CALCIUM CHANNEL BLOCKERS
Calcium channel blockers, or calcium antagonists, treat a variety of conditions, such as high blood pressure, migraines and Raynaud’s disease.
Calcium channel blockers prevent calcium from entering cells of the heart and blood vessel walls. This results in lower blood pressure. Calcium channel blockers, also called calcium antagonists, relax and widen blood vessels by affecting the muscle cells in the arterial walls.
Some of the medications in this class have the added benefit of slowing your heart rate, which can further lower blood pressure.
Examples of calcium channel blockers
There are two types of calcium channel blockers: short-acting and long-acting. Short-acting medications work quickly, but their effects last only a few hours. Long-acting medications take longer to start working, but their effects last longer.
Several calcium antagonists are available. Which one is best for you depends on your health and the condition being treated.
Examples of calcium antagonists include:
- Amlodipine (Norvasc)
- Diltiazem (Cardizem, Dilacor XR)
- Nifedipine (Adalat, Procardia)
- Verapamil (Calan, Isoptin, Verelan, Covera)
Under special circumstances, your doctor might prescribe a calcium channel blocker along with other high blood pressure drugs or with cholesterol-lowering drugs such as statins.
Uses for calcium channel blockers
Doctors prescribe calcium channel blockers to prevent, treat or improve symptoms in a variety of conditions, such as:
- High blood pressure
- Chest pain (angina)
- Migraines
- Brain aneurysm complications
- Irregular heartbeats (arrhythmia)
- Raynaud’s disease
- Pulmonary hypertension
Side effects and cautions
Side effects of calcium channel blockers include constipation, headache, rapid heartbeat, rash, drowsiness, flushing, nausea, and swelling in the feet and lower legs.
Certain calcium channel blockers interact with grapefruit products. Don’t take these medications with grapefruit or grapefruit juice because they can reduce your liver’s ability to eliminate calcium channel blockers from your body, allowing the medications to build up in your body.
Aspirin, Beta Blockers, and Ace Inhibitors
I will refer to Heart Attack Prevention Series for this information as and additional.
BETA BLOCKERS
Beta blockers
Beta blockers, also called beta-adrenergic blocking agents, treat a variety of conditions, such as high blood pressure, glaucoma and migraines.
Beta blockers reduce blood pressure. Beta blockers work by blocking the effects of the hormone epinephrine, also known as adrenaline. As a result, the heart beats more slowly and with less force, thereby reducing blood pressure. Beta blockers also help blood vessels relax and open up to improve blood flow.
Examples of beta blockers
Some beta blockers mainly affect your heart, while others affect both your heart and your blood vessels. Which one is best for you depends on your health and the condition being treated.
Beta blockers are also known as beta-adrenergic blocking agents.
Examples of beta blockers include:
- Atenolol (Tenormin)
- Metoprolol (Lopressor, Toprol-XL)
- Propranolol (Inderal, Inderal LA)
Uses for beta blockers
Doctors prescribe beta blockers to prevent, treat or improve symptoms in a variety of conditions, such as:
- High blood pressure
- Irregular heart rhythm (arrhythmia)
- Heart failure
- Chest pain (angina)
- Heart attacks
- Glaucoma
- Migraines
- Generalized anxiety disorder
- Hyperthyroidism
- Certain types of tremors
Side effects and cautions
Common side effects of beta blockers include fatigue, cold hands, dizziness and weakness. Less common side effects include shortness of breath, trouble sleeping, loss of sex drive and slow heartbeat.
Beta blockers generally aren’t used in people with asthma because of concerns that the medication may trigger severe asthma attacks.
Beta blockers can also affect your lipid levels, causing a slight increase in triglycerides and a modest decrease in high-density lipoprotein, the “good” cholesterol. These changes often are temporary. You should not abruptly stop taking a beta blocker because doing so could increase your risk of a heart attack or other heart problems.
Refer also to BETA BLOCKERS
Integrilin(EPTIFIBATIDE)
What is eptifibatide injection?
EPTIFIBATIDE (Integrilin®) prevents your blood from clotting during episodes of chest pain or a heart attack, or while you are undergoing a procedure to treat a blocked coronary artery.
Eptifibatide is a cyclic heptapeptide containing six amino acids and one mercaptopropionyl (des-amino cysteinyl) residue. An interchain disulfide bridge is formed between the cysteine amide and the mercaptopropionyl moieties. Chemically it is N 6 -(aminoiminomethyl)-N 2 -(3-mercapto-1-oxopropyl-L- lysylglycyl-L-a-aspartyl- L-tryptophyl-L -prolyl-L-cysteinamide, cyclic (1Ø6)-disulfide. Eptifibatide binds to the platelet receptor glycoprotein(GP) IIb/IIIa of human platelets and inhibits platelet aggregation.
INDICATIONS
INTEGRILIN is indicated:
- For the treatment of patients with acute coronary syndrome(UA/NQMI), including patients who are to be managed medically and those undergoing percutaneous coronary intervention(PCI). In this setting, INTEGRILIN has been shown to decrease the rate of a combined endpoint of death or new myocardial infarction.
- For the treatment of patients undergoing PCI. In this setting, INTEGRILIN has been shown to decrease the rate of a combined endpoint of death, new myocardial infarction or need for urgent intervention.
COMPLICATION
Bleeding. Bleeding is the most common complication encountered during eptifibatide therapy. Administration of eptifibatide is associated with an increase in major and minor bleeding, as classified by the criteria of the Thrombolysis in Myocardial Infarction.Most major bleeding associated with eptifibatide has been at the arterial acces site for cardiac catheterization or from the gasstrointestinal or genitourinary tract.
In patients undergoing percutaneous coronary interventions, patients receiving eptifibatide experience an increased incidense of major bleeding. Special care should be employed to minimize the risk of bleeding among these patients.If bleeding cannot be controlled with pressure, infusion of eptifibatide and concomitant heparin should be stopped immediately.
Renal Insufficiency. Approximately 50% of eptifibatide is cleared by the kidney in patients with normal renal function. Total drug clearance is decreased by approximately 50% and steady-state plasma eptifibatide concentrations are doubled in patients with an estimated creatinine clearance 2 mg/dL .
Platelet Count<100,000/mm3. Because it is an inhibitor of platelet agregation,caution should be exercised when administering eptifibatide to patients with a platelet count <100,000/mm3 ; there has been no clinical experience with eptifibatide initiated in patients with a platelet count <100,000/mm3.
Nitro-Bid IV, Tridil infusion
Brand Name(s): Nitro-Bid IV, Tridil
Generic Name Nitroglycerin Injection
What is nitroglycerin injection?
NITROGLYCERIN (Nitro-Bid® IV, Tridil®) is a type of vasodilator. It relaxes blood vessels, increasing the blood and oxygen supply to your heart. Nitroglycerin infusions are used to help relieve the pain associated with angina that does not respond to oral (by mouth) treatment; to control blood pressure; and to help treat congestive heart failure. Generic nitroglycerin injections are available.
INDICATIONS
- relief of refractory or unstable angina, control of congestive heart failure
- control of hypertension during coronary artery bypass graft surgery
- management of hypertensive emergency
- as a premedication, diagnostic tool and for the treatment of angina in cardiac catheter lab
- acute myocardial infarction
ROUTES OF ADMINISTRATION
- Nitroglycerin injection must be diluted before use to a concentration not exceeding 400 mcg/mL
- IV Infusion: Starting with a concentration of 200 mcg/mL (50 mg in a 250 mL D5W) the rate of administration using a volumetric pump can be calculated as:
Number of mL/hour = [Desired dose (mcg/min) x 60 (min/hr)] / concentration (i.e. 200 mcg/mL)
- The infusion may be increased to an approximate concentration of 400 mcg/mL (100 mg in 250 mL D5W) if necessary in fluid restricted patients
ADMINISTRATION POLICY
Use is restricted to Critical Care Areas
ECG monitoring required during IV administration.
The IV infusion administration rate MUST be controlled by an automated infusion control device.
DOSAGE
- there is no fixed optimum dose of nitroglycerin; each patient must be titrated to response
- Usual dose – 0.2 – 1.5 mcg/kg/minute
-
initial dosage: 0.2 mcg/kg/min with increases in increments of 0.1 mcg/kg/min every 3-5 minutes until response is noted; if no response is seen at 0.3 mcg/kg/min, increments of 0.2-0.4 mcg/kg/min can be used
ALTERNATELY,
- initial dosage; 5 mcg/minute with increases in increments of 5 mcg/minute every 3-5 minutes until response is noted; if no response is seen at 20 mcg/min, increments of 10 and later 20 mcg/min can be used
- once a partial response is observed, the dose increase should be reduced and the interval between increases lengthened
POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION
- headache, severe hypotension, reflex tachycardia
IMPORTANT IMPLICATIO
- adequate systemic blood pressure and coronary perfusion must be maintained
- contraindicated in hypotension, uncorrected hypovolemia, increased intracranial pressure, constrictive pericarditis and pericardial tamponade
GTN Sublingual
GTN contains the active ingredient glyceryl trinitrate.Glyceryl trinitrate works by releasing a chemical called nitric oxide which also made naturally by the body and has the effect of making the veins and arteries relax and widen (dilate). This increases the space within the blood vessels and therefore reduces the resistance within the blood vessels, which makes it easier for the heart to pump blood around the body.
Widening the veins also decreases the volume of blood that returns to the heart in the veins with each heartbeat, and this makes it easier for the heart to pump that blood out again. As a result of both these actions, the heart requires less energy to pump the blood around the body and therefore does not need as much oxygen.
The medicine also widens the arteries within the heart, and this increases the blood and oxygen supply to the heart muscle.
The pain of angina is caused by too little oxygen reaching the heart when its workload increases, such as during exercise. Glyceryl trinitrate makes it easier for the heart to pump blood and so decreases the amount of oxygen that the heart needs, as well as improving the oxygen supply to the heart. It can therefore be used to relieve the pain of an angina attack.
Glyceryl trinitrate is taken as a tablet that is dissolved under the tongue, or as a spray that is sprayed under the tongue which has a large supply of blood vessels that allows the medicine to be rapidly absorbed. Glyceryl trinitrate taken in this way is used to give rapid relief from an angina attack, and can also be used to prevent an anticipated attack, for example before exercise.
Glyceryl trinitrate is also available as long acting tablets, skin patches and ointment that are used regularly each day to help prevent angina attacks.
Plavix
PLAVIX is a prescription medicine that when taken daily can help reduce your risk of having a future heart attack or stroke. It is recommended for people who have suffered from a recent heart attack or recent stroke, or who have been diagnosed with peripheral artery disease, or P.A.D.—poor circulation in the legs that may cause pain during exercise, such as walking, and may be relieved by rest.*
PLAVIX, taken with aspirin, is also recommended for people who have been hospitalized with heart-related chest pain or had a certain type of heart attack (non–Q-wave MI)—conditions doctors call Acute Coronary Syndrome (ACS).
PLAVIX helps keep platelets in the blood from sticking together and forming clots, which helps keep your blood flowing. This helps protect you from a future heart attack or stroke.
Aspririn
Aspirin is in a group of drugs called salicylates (sa-LIS-il-ates). It works by reducing substances in the body that cause pain, fever, and inflammation.
Aspirin is used to treat mild to moderate pain, and also to reduce fever or inflammation. Aspirin is sometimes used to treat or prevent heart attacks, strokes, and chest pain (angina). Aspirin should be used for cardiovascular conditions only under the supervision of a doctor.
Aspirin may also be used for purposes other than those listed in this medication guide.
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