Common Cardiac Conditions and Medication Treatment Options

Cardiac conditions and their treatment with medications is a huge topic.  Below, we will discuss some of the most common cardiac conditions in brief and also list (by category) the ever growing compendium of cardiac medications.  It is important to see the entire list so that you have somewhat of an idea of all the choices that go through the mind of your physician when they are evaluating you for medication treatment. 

Each category of medications has its own set of side effects, adverse reactions, drug interactions, monitoring parameters, food interactions and cautions and precautions to be aware of.  Further, within each category, the profile is somewhat different for each medication.  When picking up your prescriptions, always take the time to discuss your medication with your pharmacist, even if you have already discussed the process with your physician. 

The goal of this handout is to help educate you about your condition, your medication options and raise some questions for you so you may then engage your own health care practitioner in an educated discussion about your medication therapy.

Always ask your pharmacist if any of the medications you are taking have a
Black Box Warning.

 
Blood Pressure

If high blood pressure is left untreated, the blood vessels will harden and this will eventually lead to a heart attack or a stroke. Increased blood pressure will damage the vessels that supply the retina with blood and lead to vision problems. Furthermore, the filtering cells in the kidneys will become damaged and lead to kidney failure. Lastly, the heart will tire from pumping against the increased pressure and eventually lead to heart failure.

Atherosclerosis & Cholesterol

The buildup of cholesterol on a blood vessel wall causing the development of plaque is known as atherosclerosis.   Over time, this plaque will build up on the inside of the blood vessel and minimize the space for the blood to flow through.  Two bad things can happen here. First, as the blood vessel narrows because of the plaque buildup, the blood vessel downstream will have a decrease supply of blood and because of this, the tissues will get less oxygen. This can be very dangerous when the blockage leads to your heart or brain.  Second, if the plaque breaks free, it can scratch a blood cell and start the blood clot cascade which may lead to either a stroke or a heart attack.

Heart Rhythm

Quite often, heart arrhythmia's are harmless. Occasionally, people will have an irregular heartbeat that causes a bit of fluttering or temporary racing heartbeat. On the other hand, arrhythmia's have the potential of causing significant and life threatening complications. An irregular heartbeat is one of the conditions that predispose an individual to developing a blood clot which may get stuck in the legs, lungs, heart or brain. As we know, blood clots may be life threatening.

Acute Coronary Syndrome (ACS)

Acute Coronary Syndrome is brought on by decreased blood flow to the heart. This can be described as the crushing pain one feels during a heart attack, or the light chest pain one may feel while at rest or performing light physical activity.  In management of ACS, the focus is on three main therapies. First, the patient needs to be stabilized, second, the chest pain needs to be relieved, and third, anti-thrombotic therapy needs to be provided to prevent a clot.
 

Blood Pressure Control

In general, taking medications that lower your blood pressure may make you feel a little light headed, dizzy or tired.  Take it slow when you go from a sitting to standing position.  Balance yourself for 10 seconds to make sure you are stable before taking a step.  If you are dizzy when you stand up and the lightheadedness does not clear up within 30-60 seconds, have a seat.  If the dizziness continues, please let your doctor know as soon as possible. 

Angiotensin Converting Enzyme Inhibitors (ACEI’s) work by inhibiting a portion of the renin-angiotensin-aldosterone system which in turn relaxes pressure on the blood vessels and allows the blood to flow more smoothly.

  • Benazepril (Lotensin-TM)
  • Enalapril (Vasotec-TM)
  • Lisiniopril (Prinivil-TM, Zestril-TM)
  • Quinapril (Accupril-TM)
  • Ramipril (Altace-TM)

Angiotensin Receptor Blockers (ARB’s) work by inhibiting a different portion of the renin-angiotensin-aldosterone system which in turn also relaxes pressure on the blood vessels and allows the blood to flow more smoothly.

  • Candesartan (Atacand-TM)
  • Irbesartan (Avapro-TM)
  • Losartan (Cozar-TM)
  • Olmesartan (Benicar-TM)
  • Valsartan (Diovan-TM)

Renin Inhibitors work by inhibiting yet another different portion of the renin-angiotensin-aldosterone system which in turn also relaxes pressure on the blood vessels and allows the blood to flow more smoothly.

  • Aliskiren (Tekturna-TM)

Alpha Blockers-(peripheral) work to block the body’s natural chemicals that affect blood vessels and the heart. This medication may decrease blood pressure by relaxing blood vessels and decreasing the strain on the heart.

  • Doxazosin (Cardura-TM)
  • Prazosin (Minipres-TM)
  • Terazosin (Hytrin-TM)

Alpha Agonists-(centrally acting) work in your brain to block the stimulation that constricts your blood vessels.  By decreasing this stimulation, your blood vessels are relaxed and blood pressure is decreased.

  • Clonidine (Catapres-TM)
  • Guanfacine (Tenex-TM)

Beta Blockers work to block the body’s natural chemicals that affect blood vessels and the heart. This medication may decrease blood pressure by relaxing blood vessels, slowing heart rate and decreasing the strain on the heart.

  • Atenolol (Tenormin-TM)
  • Carvedilol (Coreg-TM)
  • Carvedilol (Coreg CR-TM)
  • Metoprolol (Lopressor-TM)
  • Metoprolol XR (Toprol XR-TM)
  • Nadolol (Corgard-TM)
  • Nebivolol (Bystolic-TM)
  • Propranolol (Inderal-TM)
  • Propranolol LA (Inderal LA-TM)

Calcium Channel Blockers work by relaxing the blood vessels in both the vascular system and in the heart. By doing this, the resistance that the heart needs to pump against is decreased, heart rate is decreased, and the heart does not need to work as hard to pump blood.

  • Amlodipine (Norvasc-TM)
  • Diltiazem ER (Cardizem CD-TM, Dilacor XR-TM, Taztia XT-TM and others)
  • Felodipine (Plendil-TM)
  • Isradipine (Dynacirc CR-TM)
  • Nifedipine ER (Procardia XL-TM, Adalat CC-TM, and others)
  • Nisoldipine (Sular-TM)
  • Verapamil SR (Calan SR-TM, Isoptin SR-TM, and others)

Diuretics, sometimes called water pills, increase the volume of urine eliminated from your body. Taking a diuretic helps the body rid itself of excess water and salt, thereby, decreasing blood pressure and excess strain on the heart.

  • Bumetadine (Bumex-TM)
  • Furosemide (Lasix-TM)
  • Hydrochlorathiazide (Esedrix-TM)
  • Metolazone (Zaroxolyn-TM)
  • Torsemide (Demadex-TM)

Blood Clot Treatment and Prevention

In general, you will have a tendency to bleed easily while taking this category of medication.  If you notice any unusual bleeding, such as bleeding from the gums while brushing your teeth, a constant nose bleed, or prolonged bleeding from a cut, you should notify your health care provider.  In the unusual event that you  notice any blood in your urine or stool, or are vomiting or coughing up blood, please notify your doctor and report to the nearest emergency room.  Not everyone who takes these medications will experience side effects, however, if you notice any unwanted effect, please talk about it with your doctor of pharmacist.

Vitamin K antagonists blocks the production vitamin K which in turn inhibits the production of clotting factor.   This decreases the potential for the body to develop a clot.

·         Warfarin (Coumadin-TM)

Anti-Thrombin medications interfere with thrombin and inhibit the extensive clotting cascade at one point or another.   This helps to treat and block the development of a blood clot.

·         Apixaban (Eliquis-TM)
·         Dabigatran (Pradaxa-TM)
·         Enoxaparin (Lovenox-TM)
·         Rivaroxaban (Xarelto-TM)

Anti-Platlet medications act on the platelets,(which are a type of blood cell that help damaged arteries by forming a plug to prevent bleeding). The anti-platelet medications work to inhibit platelet aggregation in patients who are at risk for developing blood clots in their arteries.

·         Aspirin/Dipyridamole (Aggrenox-TM)
·         Clopidogrel (Plavix-TM)
·         Prasugrel (Effient-TM)


Heart Rhythm Maintenance

In general; while taking anti-arrhythmic medications you may experience some nausea, vomit or diarrhea.  You may also experience some dizziness, headache, constipation, anxiety and maybe a little tiredness.  Please, if these, or any other unwanted side effect persists, call your doctor or pharmacist to discuss it with them.

Anti-arrhythmic medications work by slowing the transmission of the chemicals the heart uses for electrical conduction of the heart rhythm. This process prolongs the conduction time of the contraction in all areas of the heart which significantly decreases the chances for irregular heartbeats. This category of medication helps maintain a regular and steady heartbeat.

  • Amiodarone (Cordarone-TM, Pacerone-TM)
  • Disopyramide CR (Norpace CR-TM)
  • Dronedarone (Multaq-TM)
  • Flecanide (Tambacor-TM)
  • Propafenone (Rythmol-TM)
  • Propafenone (Rythmol SR-TM)
 
Cholesterol Medications

An infrequent side effect associated with the Statins is muscle pain, which may rarely lead to a condition known as rhabdomyolysis.  This is characterized by muscle weakness, tenderness and an unusual tiredness, possibly with a fever.  This may be damaging to the muscles and liver if not acted upon.  If you notice any of these symptoms, or any symptoms of liver difficulty such as yellowing eyes, dark urine or a persistent nausea or abdominal pain, please do not hesitate, let your doctor know immediately.

Statins work by blocking an enzyme in the liver that is necessary for the production of cholesterol

  • Atorvastatin (Lipitor-TM)
  • Lovastatin (Mevacor-TM)
  • Rosuvastatin (Crestor-TM)
  • Simvastatin (Zocor-TM)
Please remember, this is a general reference, specifically prepared with the goal that it will be utilized to help stimulate educated questions and discussions between patients and their health care practitioners.  If you have any questions, please contact your Community Pharmacist or your Primary Health Care Practitioner. 

To learn more about any of the medications discussed in this blog, please www.AudibleRx.com and listen to the Medication Specific Counseling Session you are interested in.

Thanks
Steve

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