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CVD Medications

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Beta Blockers

Uses of Beta Blockers – these medicines usually end with the letters ‘lol’ i.e.  Atenolol, Carvedilol, Metoprono
  • Treatment of high blood pressureControl of angina 
  • Treatment of certain abnormal heart rhythms 
  • Prolonged survival of patients who have had a heart attack 
  • Treatment of hypertrophic cardiomyopathy 
  • Treatment of heart failure 
  • Treatment of migraines 
  • Treatment of essential tremor 
  • Prevention of stage fright 
  • Glaucoma 

When a person is nervous, frightened or physically active, their body produces adrenalin. This makes the heart beat faster and harder. It constricts the blood vessels and raises the blood pressure. It does this by binding to receptors on the membranes of muscle cells in the heart. There are 2 types of these receptors: alpha and beta. All of the beta-blockers block the beta-receptor. Some also block the alpha-receptor. This results is a slowing of the pulse and lower blood pressure. It makes it easier for the heart to work despite narrowed coronary arteries. These effects help control the symptoms of angina.

Side affects

The most common side effects are weakness and drowsiness. These symptoms resolve promptly when the medication is withdrawn. In diabetics, beta-blockers may mask the warning symptoms of low blood sugar..

Beta-blockers may cause wheezing and should be used with caution in patients with asthma, bronchitis or emphysema. Other less frequent effects include feeling sick, skin rashes, impotence, nightmares and dizziness

Overall, beta-blockers are some of the most effective medicines for heart disease, high blood pressure and heart attack survivors and are well tolerated by most people.

Ace Inhibitors

Uses of Ace Inhibitors – these usually end with the letters ‘pril’ i.e. Ramipril, lisinopril

  • Treatment of high blood pressure 
  • Treatment of heart failure 
  • Prolonging survival of patients who have had a heart attack 
  • Preventing deaths, heart attacks and strokes in patients with vascular disease 
  • Prolongng survival of patients with weak heart muscle 
  • Helping leaking heart valves 
  • Preserving kidney function in diabetics 

ACE stands for Angiotensin Converting Enzyme. This enzyme in our bodies activates a hormone called angiotensin. Once activated, this causes blood vessels to constrict. This results in high blood pressure and a strain on the heart.

ACE inhibitors inhibit ACE and prevent the activation of angiotensin. This results in dilated blood vessels and a lower blood pressure. Even in people with normal blood pressure, blocking the activation of angiotensin and dilating blood vessels is effective for treatment of the other conditions listed above.

Side affects

One side effect of these generally well-tolerated agents is a persistent dry cough. If this happens, one can substitute one of the angiotensin blockers. These don't share this side effect but are similar in that they block the effects of angiotensin.

Paradoxically, even though ACE inhibitors preserve kidney function in diabetics, they may cause kidney function to worsen at time. They may also raise the level of potassium in the blood. Angiotensin blockers share these same side effects. If these side effects develop in someone with heart failure, the combination of nitrates and hydralazine is used instead.

They have an anti-inflammatory effect on the walls of the blood vessels.

Diuretics

Uses of Diuretics

  • Treatment of high blood pressure 
  • Treatment of fluid retention 
  • Treatment of heart failure 
  • Prevention of calcium kidney stones 
  • Treatment of Renal Tubular Acidosis 
  • Treatment of Meniere’s disease 

The loop diuretics are usually used for serious fluid overload states such as congestive heart failure. The others are used for more mild fluid retention as well as the other uses listed above.

Loop and thiazide diuretics cause the body to lose potassium and magnesium. Those minerals often need to be supplemented. The potassium sparing diuretics cause the body to retain potassium. The combination diuretics take advantage of these off-setting side effects to help maintain a normal potassium level in the body.

Diuretics may raise the level of bad cholesterol and triglycerides in the blood but this is rarely clinical problem and does not offset their otherwise beneficial effects. The cholesterol and triglycerides can be treated in the usual fashion.

Side effects

Diuretics remove fluid from the body by making people urinate more. This can cause dehydration if too high a dose is taken. Adverse effects on kidney function; serum sodium and serum calcium levels may be seen. They can affect sexual potency in men. However, these medications are safe and well tolerated by the vast majority of patients taking them. Any side effect resolves with discontinuation of the medication.

Nitrates

Use of nitrates

Nitrates work by dilating the veins in the body, which decreases the workload of the heart. They also dilate the arteries in the heart to improve blood flow to the heart muscle. They also have a mild antiplatelet effect.Other nitrates are used on a regular schedule to prevent angina from occurring.

If the body is exposed to nitrates continuously, the body becomes tolerant to them and they stop having any effect at all. Therefore, it essential to have a "nitrate-free" interval every day. This is most commonly done at night, when angina is least likely to occur for most people. Nitropatches may be removed at night and oral nitrates are taken at specified times so their effect wears off at night. If needed, other antianginal medications can be given so that they are in effect during the nitrate-free interval.

Side effects

The most common side effect of nitrates is a headache and facial flushing. This can generally be relieved with acetaminophen (Tylenol) and generally resolves after several days of use.

Statins

Use of Statins- these normally end with the word statin i.e. Simvastatin, Pravastatin, Atorvastatin

These are the cholesterol lowering medications that have been getting a lot press lately. They have the strongest evidence (compared to the other classes of cholesterol lowering medications) that they reduce the future risk of cardiac events and death.

They work by inhibiting an enzyme in the liver that is responsible for manufacturing cholesterol. They primarily lower LDL-cholesterol but also raise HDL-cholesterol levels and sometimes, lower triglyceride levels as well. They differ from one another in terms of their potency. If a low potency statin (fluvaststatin, pravastatin) is lowering the cholesterol level adequately, there is probably no need to change to a higher potency statin (atorvastatin, simvastatin, cerivastatin). Atorvastatin and cerivastatin appear to be the best at lowering triglyceride levels.

Statins have other effects that also help prevent heart disease. These include a mild blood thinning effect and an anti-inflammatory effect on the walls of the blood vessels.

Statins can reduce total cholesterol levels by more than 20% and LDL levels by more than 30%.

Side effects

The main side effect to be alert for is muscle aches and pains. These should be reported to the physician immediately. Blood tests are also monitored periodically for liver dysfunction. This complication is infrequent, readily reversible and rarely serious. Other unwanted side effects of statins can include nausea, vomiting, diarrhoea and head ache

The liver makes cholesterol mostly at night. Therefore, it is recommended that these medications be taken in the evening.

Anticoagulants  (Warfarin)

Clots are made up of platelets (tiny blood cells) clumped together, and a protein called fibrin. Anticoagulants prevent fibrin from forming but, in doing so, they may cause bleeding or make it worse.

Warfarin – used when long-term prevention of clotting is needed. This drug Is most often used for patients with disease of the heart valves.

Side effects

Regular blood test are required to ensure that clotting activity of the blood is within safe but effective levels. Oral anticoagulants may interact with other medicines such as antibiotics, aspirin, cimetidine etc.

Alcohol increases the effect of warfarin, so it Is important to avoid excessive or binge drinking.

Aspirin

Use of Aspirin

Aspirin has been used to relieve pain for more than 100 years, but it is also effective in preventing blood from clotting. It achieves this by reducing the ‘stickiness’ of platelets – the small blood cells that can clump together to form a clot. It can help with a wide range of coronary heart conditions.

Side effects

Anti-platelet drugs can cause indigestion, nausea and vomiting. More seriously, they can provoke or worsen bleeding from the stomach. Occasionally they can cause an asthma attack.

Calcium Channel Blockersi.e. Verapamil, Diltiazem

Calcium-channel blockers (sometimes called calcium-antagonists) are a group of drugs that affect the way calcium passes into certain muscle cells. They are used to treat various conditions including high blood pressure, angina, Raynaud's phenomenon, and some arrhythmias (abnormal heart rhythms).

A calcium-channel blocker can be used alone. However, one is often combined with another drug (such as a beta-blocker) to treat high blood pressure or angina when one drug alone has not worked so well.

Side effects

Most people who take calcium-channel blockers have no side-effects, or only minor ones. Because of their action to relax and widen arteries, some people develop flushing and headache. Mild ankle swelling is also quite common, particularly with dihydropyridine calcium-channel blockers.

Constipation is quite a common side-effect, especially with verapamil. You can often deal with this by increasing the amount of fibre that you eat, and increasing the amount of water and other fluids that you drink.

Other side-effects are uncommon and include: feeling sick, palpitations, tiredness, dizziness, and rashes