Cardiac and Diuretic Drugs to Know on the floor...

 

DIURETICS

CHEMICAL NAME	BRAND NAME(S)
LOOP DIURETICS
BUMETANIDE	BUMEX
ETHACRYNIC ACID	EDECRINE
FUROSEMIDE	LASIX
TORSEMIDE	DEMADEX
THIAZIDE DIURETICS
CHLORTHALIDONE	THALITONE
CHLORTHIAZIDE	DIURIL
HYDROCHLORTHIAZIDE (HCTZ)	ESIDRIX, HYDRODIURIL, MICROZIDE, ORETIC
HYDROFLUMETHAZIDE	DIUCARDIN
INDAPAMIDE	LOZOL
METALAZONE	MYKROX, ZAROXYLYN
METHYCLOTHIAZIDE	ENDURON
POLYTHIAZIDE	RENESE (a component of MINIZIDE)
POTASSIUM SPARING
AMILORIDE	MIDAMOR
SPIRONOLACTONE	ALDACTONE
TRIAMTERENE	DYRENIUM
COMBINATION
AMILORIDE + HCTZ	MODURETIC
SPIRONOLACTONE + HCTZ	ALDACTAZIDE
TRIAMTERENE + HCTZ	DYAZIDE, MAXIDE

Diuretics are also combined with other blood pressure lowering agents. These combination medications are listed on the pages for those other agents. Diuretics are also known as water pills because they remove fluid from the body.

USES OF DIURETICS

·         TREATMENT OF HIGH BLOOD PRESSURE

·         TREATMENT OF FLUID RETENTION (including heart failure, kidney failure, cirrhosis)

·         PREVENTION OF CALCIUM KIDNEY STONES

·         TREATMENT OF NEPHROGENIC DIABETES INSIPIDUS

·         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. See LOWERING CHOLESTEROL LEVELS and CHOLESTEROL LOWERING MEDICATIONS.
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 fuction, 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.
Spironolactone is a diuretic that also inhibits the effects of a hormone called aldosterone. This hormones is deleterious to failing hearts. Spironolactone has been shown to improve symptoms and survival in patients with severe heart failure due to weakened heart muscle independent of and in addition to its fluid removing effects.

BLOOD PRESSURE MEDICATIONS

These include:

·         ACE Inhibitors

·         Angiotensin Blockers

·         Beta Blockers

·         Calcium Channel Blockers

·         Diuretics

As well as the following:

CHEMICAL NAME	BRAND NAME(S)
ALPHAMETHYLDOPA (METHYLDOPA)	ALDOMET, *ALDOCLOR, *ALDORIL
CLONIDINE	CATAPRES, *COMBIPRES
DOXAZOSIN	CARDURA
GUANABENZ	WYTENSIN
GUANADREL	HYLOREL
GUANETHEDINE	ESIMIL, ISMELIN
GUANFACINE	TENEX
HYDRALAZINE	*APRESAZIDE, APRESOLINE, *HYDRAZIDE, SER-AP-ES (in combination with reserpine and HCTZ)
MECAMYLAMINE	INVERSINE
MINOXIDIL	MINOXIDIL
PHENOXYBENZALINE	DIBENZALINE
PRAZOSIN	MINIPRESS, *MINIZIDE
RESERPINE	*DIUPRES, *DIUTENSIN-R, *HYDROPRES, SER-AP-ES (in combination with hydralazine and HCTZ)
TERAZOSIN	HYTRIN

* in combination with a diuretic.
Alphamethyldopa, clonidine, and guanfacine act on the brain to lower blood pressure.
Doxazosin, guanadrel, guanethedine, mecamylamine,phenoxybenzaline, prazosin, and terazosin act on the nerves that innervate smooth muscle in the walls of the blood vessels so that the vessels dilate and blood pressure drops.
Hydralazine and minoxidil directly act on the smooth muscle in the walls of blood vessels to dilate them and lower blood pressure.
Reserpine reduces the level of adrenalin-like substances in the body.
Terazosin is also commonly used to treat voiding problems in men with enlarged prostate glands.
Minoxidil has the side effect of causing hair growth and is now most commonly used as a treatment for baldness.
High blood pressure may also respond to lifestyle changes.

ACE INHIBITORS

CHEMICAL NAME	BRAND NAME(S)
BENAZEPRIL	LOTENSIN, *LOTENSIN HCT, LOTREL (in combination with AMLODIPINE)
CAPTOPRIL	CAPTOTEN, *CAPOZIDE
ENALAPRIL	VASOTEC, *VASERETIC, LEXXEL (in combination with FELODIPINE), TECZEM (in combination with DILTIAZEM)
FOSINOPRIL	MONOPRIL
LISINOPRIL	PRINIVIL, *PRINIZIDE, ZESTRIL, *ZESTORETIC
MOEXIPRIL	UNIVASC, *UNIRETIC
PERINDOPRIL	ACEON
QUINAPRIL	ACCUPRIL
RAMIPRIL	ALTACE
TRANDOLAPRIL	MAVIK, TARKA (in combination with VERAPAMIL)

*These are in combination with a thiazide diuretic.

USES OF ACE INHIBITORS

·         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 AND IN DIABETICS WITH OTHER VASCULAR RISK FACTORS

·         PROLONGING 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.
One side effect of these generally well tolerated agents is a persistant 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.

CALCIUM CHANNEL BLOCKERS

CHEMICAL NAME	BRAND NAME(S)
AMLODIPINE	NORVASC, LOTREL (in combination with BENAZEPRIL)
BEPRIDIL	VASCOR
DILTIAZEM	CARDIZEM, CARTIA, DILACOR, DILTIA, TIAMATE, TIAZAC, TECZEM (in combination with ENALAPRIL)
FELODIPINE	PLENDIL, LEXXEL (in combination with ENALAPRIL)
ISRADAPINE	DYNACIRC
MIBEFRADIL*	POSICOR*
NICARDIPINE	CARDENE
NIFEDIPINE	ADALAT, PROCARDIA
NIMODIPINE	NIMOTOP
NISOLDIPINE	SULAR
VERAPAMIL	CALAN, COVERA-HS,  ISOPTIN, VERELAN, TARKA (in combination with TRANDOLAPRIL)

*Voluntarily withdrawn from market by manufacturer.

USES OF CALCIUM CHANNEL BLOCKERS

·         LOWERING BLOOD PRESSURE

·         CONTROLLING ANGINA

·         TREATING CERTAIN TYPES OF ABNORMAL HEART RHYTHMS

·         TREATING A CONDITION KNOWN AS HYPERTROPHIC CARDIOMYOPATHY

·         PREVENTING MIGRAINES

·         PREVENTING VASCULAR SPASM AFTER BRAIN HEMORRHAGES

Movement of calcium ions across cell membranes is crucial to the functioning of muscle in the heart and blood vessels as well as the electrical conduction system of the heart.
Calcium Channel Blockers (CCBs) , as the name implies, block the influx of calcium into cells. This relaxes the muscle in the walls of arteries, resulting in dilation of arteries. This, in turn, lowers the blood pressure and improves the blood supply to the heart. They also relax the heart muscle. All of these effects allow the heart to make do with a reduced blood supply and help treat the symptoms of angina.
Some CCBs (diltiazem, mibefradil, verapamil) slow the heart rate, which further helps to control angina. Diltiazem and verapamil are also helpful in controlling abnormally fast heart rhythms.
Bepridil can cause abnormal heart rhythms and use is reserved for people with angina who have exhausted other treatment options.
The most common side effect from verapamil is constipation.
Side effects from diltiazem are quite rare.
The most common side effects of the others include dizziness, flushing, headaches and swelling of the ankles. The exact incidence depends on which CCB is used. In most people, they are well tolerated.
Some time ago, there were reports that use of CCBs in high blood pressure patients may increase the risk of a heart attack. Those studies suffered from methodological flaws. There is no clear evidence that these medicines are dangerous if used properly.

BETA BLOCKERS

CHEMICAL NAME	BRAND NAME(S)
ACEBUTOLOL	SECTRAL
ATENOLOL	TENORMIN, *TENORETIC
BETAXOLOL	KERLONE
BISOPROLOL	ZEBETA, *ZIAC
CARTEOLOL	CARTROL
CARVEDILOL**	COREG
ESMOLOL	BREVIBLOC (only available for intravenous use)
LABETOLOL***	NORMODYNE, TRANDATE
METOPROLOL	LOPRESSOR, *LOPRESSOR HCT, TOPROL
NADOLOL	CORGARD
PENBUTOLOL	LEVATOL
PINDOLOL	VISKEN
PROPRANOLOL	INDERAL, *INDERIDE
TIMOLOL	BLOCADREN, *TIMOLIDE, TIMOPTIC (eye drops)

* These are a combination of the beta blocker with a diuretic for the control of blood pressure.
**This is also an alpha blocker and a free radical scavenger. It has been specifically developed as a treatment for heart failure.
***This is a combined alpha and beta blocker and also dilates arteries.

USES OF BETA BLOCKERS

·         TREATMENT OF HIGH BLOOD PRESSURE

·         CONTROL OF ANGINA

·         TREATMENT OF CERTAIN ABNORMAL HEART RHTHMS

·         PROLONGING SURVIVAL OF PATIENTS WHO HAVE HAD A HEART ATTACK

·         TREATMENT OF HYPERTROPHIC CARDIOMYOPATHY

·         TREATMENT OF HEART FAILURE

·         TREATMENT OF VASOVAGAL FAINTING

·         TREATMENT OF MIGRAINES

·         TREATMENT OF ESSENTIAL TREMOR

·         PREVENTION OF BLEEDING FROM ESOPHAGEAL VARICES

·         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.
The most common side effects are weakness and drowsiness. These symptoms reslove promptly when the medication is withdrawn. In diabetics, beta blockers may mask the warning symptoms of low blood sugar.
Some beta blockers may raise the level of triglycerides and lower the level of good cholesterol 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. See LOWERING CHOLESTEROL AND FAT LEVELS and CHOLESTEROL LOWERING MEDICATIONS.
Beta blockers may cause wheezing and should be used with caution in patients with asthma, bronchitis or emphysema.
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.