Cardiovascular
Anemia
Epoetin (Procrit)
This new drug stimulates the bone marrow to produce increased amount of red blood cells. When given subcutaneously for 10 days prior to surgery is indicated for the treatment of patients with anemia (hemoglobin >10-<13 g/dl) who are scheduled to undergo noncardiac and nonvascular surgery and in whom significant blood loss is anticipated. There may be an increased risk of thrombotic events particularly if the target hematocrit is above 40%.
Anticoagulants-Antithrombosis
Agrylin (Anagrelide)
This orally administered drug is used to reduce platelet number in those with elevated platelets (thrombocythemia). An elevation of platelets make it more likely that blood clots will form producing an obstruction of blood flow to an essential organ. Side effects include: headache, diarrhea, edema, heart palpitations, and abdominal pain.
Plavix (Clopidogrel)
Plavix, given orally, prevents aggregation of platelets, a step required for the formation of thrombosis (blood clot). It is indicated for patients who either have an excess amount of circulating platelets or who have hyperactive clotting activity due to platelet hyperreactivity. It is indicated to reduce the chances of a thrombotic event which would produce myocardial infarction or stroke. As expected the main side effect is bleeding.
Asthma
Zileuton (Zyflo) and Zafirlukast (Accolate)
These two drugs are the first releases of agents to prevent asthmatic attacks by inhibiting the formation of leukotriene(s). Leukotrienes are produced as a result of the inflammatory process and are believed to be partially responsible for the producing bronchospasm characteristic of asthmatic attacks. Continued use may result in a reduction of acute asthmatic attacks thus reducing both oral steroid and inhaled adrenergic bronchodilator use. Side effects are: muscle pain, heartburn, and headaches. It should not be used in patients with liver disease. There are significant drug interactions with an increase in effect of warfarin, propranolol, and theophylline.
Congestive Heart Failure
Carvedilol (Coreg)
This is a non-selective beta-adrenergic blocker which is the first of its class to be approved for the treatment of mild to moderate congestive heart failure (CHF). It appears to reduce the need for hospitalization associated with CHF. In individuals >65, the all cause mortality and all cause hospitalization was reduced by 29%. The most common side effect is dizziness.
Hypercholesteremia
Atorvastatin (Lipitor)
This is the newest and most effective agent in the class of antihyperlipidemic drugs which act to prevent the synthesis of cholesterol in the liver. In addition to producing a greater decrease in cholesterol than other agents in its class, it also results in a significant lowering of triglyceride levels, a property not shared by other cogeners. The most significant side effect is liver damage thus making periodic liver function studies mandatory, at least in the first months of therapy. As with other agents in its class, it rarely produces muscle breakdown characterized by muscle pain or weakness and can produce photosensitivity.
Severe Hypertension
Fenoldopam (Corlopam)
This injectable drug is a dopamine receptor agonist is indicated for the mamagement of severe malignant hypertension which cannot be controlled using more conventional drugs. The dug should be given via constant infusion as a more rapid than desired blood pressure drop can occur if given by bolus.
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