PTCE: The Basics of Medications - Cardiovascular Agents

Table: USAN Stems for Cardiovascular Agents
This table reviews commonly used USAN stems for cardiovascular agents.

The ACE (angiotensin-converting enzyme) inhibitors prevent the conversion of angiotensin I to angiotensin II. This inhibition results in vasodilation and indirectly inhibits the increase of fluid from aldosterone. Medications in this class end in the suffix “-pril” and include lisinopril (Prinivil, Zestril). Common side effects include hyperkalemia (an increase in serum potassium), a dry hacking cough, rash, and hypotension.

Beta blockers, such as atenolol (Tenormin), block the stimulatory effects of epinephrine by exerting antagonist effects on beta-1 and beta-2 receptors. Medications such as atenolol (Tenormin) are used as antihypertensive agents to reduce the workload of the heart and to reduce blood pressure. Common side effects include drowsiness, weakness, and dry mouth. Caution should be observed in patients with diabetes because these agents have been found to mask symptoms of hypoglycemia. Calcium channel blockers (CCB) block the entry of calcium into the heart muscle and vessel walls. The conduction of electrical signals depends on the movement of calcium into the cell. A blockage of calcium results in relaxation of the vessel wall, causing dilation of the arteries. The relaxed vessels allow blood to flow easier, thereby lowering blood pressure.

Medications that reduce the strength and rate of the heart’s contraction include diltiazem (Cardizem) and verapamil (Isoptin, Calan). These drugs are primarily used as antiarrhythmics. Amlodipine (Norvasc) is recommended for the treatment of heart failure due to its vasodilatory effects. CCB side effects include edema, rash, hypotension, and gingivitis. Patients should be advised to avoid concomitant consumption of grapefruit juice to avoid increased serum concentrations of the CCB. Diuretic agents promote the excretion of salt and water from the kidneys, thus, resulting in an increase in urine production. These agents are generally used to treat hypertension and CHF (congestive heart failure). Loop diuretics, including furosemide (Lasix), prevent the reabsorption of chloride and sodium in the loop of Henle. Both thiazide and potassium-sparing diuretics exert effects on the distal convoluted tubules. Thiazide diuretics, such as hydrochlorothiazide (Microzide), prevent the reabsorption of sodium, whereas potassium-sparing diuretics prevent an excessive loss of sodium ions. Thiazide diuretics may cause photosensitivity, dizziness, blurred vision, and hypokalemia. Potassium-sparing diuretics may cause hyperkalemia, diarrhea, rash, edema, and—in some cases—gynecomastia (an enlargement of breasts in males).

Statins are a class of antihyperlipidemics that inhibit the enzyme HMG-CoA reductase, resulting in decreased cholesterol production. This class includes agents such as atorvastatin (Lipitor) and simvastatin (Zocor). These agents are commonly taken at night when the body produces endogenous cholesterol. Side effects may include muscle pain and weakness, hyperglycemia, rash, flushing, and liver damage.

Nitrates, such as nitroglycerin (Nitrostat), are vasodilator agents that are used to prevent and treat angina, a heart condition that occurs when blood and oxygen flow to the heart is impaired. These agents relax and widen blood vessels to improve blood and oxygen flow to the heart. Side effects of this class include headaches, facial flushing, postural hypotension, and reflex tachycardia.

Thrombolytic drugs are also called plasminogen activators or fibrinolytic drugs due to mechanisms used to dissolve blood clots. These agents activate plasminogen, forming a product called plasmin. This resulting compound is an enzyme that breaks cross-links between fibrin molecules, resulting in the compromised structural integrity of a blood clot.

NOTE Sublingual nitroglycerin should be kept in the original container and at room temperature away from heat, light, and moisture. Pharmacy technicians may be required to label the medication container along with the prescription vial. Make sure to check with your pharmacist for state-specific requirements.

Table: Cardiovascular Agents