Drug types

Cardiac glycosides | Antiarrhythmics | Antianginals | Antihypertensives

a human heartWhat are cardiovascular drugs?

Cardiovascular drugs encompass a large number of prescription medications that are used to control heart disease. It is a complicated group of drugs with many being used for multiple heart conditions.

For example, Propranolol is a common cardiovascular drug that can be used to treat hypertension as well as arrhythmias.

You may also encounter patients who have one or more cardiovascular conditions such as CHF, hypertension and an arrhythmia. These patients may be taking multiple medications for each condition.

If you look at the list of Top 200 drugs, you will find that 25% of those drugs are cardiovascular drugs, which is another good reason to become familiar with these drugs and how they might interact with other medications.

Cardiac glycosides

Cardiac (digitalis) glycosides are commonly used in the treatment of congestive heart failure (CHF). Consult the table below for more information on their mechanism of action and adverse effects.

Drug

Mechanism

Adverse effects

digoxin (Lanoxin)

 

  • increases force & strength of myocardial contractions

  • makes heart a more efficient pump

  • increases cardiac output

  • reduces heart size, helping it function more effectively

  • removes & eliminates from body fluid accumulated in tissues

  • extreme toxicity
  • increased salivation
  • increased gag reflex
  • anorexia, nausea, vomiting
  • headache
  • drowsiness, weakness, faintness
  • visual changes (halo around lights)
  • confusion

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Antiarrhythmic agents

Antiarrhythmic drugs are used in the treatment of arrhythmias (abnormal rhythms of the heart).

Drugs

Mechanism

Adverse effects

Prevents transmission of impulse

  • headache
  • drowsiness
  • lightheadedness
  • depression
  • confusion
  • bradycardia
  • sleep disturbances
  • fatigue
  • hypotension
  • diarrhea
  • nausea
  • constipation
  • rash
  • dermitis

Caution:
the difference between a therapeutic dosage and a life-threatening one is very small.

beta-adrenergic blocking agents
  • acebutolol
    (Monitan, Sectral)
  • propranolol
    (Inderal)

 

Blocks beta-adrenergic receptors & depresses transmission of impulse

 

Alters rate of conduction

acts as calcium channel blocker & slows conduction velocity

Note: digoxin is used to treat arrythmias in some patients. See previous section for more information regarding cardiac glycosides.

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Antianginal agents

Nitroglycerin-like compounds were initially the only drugs capable of relieving the symptoms of angina, but now other classes of drugs (beta-adrenergic blocking agents & calcium channel blockers) are equally as effective.

Note: drugs do not cure the condition and angina can occur at anytime, so it is important for you to know how to manage an angina attack that occurs in the dental office.

Drugs

Mechanism

Adverse effects

Nitroglycerin-like compounds

Taken to ...

  • treat acute attacks
  • prevent attacks (prophylactically)

  • decrease workload of heart by decreasing cardiac output, peripheral vascular resistance, or both

  • decrease oxygen requirement of heart muscle & relieve symptoms

  • severe headaches
  • flushing
  • hypotension
  • lightheadedness
  • fainting

Beta-adenergic blockers:

  • propranolol
    (Inderal)
  • metoprolol
    (Lopressor)
  • atenolol
    (Tenormin)
  • block response to catecholamine stimulation

  • decrease myocardial oxygen demands

  • bradycardia
  • headache
  • weakness
  • xerostomia
  • blurred vision
  • unpleasant dreams

Calcium channel blockers:

  • verapamil
    (Calan, Isoptin)
  • nifedipine (Procardia, Adalat)
  • diltiazem
    (Cardizem)

inhibit movement of calcium ions during cardiac & vascular smooth muscle contraction

  • dizziness
  • weakness
  • constipation
  • hypotension
  • gingival hyperplasia
  • taste alterations

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Antihypertensive agents

Antihypertensive medications control blood pressure by several different mechanisms. In many cases, several different classes of hypertensive drugs are used to maintain adequate control of the person’s blood pressure.

Drugs

Mechanism

Adverse effects

Diuretics:

increase sodium & water excretion by kidneys

  • hypokalemia
  • hyperuricemia
  • hyperglycemia
  • hypercalcemia
  • anorexia
  • oral lichenoid reactions

Beta-adrenergic blockers:

  • propranolol
    (Inderal)
  • metoprolol
    (Lopressor)
  • atenolol
    (Tenormin)

decrease cardiac output & peripheral vascular resistance

  • bradycardia
  • depression
  • confusion
  • hallucinations
  • dizziness
  • fatigue
  • diarrhea, nausea, vomiting
  • xerostomia

ACE inhibitors:

  • captopril
    (Capoten)
  • enalapril
    (Vasotec)
  • lisinopril
    (Prinivil, Zestril)

block an enzyme in the kidneys

This...

  • reduces vasoconstriction
  • stimulates water excretion
  • dizziness
  • fainting, lightheadedness
  • insomnia
  • fatigue
  • headache
  • nausea, vomiting
  • diarrhea
  • dry cough
  • xerostomia
  • rash
  • angioedema
  • taste alternations

Calcium channel blockers:

  • verapamil
  • nifedipine
    (Procardia)
  • amiodipine
    (Norvasc, Lotrel)

prevent entry of calcium into cardiac and smooth muscle cells

This ...

  • results in vasodilation,
  • which lowers blood pressure
  • dizziness
  • fainting, lightheadedness
  • headache
  • nausea, vomiting
  • constipation
  • bradycardia
  • flushing
  • edema
  • xerostomia
  • gingival hyperplasia

 

Alpha-adrenergic blockers:

cause vasodilation

This ...

  • decreases blood pressure
  • orthostatic hypotension
  • dizziness
  • depression
  • fainting
  • drowsiness
  • excitation & headache
  • tachycardia
  • arrhyhthmias
  • palpitations
  • sedation
  • xerostomia

Learn more about the hypertension drugs.


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