Cardiovascular drugs are drugs that are prescribed to a patient to prevent or control various heart diseases, which could include hypertension, coronary artery diseases (CAD), and diabetes among others. To expound further on cardiovascular drugs, this paper analyzes three types of cardiovascular drugs namely, Calcium channel blockers, Nitroglycerin, and cardiac digitalis.
Firstly, Calcium channel blockers; these drugs slow down the movement of calcium in the heart and blood vessel cells making the blood vessels relax, increasing the supply of oxygenated blood into the heart, and thus reducing the heart’s workload. This drug can be prescribed to persons suffering from abnormal heart rhythms or high blood pressure also other physicians see the drugs applicable to people who are suffering from panic attacks and can also be administered to people who have frequent migraine headaches as they assist in preventing their reoccurrence. These drugs are ingested in various forms; tablets, capsules, and injections. Several frequently prescribed “calcium channel blockers comprise of, isradipine (DynaCirc), diltiazem (Cardizem), nifedipine (Adalat, Procardia), nicardipine (Cardene), amlodipine (Norvasc) and verapamil (Calan, Isoptin, Verelan)” (Lessard et al 2005).
Patients taking other medicines may develop certain issues if they use calcium channel blockers. Before using the medication, the recommending physician ought to be aware of a prior issue that the patient may be having or suffering from, for example, allergies. Therefore, it is highly recommended that anyone who suffered a negative effect due to using any calcium channel blocker ought to let the physician be aware of that fact before resuming/continuing using the medication, therefore the doctor should be informed of any issues such as allergies to foods or other issues.
Pregnancy, effects of using calcium channel blockers when expectant have not been analyzed or researched yet. “However, in studies of animals, large doses of these drugs have been reported to cause stillbirths, poor bone growth, and other problems when taken during pregnancy. Women who are pregnant should check with their physician before using these drugs.” (Lessard et al 2005).
Breastfeeding, although some calcium channel blockers are found in breast milk, there have been no hard facts indicating negative reactions arising due to lactation of babies with that milk by mothers using the medication. Breastfeeding mothers taking this medication are advised to check with their physicians before doing so. “Effects of calcium channel blockers may be greater in people with kidney or liver diseases because their bodies are slower to clear the drug from their systems.” (Lessard et al 2005).
Using calcium channel blockers together with other medication could increase the chances of negative reactions arising. Montebugnoli & Prati (2002) notes “as with most medications, side effects are possible and some interactions with other substances may occur. Calcium channel blockers can interact with other medications; thus, the effects of both drugs may change or the risk of side effects may increase.” Patients who take calcium channel blockers should not take any other medicines without checking first with the physician.
The second type of drug is Nitroglycerin, which is available in form of tablets and sprays. Nitroglycerin is used to treat chest pains in people who have coronary artery diseases. The tablet is taken just before activities that may cause episodes of Angina [chest pains] to prevent the pains from happening. Nitroglycerin is in a class of medications called vasodilators, these work by relaxing the blood vessels so the heart doesn’t work so hard thereby reducing the amount of oxygen consumed in the process.
Nitroglycerin is the prescription of “choice for an episode of acute chest pain in patients who’ve had angina pectoris. It acts mainly by relaxing vascular smooth muscle, opening systemic venous and arterial vascular beds and leading to a reduction in venous return and systemic vascular resistance, which combine to reduce myocardial oxygen consumption” (Mito & Yagiela 1988).
Nitroglycerin may interact with antihypertensive drugs by increasing their blood pressure. A patient is advised to take aspirin, heparin, ergotamine, and tissue-type plasminogen activators with care while on the drug. Using nitroglycerin with acetylcysteine, dihydroergotamine, or pancuronium may increase the risk for certain side effects. It’s not recommended to take sildenafil, (Viagra, Revatio) tadalafil, vardenafil, alteplase, or any other inhibitors while using nitroglycerin as they all cause sudden dizziness, blurred vision, lightheadedness, or even fainting. One should get to the hospital immediately if he/she suffers an angina attack while on any of these medications (Montebugnoli & Prati 2002)
Thirdly, Cardiac digitalis; this medication is prescribed to certain heart patients. Digitalis toxicity also “known as acute ingestion is a problem of digitalis therapy, or may take place when one takes an excess of the drug at one time. The most common medication for digitalis is known as digoxin” (Montebugnoli & Prati 2002). Digoxin is prescribed by a doctor as a paradigm of managing heart failure and atrial fibrillation which have shifted to other classes of drugs. For patients prescribed digoxin, it is advisable to record baseline pulse rate and rhythm before starting dental treatment because it has side effects that relate to cardiac arrhythmia; it’s advisable to be cautious when prescribing epinephrine or anticholinergics that may cause extra cardiac incitement.
Macrolide and tetracycline antibiotics increase the digoxin serum concentration and increase the risk for digoxin toxicity, so they are not advisable. Captopril and digoxin may be used together to treat chronic heart failure. Patients with heart failure should be advised that simultaneous use of captopril and digoxin can cause a drug interaction. Patients taking Digoxin are advised to take foods high in magnesium and potassium and avoid foods with high calcium (Hu & Ertl 1999).
Research shows peak sales of US$5,580 million in 2002, though Merck & Co’s Zocor (simvastatin) lost its basic patent protection in Canada and several countries in Europe, including the UK and Germany in 2003. Sales then declined in these countries as a result of generic competition (Friedlander et al 2009). The US copyright on Zocor finally expired on 23rd June 2006, following six months pediatric extension. The FDA accepted two generics with 180-days market exclusivity, resulting in a downturn in sales of Zocor to US$2.8 billion for the full year. The entry of multiple generics onto the market from December 2006, however, resulted in a dramatic fall in sales of Zocor in 2007, to US$876 million. The effect of generic simvastatin was not, restricted to Zocor but rippled through the market, impacting sales of Pfizer’s Lipitor (atorvastatin) in the short term.
However, there are general modifications that relate to all patients with cardiovascular diseases, and these modifications are; one should make sure the patient takes his/her medications, always reduce patients anxiety and stress, keep appointments short and conclude them if the patient becomes agitated or weary, monitor vital signs on various appointments, change patients position in a dental chair in a slow-motion to avoid postural hypotension, for patients taking cardiac drugs (beta & alpha-adrenergic blockers and antiarrhythmic agents) examine the patient’s teeth carefully for signs of carious lesions; recommend saliva substitutes and sugar-free candies or gum.
References
Friedlander, A. H. et al (2009). Surgical management and dental implications. The Journal of the American dental association, 56.
Hu, C. & Ertl, R. (1999). Potential role of mixed ACE and neutral endopeptidase inhibitor in the treatment of heart failure. Cardiovascular Res. 41, 503-505.
Lessard, E. et.al. (2005). The patient with a heart murmur. J Am Dent Assoc, Vol 136, No 3, 347-356.
Mito, R. S. & Yagiela, J. A. (1988). Hypertensive response to levonordefrin in a patient receiving propranolol: report of case. J Am Dent Assoc. 116(1): 55-7.
Montebugnoli, L. & Prati, C. (2002). Dentistry and Medicine. The journal of the American dental association, 1(2), 2-36.