Ep181: A&P: 9 Common Cardiac Medication Classes

cardiac medications by class
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Today I want to talk about nine common classes of cardiac meds, that you’re going to need to understand, and you’re going to need to know at a very high level.

We’re going to talk about these meds at a very upper level, what’s going on, why we give these meds, and really what you need to know about them. Again, we’re going to cover nine common classes of cardiac medications.

A lot of times with our heart attack we have that mnemonic, MONA, which is immediate treatment for heart attack.

One of that’s going to be the “N” in MONA is nitrates. What it’s going to do is it’s really going to try to massively dilate the vessel to allow blood to flow. That’s when we would give it, we could give it for that.

Also, if someone has a hypertensive crisis we can give them hydralzine. There’s a lot of things that we can do, and what these, the primary primary purpose of these is to relax the vessels.

 

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Podcast Transcription

Today I want to talk about nine common classes of cardiac meds, that you’re going to need to understand, and you’re going to need to know at a very high level. We’re going to talk about these meds at a very upper level, what’s going on, why we give these meds, and really what you need to know about them. Again, we’re going to cover nine common classes of cardiac medications.

 

The first class is anti-coagulants. We’re also going to talk about anti-platelet agents. We’re going to talk about ACE inhibitors. We’re going to talk about ARBs, beta-blockers, combined Alpha-Beta blockers, calcium channel blockers, digitalis, and vasodilators. There are a lot of other kinds of medications you’re going to give for cardiac patients, but these are nine of the most common. Many patients have cardiac conditions, right? Remember when we were talking about patients in the hospital. These are the medications you’re going to see, you’re going to give, for any patient that has different cardiac issues.

 

The first class we’re going to talk about is anti-coagulants. What these medications do is they actually decrease clotting. The role of anti-coag is to decrease clotting by interrupting the clotting cascade. These all are going to work in different ways, but some of the medications in this class are Heparin, you also have Warfarin or Coumadin, you have Eliquis, which is apixaban, and then you have Xarelto, which is rivaroxaban. These four medications are four of the most common anti-coagulants you’re going to see, and you’re going to give your patient. Again, what these really do, and they work in different ways, but they work by interrupting that clotting cascade.

 

Next is anti-platelet agents, and these work by preventing clots. They prevent the aggregation of platelets. The two most common ones you’re going to see here are aspirin and Clopidogrel, or Plavix. Aspirin is a very common one, aspirin is one that is given for patients that are at risk of heart attack, that have had ischemic strokes, and so this is a really common one that you’re going to see a lot of patients get. If we really want to work on clot prevention we’re going to start these patients on Plavix, and they’re going to take that as well. Really important to let these patients understand to watch for signs of bleeding as we’re interrupting that clot prevention. We really want to let them know to watch for that at home.

 

Another very common class of medications that we need to understand, we need to take about, are ACE inhibitors. What ACE inhibitors do, we know that what ACE inhibitor stands for is angiotensin-converting enzyme inhibitor. What angiotensin wants to do, angiotensin I is going to come into the lungs, there’s an enzyme there that’s going to covert angiotensin I to angiotensin II, and that’s going to have an affect to constrict our vessels. What ACE inhibitors do is they actually prevent that conversion of angiotensin I to angiotensin II, preventing that constriction of the vessels.

 

Some of the common medications, and what you really need to watch for here are prils. Any medication that ends in the suffix pril is going to be ACE inhibitor. The common ones are going to be Captopril, Enalapril, and Lisinopril, so those are going to be some of the common ones you’re going to give for these patients. Again, you’re going to see this a lot in patients with hypertension, and it’s going to really help to prevent the constriction of the vessels.

 

Another common medication that works similar to ACE inhibitors is ARBs. These are angiotensin receptor blockers. What these are really going to do is they’re going to prevent angiotensin from binding to the site that it wants to be on to constrict the vessel. It blocks that receptor site for angiotensin. These are going to end in sarten; Losarten, Dalsarten. In my experience I’ve seen the ACE inhibitors used a bit more than the ARBs, but ARBs are definitely another medication you’re going to see for this.

 

Another common medication class that we need to talk about are beta-blockers. What beta-blockers really do, and what they’re trying to do as end effect, is they’re trying to decrease cardiac output and heart rate. These are going to end in the olol. We have Metoprolol, which is Lopressor. We have Propranolol, which is Inderal, and then we have Atenolol, which is Tenormin.

 

Again, what these medications do, you know beta-blockers right? What they’re going to do is they’re really going to try to block this response in our heart to beat faster and everything. What it’s really going to do is it’s going to slow that fight or flight response, and so that’s where beta-blockers are going to work. They’re going to block the beta-receptor sites within the heart and the vessels.

 

Then we also have our combined alpha-beta blockers. Where this is going to work with the vessels, more on the vessels than within the heart. We have our alpha-beta blocker combined ones, which is Carbatrol or Coreg.

 

Then we have calcium channel blockers. Calcium channel blockers are really going to work on the vessels. They’re going to relax the vessels by blocking the binding sites for calcium on the vessels themselves, which is going to help to relax the vessels. Again, also lower blood pressure. These are going to end, a lot of these are going to end in the P-I-N-E, so we have amlodipine, nifedipine, nimodipine, and nicardipine. Then we also have diltiazem. These are all calcium channel blockers, amlodipine is Norvasc, deltiazem is Cardizem, nifedipine is Adalat, nimodipine is Nimotop, nicardipine is Cardene.

 

Then we have digitalis. What digitalis does, these drugs is what they do is they actually provide a positive inotropic effect. What’s an inotropic effect? If you think of the heart as a sponge it has to squeeze. It has to squeeze to get the blood out. This inotropic effect, what it does, digitalis increases that inotropic effect, which means it squeezes harder. Positive inotropes increase the squeeze. Obviously, digitalis we know as digoxin, trade name Lanoxin. The big thing to keep in mind here are going to be visual disturbances in your patients, and then we need to watch electrolytes very closely. With potassium it can affect and increase digoxin toxicity.

 

Then we have vasodilators. Obviously, what these do is these dilate the vessels, or relax the vessels, and they work by various different ways, but they’re something you really need to keep in mind. You will not most likely see these as drips, or anything like that, unless you work in an ICU. Some of the common medications in this isosorbide, which is Isordil, and then you have hydralazine, which is Apresoline, and then you have your nitrates. What these are going to do is they’re really just going to relax the vessels, allow the vessels to expand.

 

A lot of times with our heart attack we have that mnemonic, MONA, which is immediate treatment for heart attack. One of that’s going to be the “N” in MONA is nitrates. What it’s going to do is it’s really going to try to massively dilate the vessel to allow blood to flow. That’s when we would give it, we could give it for that. Also, if someone has a hypertensive crisis we can give them hydralzine. There’s a lot of things that we can do, and what these, the primary primary purpose of these is to relax the vessels.

 

That’s a top level overview of some of the common cardiac meds you’re going to see, you’re going to encounter, and you’re going to need to know about. That’s really the nine classes, there’s many, many more, of course, and there’s many other drugs under these classes. I wanted to give you guys a really top level overview of some of these medications, what they do, and what you’re going to see.