Cardiology- Drug Classifications

Angiotensin-Converting Enzyme Inhibitors

• Mechanism

• Indication

• Contraindication

• Side effects

Mechanism: block enzyme that activates angiotensin → help widen blood vessels and lower BP

Indication: Hypertension, congested arteries, post myocardial infarction

Contraindication: pregnancy

Side effects: dry cough (switch to ARBs)

Angiotensin Receptor Blockers

• Mechanism

• Indication

• Contraindication

Mechanism: block receptors that receive angiotensin→ lower BP

Indication: Hypertension, congested arteries, post myocardial infarction

Contraindication: pregnancy

Beta-Blockers

• Mechanism

• Indication

• Contraindication

• Metropolol Tartrate vs Succinate

• Side effects

Mechanism: Block effects of epinephrine (adrenaline) → lower BP

Indication: hypertension, heart failure, arrhythmias, angina

Contraindication: asthma

Metropolol Tartrate: immediate release (take twice daily)

Metropolol Succinate: extended-release (take once daily)

Side effects: fatigue, bradycardia (slow heart rate)

Calcium Channel Blockers

• Mechanism

• Indication

• Side effects

• 2 types and difference

Mechanism: inhibit entry of calcium ions into heart muscle cells → relax blood vessels and reduce heart rate

Indication: Hypertension, angina, arrhythmia

Side effects: peripheral edema (swelling), palpitations, drowsiness, headache

Classified into 2 types: dihydropyridine (end in -pine), non-dyhydropyridine (no common suffix)

Diuretics (water pills)

• Mechanism

• Indication

• Side effects

• Thiazide vs Loop vs Potasium-sparing

Mechanism: promote amount of water excreted through urine → reduce BP

Indication: edema related hypertension

Side effects: frequent urination

Thiazide Diuretics:

• promote sodium/potassium, excretion of water thru kidneys

• Side effects: hyponatremia (caused by low sodium) and hypokalemia (caused by low potassium in blood)

Loop Diuretics:

• Mechanism: increase excretion of water by excreting potassium

• Side effects: Decreased potassium (hypokalemia)

• Many patients will need to supplement with potassium chloride

• Potassium-Sparing Diuretics

• Mechanism: Potassium-sparing diuretics increase water excretion without wasting potassium.

• Adverse reaction: May cause increased potassium (hyperkalemia)

• Counseling point: Patients should avoid salt substitutes

Alpha Blockers

• Mechanism

• Side effects

• Counseling point

• Mechanism: Alpha-blockers are used to treat both high blood pressure and benign prostatic hypertension (BPH).

• Adverse reactions: Dizziness, orthostatic hypotension

• Counseling point: Blood pressure may drop when switching from sitting to standing.

Peripheral Vasodilators

• Mechanism

• Mechanism: Peripheral vasodilators dilate (enlarge) blood vessels, which results in lower blood pressure.

Alpha Agonist

• Mechanism

• Indication

• Mechanism of action: Alpha agonists affect neurotransmitters in the brain to lower blood pressure.

• Other indication: Attention deficit hyperactivity disorder (ADHD

Blood Thinners

• Mechanism

• Side effects

• Blood thinners are medications that prevent blood clots from forming inside blood vessels.

• Adverse drug reactions: Increased risk of bleeding

Nitrates

• Mechanism

• Indication

• Contraindication

• Mechanism: Nitrates dilate (widen) arteries, leading to more blood flow.

• Indication: angina

• Contraindication: Phosphodiesterase-5 inhibitors (PDE-5 inhibitors)

• Examples of PDE-5 inhibitors: Sildenafil (Viagra); Tadalafil (Cialis). Both nitrates and PDE-5 inhibitors dilate blood vessels. They can cause a very severe drop in blood pressure if used together.

Digoxin

• Mechanism

• Indication

• Mechanism: Digoxin makes the heart beat slower but more forcefully.

• Indication: Heart failure and atrial fibrillation

• Narrow therapeutic index drug