Cardiology Drugs

ACE Inhibbitors

Competitive inhibitor of angiotension - converting enzyme (ACE). Block the conversion of angitension I to angiotensin II by blocking the angiotensin converting enzyme which leads to decreased vasoconstriction and decreased aldosterone secretion and blocks degradation of bradykinin

Benazepril

Lotensin

CD - 5 - 40mg daily - BID

ADE:

• Increased K

• Increased SCr

• Dry Cough

• Angioedema

CP-

• Contrindicated with an ARB

• Contraindicated in Pregnancy

Enalapril

Vasotec

CD- 5-40mg daily-BID

ADE:

• Increased K

• Increased SCr

• Dry Cough

• Angioedema

CP-

• Contrindicated with an ARB

• Contraindicated in Pregnancy

Fonsinopril

Monopril

CD- 10-40mg daily

ADE:

• Increased K

• Increased SCr

• Dry Cough

• Angioedema

CP-

• Contrindicated with an ARB

• Contraindicated in Pregnancy

Lisinipril

Zestril, Prinivil

CD - 5-40mg daily

ADE:

• Increased K

• Increased SCr

• Dry Cough

• Angioedema

CP-

• Contrindicated with an ARB

• Contraindicated in Pregnancy

Quinapril

Accupril

CD - 5-40mg daily-BID

ADE:

• Increased K

• Increased SCr

• Dry Cough

• Angioedema

CP-

• Contrindicated with an ARB

• Contraindicated in Pregnancy

Ramipril

Altace

CD - 2.5-10mg daily - BID

ADE:

• Increased K

• Increased SCr

• Dry Cough

• Angioedema

CP-

• Contrindicated with an ARB

• Contraindicated in Pregnancy

ARBs

Angiotensin II Receptor Blockers (Antagonist)(ARB). Angiotensin II acts as a vasoconstrictor.

These blockers bind to the angiotensin II receptor; the binding prevents angiotensin II from binding to the receptor and blocks vasoconstriction and the aldosterone secreting effects of angiotensin II

Candesartan

Atacand

CD - 4-32mg PO daily-BID

ADE - Increased K, Increased SCr

CP - Contraindicated with an ACE and in pregnancy

Irbesartan

Avapro

CD - 150-300mg daily

ADE - Increased K, Increased SCr

CP - Contraindicated with an ACE and in pregnancy

Losartan

Cozaar

50-100mg daily-BID

ADE - Increased K, Increased SCr

CP - Contraindicated with an ACE and in pregnancy

Olmesartan

Benicar

10-40mg daily

ADE - Increased K, Increased SCr

CP - Contraindicated with an ACE and in pregnancy

Telmisartan

Micardis

80-3200mg daily

ADE - Increased K, Increased SCr

CP - Contraindicated with an ACE and in pregnancy

Valsartan

Diovan

80-3200mg daily

ADE - Increased K, Increased SCr

CP - Contraindicated with an ACE and in pregnancy

Calcium Channel Blockers (CCB)

Act directly on vascular smooth muscle to produce peripheral arterial vasodialation decreasing peripheral vascular resistance and blood pressure. Achieved through the inhibition of calcium ions entering “slow channels” or select votage sensitive areas of vascular smooth muscle and myocardium during depolarization

Amlodipine

Norvasc

CCB Class: Dihydropyridines (DHP)

CD - 2.5 to 10 mg daily

ADE for all CCB:

• peripheral edema

• constipation

• headache

ADE for DHP:

• flushing

• reflex tachycardia

Nifedipine

Procardia

CCB Class: Dihydropyridines (DHP)

CD - 30 to 90 mg daily

ADE for all CCB:

• peripheral edema

• constipation

• headache

ADE for DHP:

• flushing

• reflex tachycardia

Diltiazem

Cardizem, Cartia XT, Dilt-XR, Tiazac

60 to 360 mg BID XL 12- hour or 120 - 240 mg daily XL 24 hr

ADE for all CCB:

• peripheral edema

• constipation

• headache

ADE for Non-DHP:

• Bradycardia

• Heart Block

• Gingival Hyperplasia

CP: Avoid Non-DHP with beta-blockers in patients with or at risk of bradycardia

Verapamil

Calan, Verelan

40 - 80 mg IR TID or 120 - 180mg XR Daily

ADE for all CCB:

• peripheral edema

• constipation

• headache

ADE for Non-DHP:

• Bradycardia

• Heart Block

• Gingival Hyperplasia

CP: Avoid Non-DHP with beta-blockers in patients with or at risk of bradycardia

Beta Blockers

Competatively block response Beta 1 and 2 adrenergic stimulation which causes a reduction in heart rate, myocardial contractility, blood pressure, and myocardial oxygen demand

Atenolol

Tenormin

Cardioselective: prefer Beta₁ over Beta₂

CD: 25 to 100 mg daily - BID

ADE:

• Bradycardia

• Fatigue

• Dizziness

• Decreased exercise tolerence/weight gain

CP:

• Selective prefered in patients w/ asthma and COPD

• Masks symptoms of hypoglycemia

• Do not stop abruptly due to risk of rebound hypertension

Bisoprolol

Zebeta

Can be used in Heart Failure

Cardioselective: prefer Beta₁ over Beta₂

CD: 2.5 to 10 mg daily

ADE:

• Bradycardia

• Fatigue

• Dizziness

• Decreased exercise tolerence/weight gain

CP:

• Selective prefered in patients w/ asthma and COPD

• Masks symptoms of hypoglycemia

• Do not stop abruptly due to risk of rebound hypertension

Metaprolol Succinate

Toprol XL

Can be used in Heart Failure

Cardioselective: prefer Beta₁ over Beta₂

CD: 25 to 100 mg daily

ADE:

• Bradycardia

• Fatigue

• Dizziness

• Decreased exercise tolerence/weight gain

CP:

• Selective prefered in patients w/ asthma and COPD

• Masks symptoms of hypoglycemia

• Do not stop abruptly due to risk of rebound hypertension

Metoprolol Tartrate

Lopressor

Cardioselective: prefer Beta₁ over Beta₂

CD: 25 to 100 mg BID

ADE:

• Bradycardia

• Fatigue

• Dizziness

• Decreased exercise tolerence/weight gain

CP:

• Selective prefered in patients w/ asthma and COPD

• Masks symptoms of hypoglycemia

• Do not stop abruptly due to risk of rebound hypertension

Nebivolol

Bystolic

Cardioselective: prefer Beta₁ over Beta₂

CD: 2.5 to 10 mg daily

ADE:

• Bradycardia

• Fatigue

• Dizziness

• Decreased exercise tolerence/weight gain

CP:

• Selective prefered in patients w/ asthma and COPD

• Masks symptoms of hypoglycemia

• Do not stop abruptly due to risk of rebound hypertension

Propranolol

Inderal, Inderal LA

Non-cardioselective

CD: 40 to 160 mg BID to QID or 80 to 320 mg (XR) daily

ADE:

• Bradycardia

• Fatigue

• Dizziness

• Decreased exercise tolerance/weight gain

CP:

• Masks symptoms of hyperglycemia

• Do not stop abruptly due to risks of rebound hypertension

• Can be helpful for anxiety

Carvedilol

Coreg, Coreg CR

Can be used in heart failure

Non-cardioselective

CD: 3.125 to 25 mg BID or 10 to 80 mg daily (CR)

ADE:

• Bradycardia

• Fatigue

• Dizziness

• Decreased exercise tolerance/weight gain

CP:

• Masks symptoms of hyperglycemia

• Do not stop abruptly due to risks of rebound hypertension

  • must be taken with food

Labetalol

Normodyne

Non-cardioselective

CD: 100 to 300 mg BID

ADE:

• Bradycardia

• Fatigue

• Dizziness

• Decreased exercise tolerance/weight gain

CP:

• Masks symptoms of hyperglycemia

• Do not stop abruptly due to risks of rebound hypertension

• preferred with pregnancy

Thiazides MOA

A type of diuretic that interfers with sodium and chlorides reabsorption in distal tubules and increase excreation of sodium and water as well as potassium

Loop MOA

a type of diuretic that competes for the chloride site on the potassium/sodium pumps in the ascending loop of henle and distal tubules. Which results in a decrease in sodium reabsorption and increase excretion of sodium and water

Hydrochlorothiazide (HCTZ)

Oretic

Thiazide

CD: 12.5 to 25 mg daily

ADE:

• Decreased K, Mg, Na

• Increased Ca, uric acid, glucose

CP:

• Avoid when CrCl< 30 mL/min

• Monitor electrolytes

• take in the morning to decrease nocturnal diuresis

Chlorthalidone

Thalitone, Hygroton

Thiazide

CD: 12.5 to 25 mg daily

ADE:

• Decreased K, Mg, Na

• Increased Ca, uric acid, glucose

CP:

• Avoid when CrCl< 30 mL/min

• Monitor electrolytes

• take in the morning to decrease nocturnal diuresis

Furosemide

Lasix

Loop

CD: 20 - 40 mg daily - BID

ADE:

• Decreased Na, K, Mg, Ca

• Hypotension

• Increased Uric Acid

CP:

• Preferred diuretic when CrCa < 30 mL/min

• Monitor electrolytes

• Symptom Control vs HTN Control

Torsemide

Demadex

Loop

CD: 5 to 10 mg daily

ADE:

• Decreased Na, K, Mg, Ca

• Hypotension

• Increased Uric Acid

CP:

• Preferred diuretic when CrCa < 30 mL/min

• Monitor electrolytes

• Symptom Control vs HTN Control

Triamterene MOA

A diuretic that blocks epithelial sodium channels in the late distal convoluted tubule and collecting duct which inhibits sodium reabsorption and reduces intracellular sodium. The reduction decreases the function of Na+/ K+ ATPase, resulting in potassium retention

Aldosterone Antagonsit MOA

This diuretic increases water and sodium chloride excretion through competitive antagonism at aldosterone receptor sites in distal renal tubules. This also results in conservation of potassium and Hydrogen Ions

Triamterene/HCTZ

Mazide, Dyazide

Potassium Sparing Combos

CD: 37.5/25 mg daily

ADE:

• increased K

CP:

• Take in the morning

Spironolactone

Aldactone

Aldosterone Antagonist

CD: 25 mg daily

ADE:

• increased K

• Gynecomastia

CP:

• Take in the morning

Central Alpha₂ - agonist

Activates inhibitory neuron through the stimulations of adrenergic alpha₂ receptors. This inhibitory effect causes a decreased sympathetic output. A reductionin heart rate, peripheral resistance, and blood presure is observed as a result

Clonidine

Catapres

Cental alpha₂ agnonist

CD: 0.1 to 0.2 mg BID

ADE:

• orthostatic hypotension

• sedation

• dry mouth

• rebound hypertension

CP:

• avoid abrupt discontinuation