Cardiovascular Drugs: Mechanisms, Effects, and Classifications for Pharmacology

Calcium Channel Blockers

Inhibit the influx of calcium ions into cells, relaxing blood vessels, decreases force and rate of muscle contractions, lowering cardiac workload.

Cardiac Glycosides

Increases force of heart contractions and slows HR by inhibiting the sodium potassium ATPase pump in cardiac muscle cells, increases extracellular calcium which improves heart pumping ability.

Antianginals

Reducing myocardial O2 demand or increasing oxygen supply to the heart muscle, relaxes and dilates blood vessels to increase blood flow and decrease heart rate, contractility, and blood pressure to lessen heart's workload.

Coagulation Modifiers

Work by either promoting (anticoagulants, antiplatelets) or dissolving (thrombolytics) blood clots, anticoagulants interfere with coagulation cascade while antiplatelets prevent platelet aggregation.

Oral Anticoagulants

Directly inhibit or indirectly decrease vitamin K dependent clotting factors to prevent blood clot formation (e.g., warfarin).

Heparin

Prevents blood clots by inhibiting the coagulation cascade, inhibits thrombin and factor XA factors, prevents fibrin formation.

Low Molecular Weight Heparin

Similar to Heparin mechanism of action.

Antiplatelets

Prevent blood clots by inhibiting platelet aggregation, a process where platelets stick to each other and form a plug.

Angiotensin II Receptor Blockers (ARBs)

Block renin-angiotensin-aldosterone system, a hormone that regulates blood pressure, prevents vasoconstriction lowering BP, promotes sodium and water loss.

ACE Inhibitors

Block the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor, resulting in vasodilation decreasing BP, also reduces cardiac afterload, and reduces aldosterone production improving renal blood flow.

Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)

Inhibit the enzyme neprilysin and block angiotensin II, reduces harmful effects on the heart and vessels, cause vasodilation, natriuresis (sodium and water loss), lowers cardiac workload, limits cardiac remodeling that occurs during heart failure.

Adrenergic Drugs

Blocks the effects of the body's natural adrenaline and noradrenaline by acting on alpha and beta adrenergic receptors, reduces sympathetic nervous system activity decreasing HR and BP.

Alpha 1 Blockers

Bind to alpha-1 adrenergic receptors preventing the binding of norepinephrine.

Verapamil

Major adverse effect includes hypotension.

Digoxin

Major adverse effect includes toxicity leading to arrhythmias.

Nitroglycerin

Major adverse effect includes headache and hypotension.

Furosemide

Major adverse effect includes electrolyte imbalances.

Valsartan

Major adverse effect includes hypotension.

Hydralazine/Isosorbide Dinitrate

Major adverse effect includes headache and hypotension.

Metoprolol

Major adverse effect includes bradycardia.

Propranolol

Major adverse effect includes fatigue.

Ivabradine

Major adverse effect includes bradycardia.

Hydrochlorothiazide

Major adverse effect includes electrolyte imbalances.

Enalapril

Major adverse effect includes cough.

Valsartan/Sacubitril

Major adverse effect includes hypotension.

Amlodipine

Drug class includes calcium channel blockers.

Losartan

Drug class includes ARBs.

Lisinopril

Drug class includes ACE inhibitors.

Enoxaparin

Drug class includes low molecular weight heparin.

Isosorbide Dinitrate

Drug class includes antianginals.

Clopidogrel

Drug class includes antiplatelets.

Doxazosin

Drug class includes alpha blockers.

Beta Blockers

Block the effects of epinephrine (adrenaline) and norepinephrine (noradrenaline), bind to beta adrenergic receptors reducing HR and contractility, lower BP, inhibit release of renin.

Combination Alpha/Beta

Lower BP and HR by blocking both alpha-1 and beta-receptors, dilates blood vessels and reduces force and speed of heart contractions.

SA Node Modulators

Inhibits the If current in the hearts SA node (natural pacemaker), selectively slows the HR by targeting specific ion channels (K+ and Na+) reducing the rate of depolarization without affecting other cardiac functions such as contractility.

Diuretics

Increase urine output by blocking sodium reabsorption at different parts of the nephron, causing more water to be excreted.

Loop Diuretics

Inhibit sodium potassium chloride cotransporter in ascending loop of Henle, increases excretion of sodium, potassium, and chloride, as well as calcium and magnesium.

Thiazide Diuretics

Block the sodium chloride cotransporter in early distal convoluted tubule, increase sodium, chloride, and potassium excretion, effective in treating hypertension and edema.

Potassium Sparing Diuretics

Directly blocks epithelial sodium channels on apical membrane of collecting tubule or inhibit the action of aldosterone, promote sodium excretion and increase potassium reabsorption preventing potassium loss.

Carbonic Anhydrase Inhibitors

Inhibit the enzyme carbonic anhydrase in proximal tubule, decreases formation of hydrogen ions which reduces reabsorption of sodium and bicarbonate resulting in mild diuresis.

Osmotic Diuretics

Pharmacologically inert substances that are freely filtered but poorly reabsorbed by the nephron, remain in tubular fluid increasing its osmolarity and promoting water excretion via osmosis.

Selective Aldosterone Blockers

Bind to mineralcorticoid receptors in the kidney, blocking action of aldosterone, reduces sodium reabsorption and increases potassium excretion, can also reduce cardiac remodeling such as fibrosis and improve cardiac function in HF.

Endothelin Receptor Blockers

Competitively blocks endothelin-1 from binding to its receptors leading to vasodilation, also dilate pulmonary arteries and remodel them to treat conditions such as pulmonary hypertension.

Verapamil Adverse Effects

Bradycardia, hypotension, constipation, peripheral edema.

Digoxin Adverse Effects

Bradycardia, toxicity with clinical significance.

Nitroglycerin Adverse Effects

Headache, dizziness, hypotension.

Furosemide Adverse Effects

Hypovolemia, electrolyte imbalances (hypokalemia, hypocalcemia, hypomagnesemia), dehydration, and ototoxicity.

Heparin Adverse Effects

Severe bleeding, hyperkalemia, heparin-induced thrombocytopenia.

Valsartan Adverse Effects

Dizziness, headache, hyperkalemia, renal impairment.

Hydralazine/Isosorbide DiNitrate Adverse Effects

Headache, dizziness, nausea, hypotension.

Metoprolol Adverse Effects

Bradycardia, fatigue, hypotension, impotence, bronchospasm.

Propranolol Adverse Effects

Bradycardia, hypotension, impotence, bronchospasm.

Ivabradine Adverse Effects

Bradycardia, hypertension, blurred vision, AFIB.

Hydrochlorothiazide Adverse Effects

Hypokalemia, hyponatremia, hyperuricemia, hyperglycemia, hyperlipidemia.

Enalapril Adverse Effects

Cough, hypotension, hyperkalemia, acute kidney injury, angioedema.

Valsartan/Sacubitril Adverse Effects

Hypotension, dizziness, cough, hyperkalemia, renal impairment.

Clopidrogel

Antiplatelet (P2Y12/Adenosine Diphosphate (ADP) Inhibitor).