cardiovascular medications - ejgh

Cardiovascular Medications

PART I

Introduction v  It is important for you to become familiar with your

medications. If you can understand what it does you can assist your doctor in evaluating the effectiveness and reporting side effects.

v  Discuss any side effects with your doctor. v  Do not stop taking or skip doses

of your medications.

v  You should memorize or carry a list of every medication you take including name, dosage and frequency.

v  Always check with your doctor before taking over the

counter medications. v  Refill all medications unless your doctor specified a

specific length of treatment. v  Medications are referred to by different names:

generic and brand names. Both are listed on your handout.

If you notice any reaction such as a rash, muscle cramps, or nausea/vomiting lasting more than a day that you feel may be from your medications, you should:

a)  Notify your physician before making any changes in your medications.

b)  Stop taking your medications until the next time you see your physician.

c)  Decrease the dose to see if that helps. d)  Buy an over-the-counter medicine to help you feel

better.

Antihypertensive and Antianginal

v These are two large classes of medications which lower blood pressure and prevent chest pain.

v There are many specific subclasses which include diuretics, beta blockers, calcium channel blockers, ace inhibitors, vasodilators and nitrates.

Diuretics v  USED TO TREAT: high blood pressure, congestive heart failure

Diuretics v  USED TO TREAT: high blood pressure, congestive heart failure v  EXAMPLES:

Lasix(furosemide) Lozol(indopamide) Bumex(bumetanide) Zaroxylyn(metalazone) Diamox(acetazolamide) hydrochlorothiazide

Demadex(toresmide) Diuril(chlorothiazide) Aldactone(spironolactone) & Inspra(epleronone)→ does not

lower potassium Maxide, Moduretic, Dyazide→ combination drugs





v  HOW IT WORKS: allows your body to get rid of excess fluid through urination





v  HOW IT WORKS: allows your body to get rid of excess fluid through urination

v  SIDE EFFECTS: loss of potassium, low blood pressure, dehydration

v  As most diuretics get rid of water, potassium leaves the body. Your doctor may prescribe a high potassium diet or a potassium supplement.

Potassium v  USED TO TREAT: loss of potassium from diuretic use,

excessive vomiting or diarrhea


excessive vomiting or diarrhea v  EXAMPLES:

Micro-K(capsule) K-lyte(dissolve in liquid) K-dur(tablet) K-lor(dissolve in liquid) Slow K(tablet) Kaon-cl(liquid) K-tab(tablet) Kayciel(liquid)




v  HOW IT WORKS: restores blood level of potassium




v  HOW IT WORKS: restores blood level of potassium v  SIDE EFFECTS: low or high potassium level can cause

weakness, fatigue, dizziness, or irregular pulse

Beta Blockers v  USED TO TREAT: high blood pressure, abnormal heart rhythm,

long term prevention of another heart attack


long term prevention of another heart attack v  EXAMPLES:

Inderal(propanolol) Zebeta(bisoprolol) Lopressor/Toprol(metoprolol) Betapace(sotalol) Blocadren(timolol) Sectral(acebutolol)

Tenormin(atenolol) Kerlone(betaxolol) Viskin(pindolol) Corgard(nadolol) Levatol(penbutolol) Cartrol(certeolol) Bystolic(nebivolol) Coreg(carvedilol)& Trandate/Normodyne(labetalol)→triple blockade





v  HOW IT WORKS: blocks excitation of heart which slows heart rate, decreases the heart’s force of contraction and lowers blood pressure. By lowering blood pressure and heart rate, your heart requires less oxygen therefore preventing angina.





v  HOW IT WORKS: blocks excitation of heart which slows heart rate, decreases the heart’s force of contraction and lowers blood pressure. By lowering blood pressure and heart rate, your heart requires less oxygen therefore preventing angina.

v  SIDE EFFECTS: low blood pressure, low heart rate, fluid retention, worsening of asthma or emphysema, masks signs of hypoglycemia

v Never stop taking your beta blocker unless you are advised to do so. This drug is usually tapered before stopping.

v Since beta blockers may decrease heart rate, check your pulse before taking. If the pulse is less than 50 beats per minute on three checks, you should contact your doctor before taking this medicine.

v Contact your doctor if you begin to retain fluid or have difficulty breathing.

STOP

v  The medications which lower blood pressure can also cause constipation, depression and sexual dysfunction (such as impotence).

v  If you experience any of these,

do not stop taking your medicine. v  Discuss this with your doctor so

that an effective plan of treatment can be continued.

Ace Inhibitors v  USED TO TREAT: high blood pressure, congestive heart failure

Ace Inhibitors v  USED TO TREAT: high blood pressure, congestive heart failure v  EXAMPLES:

Lotensin(benazepril) Zestril/Prinivil(lisinopril) Capoten(captopril) Accupril(quinapril) Vasotec(enalapril) Altace(ramipril) Monopril(fosinopril) Univasc(moexipril) Mavik(trandolapril) Aceon(perinopril)



v  HOW IT WORKS: prevents angiotensin converting enzymes (ACE) from working. This results in dilation of arteries and veins.



v  HOW IT WORKS: prevents angiotensin converting enzymes (ACE) from working. This results in dilation of arteries and veins.

v  SIDE EFFECTS: low blood pressure, alteration in kidney function, nonproductive persistant cough, swelling of the face or mouth should be reported immediately

v  NSDAIDs such as ibuprofen and naprosyn will decrease effects

Angiotension Receptor Blocker

(ARBs) v  USED TO TREAT: high blood pressure, congestive heart failure


(ARBs) v  USED TO TREAT: high blood pressure, congestive heart failure v  EXAMPLES:

Avapro(irestartan) Diovan(valsartan) Cozaar(losartan) Atacand(candesartan) Micardis(telmisartan) Teveten(eprosartan)

Benicar(olmesartan) Tekturna(aliskiren)




Benicar(olmesartan) Tekturna(aliskiren) v  HOW IT WORKS: blocks the effects of angiotension II which

results in dilation of arteries and veins




Benicar(olmesartan) Tekturna(aliskiren) v  HOW IT WORKS: blocks the effects of angiotension II which

results in dilation of arteries and veins v  SIDE EFFECTS: diarrhea, upper respiratory infection,

heartburn, fatique, high potassium, low sodium, low blood pressure

Calcium Channel Blockers v  USED TO TREAT: high blood pressure, angina, rapid heart beats,

prevention of coronary spasm


prevention of coronary spasm v  EXAMPLES:

Cardizem/Dilacor/Tiazac(diltiazem) Calan/Isoptin(verapamil) Procardia/Adalat(nifedipine) Norvasc(amlodipine) Cardene(nicardipine) Plendil(felodipine) Vascor(benpridil) Dynacirc (isradipine) Sular(nisoldipine) Covera(verelan)




v  HOW IT WORKS: blocks the action of calcium in cells of heart and blood vessels causing relaxation in blood vessels and decrease in force of contraction




v  HOW IT WORKS: blocks the action of calcium in cells of heart and blood vessels causing relaxation in blood vessels and decrease in force of contraction

v  SIDE EFFECTS: change in heart rhythm, low blood pressure, fluid retention

Other Antihypertensives v  USED TO TREAT: high blood pressure

Other Antihypertensives v  USED TO TREAT: high blood pressure v  EXAMPLES:

Aldomet(methyldopa) Hytrin(terazosin) Catapres(clonidine) Minipres(prazosin) Wytensin(guanabenz) Cardura(doxazosin) Apresoline(hydralazine) Tenex(guanfacine)



v  HOW IT WORKS: various mechanisms on your body to keep arteries and/or veins relaxed which decreases blood pressure



v  HOW IT WORKS: various mechanisms on your body to keep arteries and/or veins relaxed which decreases blood pressure

v  SIDE EFFECTS: specific each drug including low blood pressure

v Any medication which affect blood pressure could cause blood pressure to drop too much especially when standing. This is called ORTHOSTATIC HYPOTENSION. You may feel dizzy, lightheaded or pass out. To prevent this, change positions slowly. Report these symptoms if it persists after standing a couple of minutes.

Cardiovascular Medications

PART II

Antianginals - Nitrates v  USED TO TREAT: high blood pressure, angina, peripheral vascular

disease


disease v  EXAMPLES:

Nitrostat,Nitroquick-dissolves under the tongue Nitrolingual pumpspray Ranexa(ranolazine) Persantine(dipyridamole) Nitrobid-capsule Isordil/Sorbitrate(isosorbide dinitrate) Ismo/Imdur(isosorbide mononitrate) Nitrol, Nitrodur, Transderm nitro, Minitran, Nitrodisk --medication absorbs through skin




v  HOW IT WORKS: dilates veins in legs which decreases the amount of blood returning to the heart. This decreases the workload of the heart and oxygen needs. It also dilates arteries of the heart, providing more oxygen to heart muscle.




v  HOW IT WORKS: dilates veins in legs which decreases the amount of blood returning to the heart. This decreases the workload of the heart and oxygen needs. It also dilates arteries of the heart, providing more oxygen to heart muscle.

v  SIDE EFFECTS: headache, flushing of skin, low blood pressure

v  The side effects usually diminish over time because your body will build up a tolerance for this drug.

v  May be instructed to remove patch at night to prevent tolerance and decrease effect.

v  Oral tablets should be taken on empty stomach with glass of water.

v  Nitrostat should be placed under tongue at the beginning of your anginal pain. It may be repeated every 5 minutes for a total of three doses.

v  Call 911 with first NTG. EMS will evaluate and transport to emergency room if needed.

v  Nitroglycerin tablets must be protected from heat, light and moisture.

v  Do not use Viagra if taking long-acting or short-acting nitrates.

v  You may take Nitrostat as needed even it you are on longer lasting nitrates (pill or patch). Report any angina to your doctor so that adjustments may be made in your medical plan.

If you experience angina that is not relieved after 5 minutes of resting, which of the following statements is the correct procedure to follow: a)  Take 3 nitroglycerin tablets 5 minutes apart and then

call 911. b)  Take 1 nitroglycerin tablet and call 911; then up to 2

more tablets may be taken (if needed) 5 minutes apart. c)  Take 1 nitroglycerin tablet and wait 5 minutes; take a

second tablet if angina still persists; call 911 if 2 tablets have not relieved the angina.

d)  Try walking briskly to see if the angina worsens.

Inotropes v  USED TO TREAT: congestive heart failure, irregular and

rapid heart beats


rapid heart beats v  EXAMPLES:Lanoxin/Lanoxicap(digoxin)


rapid heart beats v  EXAMPLES:Lanoxin/Lanoxicap(digoxin) v  HOW IT WORKS:slows heart rate and makes pumping

action of heart stronger so more blood is pumped with each beat


rapid heart beats v  EXAMPLES:Lanoxin/Lanoxicap(digoxin) v  HOW IT WORKS:slows heart rate and makes pumping

action of heart stronger so more blood is pumped with each beat

v  SIDE EFFECTS: skipped heartbeats, slow or rapid

heartbeats, loss of appetite, nausea, vomiting, blurred vision, double vision

Antiarrhythmias v  USED TO TREAT: prevention or control of irregularities in

heart rate or rhythm

Normal Sinus Rhythm

SupraVentricular Tachycardia

Atrial Fibrillation

Ventricular Tachycardia


heart rate or rhythm v  EXAMPLES:

Betapace(sotalol) Norpace(disopyramide) Quinaglute/Quinidex(quinidine) Pronestyl(procainamide) Cordarone(amiodarone) Tonocard(tocainide) Ethmozine(moricizine) Mexitil(mexiletine) Rhythmol(propafenone) Tambocar(flecainide) Lanoxin(digoxin) Calan/Isoptin(verapamil) Dilantin(phenytoin) Lidocaine

Multaq(dronedarone)




Multaq(dronedarone) v  HOW IT WORKS: effects the electrical system of the heart

or directly on the heart cells to prevent irregular heart rhythms




Multaq(dronedarone) v  HOW IT WORKS: effects the electrical system of the heart

or directly on the heart cells to prevent irregular heart rhythms

v  SIDE EFFECTS: specific to each drug including skipped heartbeats, slow or rapid heartbeats

v It is important to take antiarrythmic drugs on schedule. If ordered every six hours, wake up during the night to take your dosage.

v Some of these medications will monitored by checking the level of the drug in your blood.

Anticoagulants v  USED TO TREAT: prevention of blood clots in atrial fibrillation,

pulmonary emboli, deep vein thrombosis, heart valve surgery, intravascular stents



v  EXAMPLES: aspirin Persantine(dipyridamole)

Plavix(clopidogrel) Pletal(cilostazol) Brilinta (ticagrelor) Ticlid(ticlopidine)

Effient (pradugrel) heparin Coumadin(warfarin) Lovinox(enoxaparin)

Xarelto (rivaroxaban) Pradaxa (dabigatran) Eliquis (apixaban)







v  HOW IT WORKS: interferes with formation of blood clots. Aspirin and Plavix prevent platelets from clumping together. This process occurs before blood clot. Coumadin blocks one of eight clotting factors. This slows the formation of a blood clot.







v  HOW IT WORKS: interferes with formation of blood clots. Aspirin,Plavix,Brilinta,& Effient prevent platelets from clumping together. This process occurs before blood clot. Coumadin blocks one of eight clotting factors. This slows the formation of a blood clot.

v  SIDE EFFECTS: excessive bleeding, signs of infection

v  Anticoagulants are regulated according to your clotting time (prothrombin time PT or INR). It is very important to keep these appointments and follow-up for lab tests.

v  Should be taken at 5pm daily. v  You should report any bleeding to your doctor including

bleeding gums, black tarry stools, blood in urine, excessive bruising, or sudden pain in head, stomach, or back.

v  There are certain dietary restrictions which the dietician can review with you.

v  You should carry a medic-alert card or wear a tag stating that you are on anticoagulant therapy.

We have detailed teaching available with

video and booklet for Coumadin.

Lipid Lowering Drugs v  USED TO TREAT: hyperlipidemia, high total cholesterol, low HDL,

high triglycerides


high triglycerides v  EXAMPLES:

Lipitor(atorvostatin) Mevacor(lovastatin) Crestor(rosuvastatin) Pravachol(provastatin)

Zetia(ezetimibe) Zocor(simvastatin) Tricor, Lipofen(fenofibrate) Niacin(nicotinic acid) Trilipix(fenofibric acid) Lopid(gemfibrozil) Questran(cholestyranine) Lisol(fluvastatin) Welchol(colesevelam) Colestid(colestipol)

Vytorin(simvastatin&ezetimibe) Lorelco(probucol) Caduet(atorvostatin&amlodipine) fish oil, Omega 3

Praluent (alirocumab) Repatha (evolocumab)




Zetia(ezetimibe) Zocor(simvastatin) Tricor, Lipofen(fenofibrate) Niacin(nicotinic acid) Trilipix(fenofibric acid) Lopid(gemfibrozil) Questran(cholestyranine) Lisol(fluvastatin) Welcol(colesevelam) Colestid(colestipol)


Praluent (alirocumab) Repatha (evolocumab) v  HOW IT WORKS: reduces the levels of fats and cholesterol in

blood to prevent build up on walls of blood vessels




Zetia(ezetimibe) Zocor(simvastatin) Tricor, Lipofen(fenofibrate) Niacin(nicotinic acid) Trilipix(fenofibric acid) Lopid(gemfibrozil) Questran(cholestyranine) Lisol(fluvastatin) Welcol(colesevelam) Colestid(colestipol)


Praluent (alirocumab) Repatha (evolocumab) v  HOW IT WORKS: reduces the levels of fats and cholesterol in

blood to prevent build up on walls of blood vessels v  SIDE EFFECTS: muscle and joint pain(Co-enzyme Q10 may help),

nausea, constipation, alteration in liver function v  These medications should be used only in conjunction with dietary

restriction and exercise.

Smoking Cessation Medications

v  USED TO TREAT: tobacco dependance


v  USED TO TREAT: tobacco dependance v  EXAMPLES: Chantix

Zyban(bupropion SR) Nicorette(nicotine gum) Clonidine nortriptyline Nicotrol Inhaler or NS(nicotine inhaler or nasal spray) Nicoderm CQ/Nicotrol(nicotine patch)




v  HOW IT WORKS: nicotine replacement relieves withdrawal symptoms and urge to smoke without the negative effects of cigarette smoke. Bupropion, clonidine and nortriptyline acts on the pathways in the brain to help cigarette addiction.




v  HOW IT WORKS: nicotine replacement relieves withdrawal symptoms and urge to smoke without the negative effects of cigarette smoke. Bupropion, clonidine and nortriptyline acts on the pathways in the brain to help cigarette addiction.

v  SIDE EFFECTS: irritation to mouth, throat, nose or skin from replacement therapy. Insomnia, dry mouth with bupropion.

v  Begin Zyban 1-2 weeks before quit date. v  Do not smoke cigarettes when wearing nicotine patch.

cardiovascular medications - ejgh

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