At times there may be some side effects from taking Digoxin. Notify your surgeon's office if.

1. You have nausea, vomiting, loss of appetite or diarrhea for more than two days.

2. You experience blurred vision or see green or yellow halos around objects,

3. You have an irregular heart rhythm or experience palpitations.

4. Your pulse is less than 50 beats per minute.

Lasix (Furosemide),Dyazide
These drugs are diuretics and help the body get rid of excess fluid. They will help reduce the workload of the heart and also help reduce swelling in the legs. You may need to take potassium supplements if you are on a water pill. Potassium is flushed out of the body along with the water. If a potassium supplement is not prescribed you may wish to eat foods high in potassium in your daily diet. Foods high in potassium include: bananas, oranges, apricots, grapefruits and fresh tomatoes as well as dried beans and green vegetables.

You should take this pill in the morning or late afternoon because it will increase urine output throughout the day. Notify your surgeon's office if you have an unusual weight gain (more than 2-3 pounds in one day).

lnderal (Propanolol)
This drug helps prevent your heart from beating too rapidly and helps regulate the rhythm. It also reduces the amount of work your heart must do. It may be used to lower your blood pressure. Notify your surgeon's office if you are short of breath or wheezing.

Pronestyl, Procan SR (Procainamide)
These medications are used to treat irregular heart rhythms and maintain a more normal rhythm of the heart beat. Notify your surgeon's office if:

1. You develop a skin rash.
2. You have fever or chills.
3. You have painful and/or swollen joints.
4. You have nausea or vomiting lasting more than 48 hours.

Quinidine, Quinaglute, Quinidex Quinidine
is used to help regulate the heart rhythm. Notify your surgeon's office if:

1. You have diarrhea, nausea or vomiting,
2. You have blurred vision or ringing in your ears.

Verapamil (isoptin, Calan)
This medication is used in the treatment of irregular heart beats and angina. Notify your surgeon's office if:

1. You have unusual swelling of the arms or legs.
2. You have dizziness.

Nitropatch,Transderm Nitro, Nitrodur
This type of Nitroglycerin medication is absorbed through the skin over a sustained time period. The patches can be placed anywhere on the body and usually the arms or chest are used. The patch should be placed on a different part of the upper body every morning and removed at bedtime.

Ferrous Gluconate, Ferrous Sulfate
This is a drug used to replace iron in the body. Iron is important in the formation of hemoglobin (red blood cells). This medication increases your blood count and helps you feel stronger.
- Your stools will normally be black when you are on iron.
- This medicine may contribute to constipation.
- You should take iron pills with meals to minimize stomach upset.

Tylenol #3 (Tylenol with Codeine)
This medication is a combination of Tylenol and Codeine and is prescribed for relief of incisional discomfort. Many patients find it helpful to take this upon arising in the morning to relieve some of the stiffness and soreness from lying in bed all night. It may also be helpful to take it before going to bed at night to help you sleep.
- The Codeine in the medicine may contribute to constipation.
- This drug can be habit forming so take only as directed.

Percocet (Oxycodone with Acetaminophen)
This medication is prescribed for relief of incisional discomfort. Many patients find it helpful to take this upon arising in the morning to relieve some of the stiffness and soreness from lying in bed all night. It may also be helpful to take it at bedtime to help you sleep.
- This drug can be habit forming so take only as directed.
- REMEMBER, this medication CANNOT be refilled over the phone to a pharmacy. To request a refill, call the surgeon's office 2-3 days before the prescription runs out and we will mail a prescription to you, or have you pick one up at the office.

Plain Tylenol, Extra Strength Tylenol, Datril, Anacin-3, Panadol (Acetominophen) (Non-Aspiein Pain Relievers)
You may use any of the non-aspirin pain relievers instead of your prescribed pain pill if you wish. Many patients find that these medications are helpful when the incisional discomfort becomes less and they do not require the stronger pain pills. Alternating a non-aspirin pain reliever with your prescribed pain pill will improve pain control throughout the day and decrease the need for the stronger pills.

Coumadin
Coumadin is an anticoagulant (blood- thinner) medication used to prevent the formation of blood clots. Clotting of blood (coagulation) is a normal process. Anticoagulant medications purposely slow this process down. Some medical conditions and patients with certain artificial (prosthetic) heart valves require Coumadin to prevent the formation of blood clots. Coumadin is specifically used in patients after a valve operation to decrease the formation of small clots on the artificial valve.

A blood test called a Prothrombin Time (also called Protime, or PT.) which is measured in seconds, determines how long it takes the blood to clot. This blood test is used to determine the amount of Coumadin required to keep blood coagulation within a therapeutic (prescribed treatment) range. The therapeutic range for patients taking Coumadin is 11/2to 2 times greater than a normal prothrombin time. A normal prothrombin time is about 12 seconds. Therefore, most patients receiving Coumadin require a prothrombin time in the range of 18 to 24 seconds.

A daily prothrombin time will be performed while you are in the hospital to determine your daily dosage of Coumadin. You will require a prothrombin time once or twice a week the first few weeks after discharge. The frequency of prothrombin times will decrease over the next I to 2 months as your dosage of Coumadin stabilizes. As long as you are taking Coumadin you will require a prothrombin time every 4-6 weeks.

It is important to remember the following rules while you are taking Coumadin:

1. NEVER take any medication containing aspirin while on Coumadin. Aspirin products such as Bufferin, Anacin, Bayer, Excedrin and Alka- Seltzer are also mild anti- coagulants and increase the effect of Coumadin.

2. learn to read medicine bottle labels. Some cold preparations contain aspirin.

3. You may use any of the "aspirin-free" or "non-aspirin" pain relievers such as Tylenol, Panadol and Anacin-3 as minor pain relievers.

4. You must aIways report ANY signs of bleeding to your doctor. Notify your physician if you notice any of the following symptoms:
- Bleeding gums
- Nosebleeds
- Bloody or black stools
- Bloody or cherry-colored urine
- Excessive menstrual-flow
- Coughing or vomiting off blood
- Severe abdominal pain
- Severe headaches
- Excessive braising

5. Learn your Coumadin dosage by milligrams NOT by the number of pills.

6. Limit alcohol intake to no more than 2 drinks within a 24-hour period. Alcohol may interfere with the absorption of Coumadin.

7. Wear a Medic-Alert bracelet or necklace stating you have an artificial heart valve and are on Coumadin.

8. If a long vacation is planned, notify your doctor so arrangements can be made to follow your prothrombin time while you are away.

Coumadin is available in several strengths and tablet sizes. You will be instructed by one of the thoracic surgery clinical nurse specialists on how to take the right dosage of Coumadin after discharge. Instructions will also be given on who will manage your prothrombin time and when to obtain the blood tests. You may wish to keep a record of your prothrombin time results and adjustments in the Coumadin dose.

Acknowledgements
Content: Jaelene K. Williams, RN, MS
Medical Illustrations: Kathleen Wagner
Illustrations: Catherine Gendron