Category: Cardiovascular Drugs

Lidocaine HCl (Xylocaine®, Zingo®, Lidoderm®, RectiCare®, LMX®, Akten®)

Continue reading “Lidocaine HCl (Xylocaine®, Zingo®, Lidoderm®, RectiCare®, LMX®, Akten®)”

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Atorvastatin (Lipitor®)

Overview

Atorvastatin is statin-class drug commonly prescribed for the treatment of dyslipidemias and for the prevention of ischemic cardiovascular events.  It works by inhibiting hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase, a key enzyme in the cholesterol biosynthetic pathway.  Inhibition of HMG-CoA reductase decreases hepatic cholesterol synthesis, increases hepatic cholesterol re-uptake, and decreases serum cholesterol levels. Continue reading “Atorvastatin (Lipitor®)”

Lisinopril (Zestril®, Prinivil®, Qbrelis®)

Overview

Lisinopril is an angiotensin-converting enzyme (ACE) inhibitor used in the treatment of hypertension and congestive heart failure.  It acts by inhibiting the conversion of angiotensin I to angiotensin II, lowering serum levels of the vasopressor hormone angiotenin II.  Decreased angiotensin II receptor stimulation also decreases adrenal secretion of aldosterone.  Continue reading “Lisinopril (Zestril®, Prinivil®, Qbrelis®)”

Hydrocodone-Acetaminophen (Vicoden, Norco, Lortab, Maxidone, Xodol, Hycet®)

Overview

Combination hydrocodone/acetaminophen is an analgesic medication prescribed for the treatment of acute and chronic pain.  Hydrocodone activates pre- and post-synaptic μ-opioid receptors in the central nervous system (CNS) and mediates suppression of nociceptive signaling through both ascending and descending neuronal pain tracts.  Hydrocodone is metabolized to hydromorphone, a metabolite with strong agonist properties at the μ-opioid receptor.

Acetaminophen is a non-selective cyclooxygenase (COX) inhibitor that acts primarily in the central nervous system and in endothelial cells, mitigating pain sensation through incompletely understood mechanisms.  Unlike non-steroidal anti-inflammatory drugs (NSAIDS), which also inhibit arachidonate metabolism via inhibition of COX, acetaminophen does not appear to be active in platelets and lymphocytes and thus demonstrates minimal anti-inflammatory or anti-platelet activity.

Opioid combination medications are one of the most frequently prescribed medications in the United States, often given as post-procedural analgesic agents.  They carry a high risk of abuse, dependency, and lethal overdose.

In Plain English

Hydrocodone-acetaminophen medications combine two different painkillers in one pill to decrease pain sensations.  Hydrocodone is an opioid drug, affecting your nerves and brain through the same mechanism as morphine and heroin.  Acetaminophen works by blocking a key enzyme responsible for producing pain sensation and fever.

Clinical Considerations

hydrocodone_acetaminophen

Figure 1. Hydrocodone-Acetaminophen combination clinical considerations at a glance

 

Evidence Basis

 

Hydrocodone-Acetaminophen Combination In the News

 

Citations

  1. Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M. DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2017 Nov 8. doi: 10.1093/nar/gkx1037
  2. Epocrates Rx Online [Internet database]. San Mateo (CA): Epocrates, Inc. 2003. Retrieved at mobile.epocrates.com. Web-based; continuous content updates. Accessed 2018 May 14.
  3. “Prescription Prices, Coupons & Pharmacy Information – GoodRx.” Prescription Prices, Coupons & Pharmacy Information – GoodRxhttp://www.goodrx.com
  4. “DailyMed.” U.S. National Library of Medicine, National Institutes of Health, dailymed.nlm.nih.gov/dailymed/.

 

Losartan (Cozaar®)

Losartan is an angiotensin II receptor blocker approved for the treatment of hypertension and diabetic nephropathy.  The drug antagonizes the angiotension II type I (AT1) receptor, inhibiting Gq, Ras, STAT, and growth factor-related tyrosine kinase signaling pathways.  This leads to decreased smooth muscle contraction and vasodilation, as well as decreased aldosterone secretion from the adrenal gland.

Losartan is often prescribed for patients with hypertension who develop a bradykinin-associated cough during angiotensin-converting enzyme (ACE) inhibitor therapy.  It is also indicated for reducing stroke risk in patients with hypertension and left ventricular hypertrophy, although some studies have shown that this effect is attenuated in black patients (beta-blockade may be more effective at lowering thromboembolic risk in this population).  Losartan is also prescribed off-label for the treatment of heart failure with reduced ejection fraction and may mitigate pathological myocardial remodeling associated with chronic heart failure.

 

losartan

Citations

  1. Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M. DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2017 Nov 8. doi: 10.1093/nar/gkx1037
  2. Epocrates Rx Online [Internet database]. San Mateo (CA): Epocrates, Inc. 2003. Retrieved at mobile.epocrates.com. Web-based; continuous content updates. Accessed 2018 May 7.
  3. “Prescription Prices, Coupons & Pharmacy Information – GoodRx.” Prescription Prices, Coupons & Pharmacy Information – GoodRxhttp://www.goodrx.com
  4. “DailyMed.” U.S. National Library of Medicine, National Institutes of Health, dailymed.nlm.nih.gov/dailymed/.

 

Dabigatran Etexilate (Pradaxa®)

 

Dabigatran etexilate is a direct-acting oral anticoagulant used in the prevention of thromboembolism in atrial fibrillation and in the prevention and treatment of deep venous thrombosis and pulmonary embolism. Dabigatran etexilate is a pro-drug converted via plasma and hepatic esterases to dabigatran, which directly inhibits the enzyme thrombin.  Thrombin catalyzes the conversion of fibrinogen to fibrin and fibrin-mediated platelet aggregation.

Dabigatran should not be prescribed in actively bleeding patients or patients with mechanical heart valves.  Dabigatran toxicity may involve significant hemorrhage and is partially reversible through the reversal agent idarucizumab (Praxbind®).

 

dabigatran

Citations

  1. Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M. DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2017 Nov 8. doi: 10.1093/nar/gkx1037
  2. Epocrates Rx Online [Internet database]. San Mateo (CA): Epocrates, Inc. 2003. Retrieved at mobile.epocrates.com. Web-based; continuous content updates. Accessed 2018 April 29.
  3. “Prescription Prices, Coupons & Pharmacy Information – GoodRx.” Prescription Prices, Coupons & Pharmacy Information – GoodRxhttp://www.goodrx.com
  4. “DailyMed.” U.S. National Library of Medicine, National Institutes of Health, dailymed.nlm.nih.gov/dailymed/.