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Medications
Many medicines are used to treat patients with cardiac disease. However, individual
patients may respond differently to these medications. The effectiveness of a
medication may also change with time. For this reason, doctors often prescribe
different medications to control, hypertension, for example, until they find a medicine
or combination of medicines that works for a given patient. Commonly used
medications include: ACE inhibitors, angiotensin receptor blockers, antiarrhythmics,
antihypertensives, beta-blockers, calcium-channel blockers, nitrates and statins just to
name a few.
ACE Inhibitors
ACE (angiotensin converting enzyme) inhibitors are used to treat high blood pressure
and weakened heart muscles. Angiotensin II is a substance in the blood that causes
vessels to tighten and elevates blood pressure. It is formed from angiotensin I in the
blood by the angiotensin converting enzyme (ACE). ACE inhibitors slow (inhibit) the
activity of the enzyme, which decreases the production of angiotensin II. As a result,
the blood vessels enlarge (dilate), and blood pressure is reduced. In addition, these
drugs decrease sodium and water retention, which often accompanies congestive heart
failure (CHF). A common side effect of ACE inhibitors is a dry cough that begins 1-2
weeks after starting the medication. If this happens the physician may change the
patient's medication to an Angiotensin II Receptor Blocker (ARB)
ACE inhibitors currently available in the United States include: captopril (Capoten),
benazepril (Lotensin), enalapril (Vasotec), lisinopril (Prinivil, Zestril) fosinopril
(Monopril), ramipril (Altace), perindopril (Aceon), quinapril (Accupril), moexipril
(Univasc), and trandolapril (Mavik).
Angiotensin II Receptor Blockers
Angiotensin II is a substance in the blood that causes vessels to tighten (constrict) and
elevates blood pressure. Angiotensin receptor blockers (ARBs) block the action of
angiotensin II. ARBs are used for controlling high blood pressure, treating heart
failure, and preventing kidney failure in people with diabetes or high blood pressure.
Their effects are similar to those of ACE inhibitors so they are often used when a
patient cannot tolerate an ACE inhibitor.
Currently available ARBs include: candesartan (Atacand) eprosartan (Tevetan),
irbesartan (Avapro), telmisartan (Mycardis), valsartan (Diovan), and losartan
(Cozaar).
Anticoagulant Drugs
Anticoagulants can help prevent an existing clot from enlarging or new clots from
forming in the coronary arteries; however, they do not dissolve existing clots. They
are prescribed for people at particular risk for forming clots, such as those with
artificial heart valves or atrial fibrillation. (See also antiplatelet drugs.)
Commonly prescribed anticoagulants include: dalteparin (Fragmin), enoxaparin
(Lovenox), heparin (various) and warfarin (Coumadin)
Anti-Hypertensive Drugs
These are used to treat high blood pressure (hypertension). The most common types
include ARB, ACE inhibitors, diuretics, beta blockers and calcium channel blockers.
Antiplatelet Drugs
Like anticoagulants, antiplatelet drugs can help prevent an existing clot from
enlarging or new clots from forming in the coronary arteries, but they do not dissolve
existing clots. Antiplatelets are effective in the arterial circulation, where
anticoagulants have little effect. They are prescribed for people at particular risk for
forming clots, such as those with new stents, artificial heart valves or atrial
fibrillation.
The most common antiplatelet drugs are: cyclooxygenase inhibitors (aspirin);
adenosine diphosphate receptor inhibitors, such as clopidogral (Plavix) and
ticlopidine (Ticlid).
Aspirin:
Aspirin is an effective therapy in reducing the occurrence of myocardial infarction
(heart attack). Heart attacks occur when atherosclerotic plaque, that is already
partially obstructing a coronary artery, ruptures (breaks apart). This creates a
roughened surface along the lining of the vessel and promotes clotting. As a clot
forms, it obstructs the vessel completely. Blood clots are formed by platelets
clustering together. Aspirin interferes with this process by making the platelets less
"sticky" -- and therefore less successful in clustering together.
Beta-Blocking Drugs
Beta-blockers (beta-adrenergic blocking drugs) slow the heart rate and decrease blood
pressure, reducing the heart's demand for oxygen. They do this by blocking the effects
of adrenaline on the body's beta receptors. This slows the nerve impulses that travel
through the heart, thus easing the heart's pumping action and widening blood vessels.
Beta-blockers also can block the impulses causing an irregular heartbeat (arrhythmia).
Beta-blockers are used to treat a variety of conditions including high blood pressure
(hypertension), chest pain (angina), arrhythmias, congestive heart failure (CHF), and
mitral valve prolapse.
Commonly used beta blockers include: acebutolol (Sectral), atenolol (Tenormin),
betaxolol (Kerlone), bisoprolol (Zebata), carteolol (Cartrol), carvedilol (Coreg),
esmolol (Brevibloc), labetalol (Normodyne, Trandate), metoprolol (Toprol-XL,
Lopressor), nadolol (Corgard), propranolol (Inderal, Inderal-LA), sotalol (Betapace),
and. timolol (Blocadren).
Calcium Channel Blocking Agents
Also called calcium antagonists or calcium blockers, these medications affect the
movement of calcium into the cells of the heart and blood vessels. As a result, they
relax blood vessels and increase the supply of blood and oxygen to the heart, while
reducing its workload. They are prescribed to treat chest pain (angina), high blood
pressure (hypertension) and some irregular heartbeats (arrhythmias).
Calcium channel blockers include: amlodipine (Norvasc), diltiazem (Cardizem),
felodipine (Plendil), nicardipine (Cardene), nifedipine (Adalat, Procardia), nimodipine
(Nimotop), and verapamil (Calan, Covera, Isoptin). They are not usually prescribed
for people with heart failure or other structural damage to the heart.
Cholesterol-Lowering Drugs
Cholesterol is necessary for building new cells, insulating nerves and producing
hormones, but sometimes the body creates and absorbs too much cholesterol,
resulting in blocked arteries. Common types of cholesterol-lowering drugs include
Niacin, bile-acid sequestrants and HMG-CoA reductase inhibitors (statins).
Digitalis
Digitalis, which is derived from the foxglove plant, is used to treat congestive heart
failure (CHF) and certain abnormal heart rhythms (arrhythmias). It increases the force
of the heart's contractions by increasing the amount of calcium in the heart's cells
(which stimulates the heartbeat), helping to improve circulation and reduce swelling
in the hands and ankles. When digitalis reaches the heart muscle, it binds to sodium
and potassium receptors. These receptors control the amount of calcium in the heart
muscle by stopping the calcium from leaving the cells. As calcium builds up in the
cells, it causes a stronger heartbeat.
Digitalis medicines help control arrhythmias by slowing the signals that start in the
sinoatrial (SA) node. This then reduces the number of signals that travel through the
atrioventricular (AV) node. Fewer signals equate to fewer arrhythmias.
Commonly used brand names include: Lanoxicaps (digoxin), Lanoxin (digoxin),
Lanoxin Elixir Pediatric (digoxin), Lanoxin Injection (digoxin), Lanoxin Injection
Pediatric (digoxin)
Diuretics
Diuretics are commonly used to treat high blood pressure (hypertension), congestive
heart failure (CHF), and water retention and swelling often associated with CHF.
They act on the kidneys to help rid the body of excess water and sodium, which can
increase blood pressure.
There are three types of diuretic medicines. Each works a little differently, but all
lower the amount of salt and water in the body, which helps to reduce blood pressure:
Thiazide diuretics. These are the only type of diuretic that widens (dilates) the blood
vessels, which also helps to lower blood pressure. Commonly used thiazides include:
chlorothiazide , hydrochlorothiazide .
Potassium-sparing diuretics. Unlike the other diuretic medicines, these do not cause
the body to lose potassium. They include: amiloride (Midamor), spironolactone
(Aldactone), and triamterene (Dyrenium).
Loop-acting diuretics. These prompt the kidneys to increase urine flow, which helps
reduce water retention and lowers blood pressure. They include: bumetanide
(Bumex), ethacrynic acid (Edecrin), furosemide (Lasix, Myrosemide), and torsemide
(Demadex).
Statins (HMG-CoA Reductase Inhibitors)
These are prescribed to lower cholesterol in the blood. Drugs in this class include:
atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin
(Pravachol), rosurastatin (Crestor) and simivastatin (Zocor). Collectively, these are
known as "the statins."
Doctors often prescribe statins if diet, weight loss, and exercise don't work to
sufficiently lower a person's cholesterol. Statins work by slowing the body's ability to
produce low-density lipoproteins (LDL) -- also called "bad cholesterol" -- as well
decreasing blood fats called triglycerides. Statins also increase blood levels of highdensity lipoproteins (HDL) -- or "good cholesterol."
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