Well, now I get to take lots of pills. I figured I'd write them down here so I don't forget, and so people have some idea of the mechanism behind cardiac medications.
In no particular order, we have:
Carvedilol (brand name Coreg).
Dosage prescribed: One pill twice daily. Dose 6.25mg
Carvedilol is a nonselective β-adrenergic blocking agent with α1-blocking activity. That means that it is a beta blocker with alpha blocking abilities as well.
Beta blockers counteract the stimulatory effects of adrenaline (epinephrine) on beta receptors, found in many tissues of the body including the nervous system and heart. When beta receptors are stimulated, the heart beats faster and harder and the blood vessels constrict, resulting in an elevation of blood pressure. If the coronary arteries are narrowed by atherosclerosis, the increased burden on the heart can cause inadequate oxygen delivery to the heart muscle, leading to the chest pain and other symptoms like I had on Saturday.
Beta blockers act by suppressing these impulses and lead to a slowing of the pulse rate and a reduction in blood pressure. They are prescribed as treatments for high blood pressure and have been shown to improve survival when administered following a heart attack.
The most common side effects are drowsiness and fatigue, along with dizziness and weakness. Dryness of the mouth, eyes, and skin may occur, and those taking beta blockers may develop cold hands and feet. Sleep disturbances and a decreased sex drive are less common but possible side effects of beta blockers. Wheezing is also a less common but potentially significant side effect of beta blockers, and for this reason, they are often not prescribed for people with asthma. Other serious side effects are rare.Simvastatin (brand name Zocor)
Dosage prescribed: 40mg, once per day
Zocor is a lipid-lowering agent. They lower cholesterol by inhibiting the enzyme HMG-CoA reductase, which is the rate-limiting enzyme of the mevalonate pathway of cholesterol synthesis. Inhibition of this enzyme in the liver results in decreased cholesterol synthesis as well as increased synthesis of LDL receptors, resulting in an increased clearance of low-density lipoprotein (LDL) from the bloodstream. The first results can be seen after one week of use and the effect is maximal after four to six weeks.
These drugs are made from by products of the fermentation of a fungus.
Statins are generally well-tolerated and have only two major side effects that occur relatively rarely: raised liver enzymes and skeletal muscle pain and/or damage.
Clopidogrel (brand name Plavix)
75mg 2/day initially, then 1/day after 2 weeks
Clopidogrel is an oral antiplatelet agent to inhibit blood clots. It works by irreversibly inhibiting a receptor called P2Y12. It inhibits platelet aggregation (clumping).
I was told that this is the most important drug for those with stents, as the body will try to stick things on the stent and this drug will reduce the impact of that activity.
Some interesting commercial information on this drug: It's nearly $6/pill as it is in exclusive north american production by the patent owner, Bristol-Myers Squibb. It is sold in nearly 110 countries, with sales of US$5.9 billion in 2005.
In 2006, generic clopidogrel was briefly marketed by a Canadian generic pharmaceutical company before a court order halted further production. The court ruled that Bristol-Myers Squibb's patent was valid and provided protection until November 2011.
Generic clopidogrel is also produced by several pharmaceutical companies in India at significantly lower retail prices, up to 1/30th of the price. Counterfeit Plavix is in circulation, as with many popular medicines.
So, this is a medication that is highly useful and expensive, so there's lots of shady and illegal duplication going on. At least in late 2011 the drug price will go down as legal generic manufacture may be permitted.Adverse effects include hemorrhage.
Aspirin
Dosage prescribed: 325mg, once per day
Aspirin also known as acetylsalicylic acid, is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication. Aspirin also has an antiplatelet effect by inhibiting the production of thromboxane, which under normal circumstances binds platelet molecules together to repair damaged blood vessels. This is why aspirin is used in long-term, low doses to prevent heart attacks, strokes, and blood clot formation in people at high risk for developing blood clots. It has also been established that low doses of aspirin may be given immediately after a heart attack to reduce the risk of another heart attack or of the death of cardiac tissue.
The main undesirable side effects of aspirin are gastrointestinal ulcers, stomach bleeding, and tinnitus, especially in higher doses.
Today, aspirin is one of the most widely used medications in the world, with an estimated 40,000 tonnes of it being consumed each year.
Glyceryl trinitrate (brand name Nitrostat)Dosage prescribed: One tablet only as needed for chest pain
Glyceryl trinitrate (GTN) is an alternate name for the chemical nitroglycerine, which has been used to treat angina and heart failure since at least 1870. Despite this, the mechanism of nitric oxide (NO) generation from GTN and the metabolic consequences of this bioactivation are still not entirely understood. In medical circles it is often referred to as "nitro."
This is the same substance as the explosive, but in very tiny quantities. I had a couple of these on Saturday - one in the ambulance, and another sometime during the ER or Cath Lab adventure.
So...now I take a cholesterol reducer, two anti-clotting drugs, and a beta blocker, and I have my "emergency pills". I'm still not sure how I feel about all of this, but if these reduce the potential for a recurrent of the symptoms, I will gladly take them!
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