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Updated: Dec 9 2019

Cardiovascular Medications

  • Cardiovascular Drug Introduction
    • Cardiovascular medications can be broken down into the following categories:
      • antiarrhythmics
      • antihypertensives
      • inotropes
      • vasodilators
      • diuretics
      • antihyperlipidemics
      • anticoagulants
      • thrombolytics
  • Cardiovascular Drug Table
    • Antiarrhythmics
        • Class I (Na+ Channel Block)
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Lidocaine
        • Na+ channel blockage
        • preferentially binds to Na+ channels in the deactivated state
        • Acute ventricular arrhythmia secondary to:
        • myocardial infarction
        • digitalis toxicity
        • cardiac manipulation (i.e., catherization, surgery)
        • Cardiotoxicity:
        • arrhythmia
        • bradycardia
        •  Neurotoxicity:
        • excitation/depression
        • Procainamide
        • Na+ channel blockage
        • preferentially binds to Na+ channels in the deactivated state
        • Ventricular arrhythmia
        •  Supraventricular arrhythmia
        • SLE-like syndrome:
        • increased incidence in slow acetylators
        • Quinidine
        • Na+ channel blockage
        • preferentially binds to Na+ channels in the activated state
        • Ventricular arrhythmia/tachycardia
        • Atrial fibrillation/flutter
        • Cinchonism
        • ↑ QT interval
      • Class II (β-Block)
        • See antihypertensives below
        • Class III (K+ Channel Block)
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Amiodarone
        • K+, Ca2+, and Na+ channel blocker:
        • broad-spectrum anti-arrhythmic
        • Most types of arrhythmias:
        • secondary due to broad mechanism of action
        • Pulmonary fibrosis
        • Hyper- or hypothyroidism
        • Blue pigment of the skin
        • "smurf skin"
        • Corneal deposits
        • Hepatotoxic
        • Photophobia
        • Bretylium
        • Unknown
        • Ventricular arrhythmia resistant to typical antiarrhythmic therapy:
        • considered last-resort
        • Orthostatic hypotension
        • Nausea
        • Vomiting
        • Sotalol
        • β-blocker
        • K+ channel blocker
        • Ventricular arrhythmia
        • Atrial fibrillation/flutter
        • Torsades de pointes
        • β-blockade
        • Class IV (Ca2+ Channel Blockers)
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Amlodipine
        • Nicardipine
        • Nifedipine
        • Ca2+ channel blocker
        • preferentially in vasculature
        • Angina
        • Hypertension
        • Peripheral edema
        • Pulmonary edema
        • Flushing/dizziness
        • Reflex tachycardia
        • Remember, they act on vascular smooth muscle
        • Gingival hyperplasia
        • Dilitiazem
        • Verapamil
        • Ca2+ channel blocker
        • preferentially in vasculature
        • Supraventricular tachycardia
        • Angina
        • Hypertension
        • Cardiac depression
        • Constipation
        • Other Antiarrythmics
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Adenosine
        • Adenosine receptor agonist:
        • ↓ cAMP via Gi
        • AV nodal arrhythmia
        • Paroxysmal supraventricular tachycardias
        • Impending doom
        • Vasodilation
        • Dyspnea
        • secondary to bronchoconstriction
        • Atropine
        • Muscarinic antagonist
        • Inhibit secretions
        •  Sinus bradycardia
        •  AV block
        •  Adjuvant with anticholinesterase
        • Antimuscarinic/cholinergic effects
        • Digoxin
        • Cardiac Na+/K+ ATPase inhibitor
        • Heart failure
        •  Atrial fibrillation
        • Arrhythmia
        •  Nausea
        •  Vomiting
        •  Diarrhea
        •  Blurry yellow vision
        • Epinephrine
        • β- and α-agonist:
        • β > α
        • Anaphylactic reactions
        • Hypotension
        • Secondary to β- and α-adrenergic receptor effects
        • β > α
        • Ibutilide
        • K+ channel blocker
        • Atrial fibrillation/flutter
        • Torsades de pointes
        • Isoproterenol
        • β-agonist
        • Heart block
        •  Bradyarrhythmias
        •  Bronchospasm
        • Arrhythmias
        •  Angina
        • Flushing
        • Magnesium sulfate
        • Effect on Ca2+ and K+ fluxes
        • Torsades de pointes
        •  Digitalis-induced arrhythmia
        • Cardiac arrest
        • ↓ Deep tendon reflexes
    • Antihypertensives
        • β-Blockers
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Atenolol
        • β-blocker
        • β1 > β2
        • Hypertension
        •  Angina
        •  Post-MI secondary prevention
        • Bradycardia
        •  Heart failure
        •  AV block
        • Esmolol
        • β-blocker
        • β1 > β2
        • Supraventricular tachycardia
        • Cardiac arrest
        •  Bradycardia
        •  Hypotension
        • Metoprolol
        • β-blocker
        • β1 > β2
        • Hypertension
        •  Angina
        •  Acute myocardial infarction in hemodynamically stable patients
        •  ↓ Morbidity and mortality in heart failure
        • Hypotension
        •  Bradycardia
        •  AV block
        •  Dyslipidemia
        • Carteolol
        • β-blocker
        • Open-angle glaucoma
        •  Intraocular hypertension
        • Conjunctival hyperemia
        • Propranolol
        • β-blocker
        • β1 = β2
        • Hypertension
        •  Angina
        •  Essential tremor
        •  Migraine prophylaxis
        •  Thyrotoxicosis
        •  Supraventricular arrhythmias:
        • also ventricular tachycardias
        • Bradycardia
        •  AV block
        •  COPD and asthma exacerbation
        •  Vasospasm exacerbation in Prinzmetal angina
        • Sotalol
        • β-blocker
        • K+ channel blocker
        • Ventricular arrhythmia
        •  Atrial fibrillation/flutter
        • Torsades de pointes
        •  β-blockade
        • Carvedilol
        • α- and β-blocker
        • Congestive heart failure
        •  Hypertension
        •  Antiarrhythmic
        • Hypotension
        •  Cardiovascular effects: bradycardia, etc.
        • Labetolol
        • α- and β-blocker
        • Hypertension
        •  Hypertensive emergencies:
        • such as in pregnancy
        • (i.e., gestational HTN, preeclampsia, eclampsia, etc.)
        • Orthostatic hypotension
        • ACE Inhibitors
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Benazepril
        • Captopril
        •  Enalapril
        •  Lisinopril
        • Angiotensin-converting enzyme (ACE) inhibitor
        • Hypertension
        •  Heart failure
        •  Diabetic kidney disease
        • Cough
        •  Hyperkalemia
        •  Teratogen
        •  Angioedema
        •  ↓ Glomerular filtration rate (GFR)
        •  Hypotensio
        • Angiotensin II Antagonists
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Losartan
        • Candesartan
        •   Valsartan
        • Angiotensin receptor blockers (ARBs)
        • Hypertension
        • Heart failure
        • Diabetic kidney disease
        • Hyperkalemia
        •   Teratogen
        •   ↓ Glomerular filtration rate (GFR)
        •   Hypotension
        • Antiadrenergics
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Clonidine
        • α2-agonist
        • Hypertension
        •  Attention deficit hyperactive disorder (ADHD)
        •  Tourette syndrome
        •  Opioid withdrawal
        • Depression of the CNS
        •  Respiratory depression
        •  Bradycardia
        •  Hypotension
        •  Miosis
        • Doxazosin
        • Terazosin
        • α1-blocker
        • Hypertension
        •  Benign prostatic hyperplasia symptoms
        • Orthostatic hypotension
        •  Urinary incontinence
    • Inotropes
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Amrinone
        • Milrinone
        • Phosphodiesterase (PDE) inhibitor
        • Heart failure
        • Arrhythmia
        • Dobutamine
        • β- and α-agonist
        • β1 > β2, α
        • Heart failure
        • Tachyarrhythmia
        •  Hypertension
        • Dopamine
        • Dopamine, β- and α-agonist
        • D1 = D2 > β > α
        • Low cardiac output/poor perfusion
        •  Hypotension
        •  At low doses, increases renal perfusion
        • Arrhythmia
        •  Angina
        • Epinephrine
        • β- and α-agonist
        • β > α
        • Type I hypersensitivity reactions
        •  Hypotension secondary to septic shock
        •  Cardiac arrest
        • Angina
        •  Arrhythmia
        •  Anxiety
        •  Respiratory difficulties
        • Norepinephrine
        • β- and α-agonist
        • α > β
        • Hypotension
        •  Cardiac arrest
        •  Septic shock
        • Hypertension
        •  Bradycardia
        •  Arrhythmia
        •  Anxiety
        •  Dyspnea
        • Phenylephrine
        • α-agonist
        • α1 > α2
        • Hypotension
        •  Decongestant
        • Hypertension
        •  Reflex bradycardia
        •  Anxiety
        •  Pulmonary edema
    • Vasodilators
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Hydralazine
        • ↑ cGMP, leading to smooth muscle relaxation
        •  Severe hypertension
        •  Heart failure
        • Tachycardia
        •  SLE
        • Nitroprusside
        • ↑ cGMP
        • Severe hypertension
        •  Decompensated heart failure
        • Hypotension
        •  Cyanide toxicity (potential)
        • Minoxidil
        • Arteriolar vasodilator
        •  Opens K+ channels
        • Severe hypertension
        •  Androgenetic alopecia
        • Tachycardia
        •  Salt and water retention
        •  Hirsutism
        • Diazoxide
        • Opens K+ channels in smooth muscle
        • Severe hypertension
        •  Hypoglycemia in the setting of insulin-secreting tumors
        • Hypotension
        •  Hyperglycemia
    • Diuretics
        • Carbonic Anhydrase Inhibitors
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Acetazolamide
        • Carbonic anhydrase inhibitor
        • Edema
        • Mountain sickness
        • Glaucoma
        • Idiopathic intracranial
        • hypertension (pseudotumor cerebri)
        • Metabolic acidosis
        •  Hyperammonemia
        •  Paresthesias
        •  Sulfa allergy
        • Loop Diuretics
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Bumetanide
        • Furosemide
        • Torsemide
        • Inhibit Na+/K+/2Cl− transporter of thick ascending limb of loop of Henle
        • Hypertension
        •  Edema:
        • due to heart failure, liver failure, nephrotic syndrome
        •  Hypercalcemia
        • Ototoxicity
        •  Metabolic hypokalemic alkalosis
        •  Hypovolemia
        •  Sulfa allergy
        •  Insterstitial nephritis
        •  Gout
        •  Efficacy is decreased when used with NSAIDs
        • Thiazide Diuretics
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Chlorothiazide
        • Hydrochlorothiazide (HCTZ)
        • NaCl reabsorption inhibitor in distal convoluted tubule
        • Heart failure
        • Edema
        • Nephrogenic diabetes insipidous
        • Calcium nephrolithiasis
        • Sulfa allergy
        • Hypokalemia
        • Hyper-uricemia, glycemia, calcemia, lipidemia
        • Metabolic alkalosis
        • K+ Sparing Diuretics
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Amiloride
        • ENaC epithelial channel blocker in cortical collecting ducts
        • Heart failure
        •  Hyperaldosteronism
        •  Nephrogenic diabetes insipidus
        •  States of K+ depletion (i.e., use of thiazides)
        • Hyperkalemia
        • Spirolactone
        • Aldosterone receptor blocker in cortical collecting ducts (in their cytoplasm)
        • Heart failure
        •  Hyperaldosteronism
        •  Hepatic ascites
        • Hyperkalemia
        • Gynecomastia
    • Antihyperlipidemics
        • HMG-CoA Reductase Inhibitors
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Atorvastatin
        • Cerivastatin
        • Fluvastatin
        • Lovastatin
        • Pravastatin
        • Simvastatin
        • HMG-CoA reducase inhibitor
        • Vascular disease secondary to atherosclerosis
        • Myopathy
        •  Hepatotoxicity
        •  Potential for teratogenicity
        • contraindicated in pregnancy
        • Other Antihyperlipidemics
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Fenofibrate
        • Gemfibrozil
        • PPAR-α agonists
        •  Upregulates lipoprotein lipase
        • Hypertriglyceridemia, low HDL
        • cholesterol
        •  Can ↑ HDL in most patients
        • Myopathy
        •  Gallstones (cholesterol)
        • Niacin
        • ↑ HDL and ↓ LDL and triglycerides
        • Dyslipidemia
        • Flushing, pruritis
        • NSAIDs can help
        •  Hepatotoxicity
        •  Hyperuricemia
        •  Hyperglycemia
    • Anticoagulants
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Abciximab
        • Tirofiban
        • GpIIb/IIIa inhibitor
        • Unstable angina
        •  Prevention of cardiac ischemia in 
        • percutaneous coronary intervention
        • Bleeding
        •  Thrombocytopenia
        • Anagrelide
        • Phosphodiesterase III inhibitor
        • Thrombocythemia
        • can be seen in myeloproliferative disorders
        • Palpitations
        •  Headache
        •  Thrombocytopenia
        •  Bleeding
        • Cilostazol
        • Phosphodiesterase III inhibitor
        • Secondary ischemic stroke prevention
        •  Intermittent claudication
        •  Thromboembolic complication prevention
        • i.e., cardiac valve replacement, percutaneous coronary intervention
        • Headache
        • Flushing
        • Hypotension
        • Aspirin
        • Irreversible COX inhibitor
        • Impairs TXA2 synthesis
        • Treatment and prevention of arterial thrombosis
        • Tinnitus
        •  Gastrointestinal toxicity
        •  Renal toxicity
        •  Reye syndrome:
        • children with viral infection
        •  Metabolic acidosis-respiratory alkalosis:
        • respiratory alkalosis early
        • Platelet Aggregation Antagonists
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Ticlopidine
        • Clopidogrel
        • ADP-receptor antagonist
        • thus impairs expression of GpIIb/IIIa receptors
        • Acute coronary syndrome
        •  Prevention of cardiac ischemia in percutaneous coronary intervention
        •  Treatment and prevention of arterial thrombosis
        • Leukopenia (ticlopidine)
        •  Thrombotic thrombocytopenic purpura
    • Thrombolytics
        • Thrombin Inhibitor
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Alteplase
        • Streptokinase
        • Urokinase
        • Aids in conversion of plasminogen to plasmin
        • Early myocardial infarction and ischemic stroke
        •  Pulmonary embolism
        • Bleeding
    • Other
        • Name
        • Mechanism of Action
        • Key Indication
        • Key Toxicity
        • Digoxin-Immune Fab
        • Binds excess digoxin or digitoxin
        • Digoxin toxicity
        • Heart failure exacerbation
        • Albumin
        • Blood volume expander:
        • acts as an oncotic agent
        •  Antihyperbilirubinemic:
        • Binds to various substances in the bloods (i.e., bilirubin, drugs, etc.)
        • Hypovolemia
        •  Subacute bacterial peritonitis
        •  Cirrhosis
        • Heart failure
        •  Edema
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