Cardiology Key Drugs Set #1

benazepril to nifedipine

generic: benazepril

brand: lotensin

pharmacologic category: benazepril

ACE inhibitor

box warning: benazepril

fetal toxicity

MOA: benazepril

prevents Ang I to Ang II, resulting in lower levels of Ang II, which causes an increase in plasma renin activity and a reduction in aldosterone secretion

counseling info: benazepril

cough, hypotension, dizziness, headache, increases potassium (monitor)

uses: benazepril

hypertension

does benazepril require renal dosing?

yes

generic: enalapril maleate

brand: vasotec

pharmacologic category: enalapril maleate

ACE inhibitor

box warning: enalapril maleate

fetal toxicity

MOA: enalapril maleate

a pro-drug that is converted to its active metabolite, prevents Ang I to ANG II so lower levels of Ang II = increase renin & reduce aldosterone

counseling info: enalapril maleate

cough, hypotension, dizziness, headache, increase potassium (monitor)

use: enalapril maleate

HF, HTN, kidney disease (non-diabetes related), diabetic neuropathy, MI, proteinuria chronic kidney disease

does enalapril maleate require renal dosing?

yes

generic: lisinopril

brand: zestril, prinivil

pharmacologic category: lisinopril

ACE inhibitor

box warning: lisinopril

fetal toxicity

MOA: lisinopril

prevents Ang I to Ang II, lowers levels of Ang II, increase plasma renin activity & reduce aldosterone secretion

counseling info: lisinopril

cough, hypotension, dizziness, headache, increase potassium (monitor)

use: lisinopril

HFrEF, hypertension, ST-elevated MI

does lisinopril require renal dosing?

yes

generic: ramipril

brand: altace

pharmacologic category: ramipril

ACE inhibitor

box warning: ramipril

fetal toxicity

MOA: ramipril

prevents Ang I to Ang II, lowers levels of Ang II, increase plasma renin activity & reduce aldosterone secretion

counseling info: ramipril

cough, hypotension, dizziness, headache, increases potassium (monitor)

uses: ramipril

HF post-MI, hypertension, reduce risk of CV events

does ramipril require renal dosing?

yes

generic: Lisinopril & hydrochlorothiazide

brand: prinzide, zestoretic

pharmacologic category: Lisinopril & hydrochlorothiazide

ACE inhibitor & thiazide diuretic combination product

MOA: Lisinopril & hydrochlorothiazide

HCTZ: inhibits Na reabsorption in the distal tubule causing increased excretion of Na and water as well as potassium and hydrogen ions

Lisinopril: competitive inhibitor of ACE, prevents Ang I to Ang II, lower Ang II, increases renin & reduce aldosterone

counseling info: Lisinopril & hydrochlorothiazide

Lisinopril: cough, hypotension, dizziness, headache, increases potassium (monitor)

HCTZ: reduced potassium (monitor), dizziness, take in morning to avoid frequent urination at night

use: Lisinopril & hydrochlorothiazide

hypertension

does Lisinopril & hydrochlorothiazide require renal dosing?

yes

generic: Norepinephrine bitartrate

brand: levophed

pharmacologic category: Norepinephrine bitartrate

alpha 1 and 2 agonist, beta 1 agonist, catecholamine (inotrope)

MOA: Norepinephrine bitartrate

Action on alpha receptors causes peripheral vasoconstriction of blood vessels to maintain blood pressure and heart function.

Beta agonist- Inotropic stimulator of heart and dilator of coronary arteries

counseling info: Norepinephrine bitartrate

bradycardia, arrythmia, anxiety, transient headache

uses: Norepinephrine bitartrate

used primarily to increase or maintain blood pressure during acute medical situations

generic: epinephrine

brand: varies

pharmacologic category: epinephrine

alpha 1 & 2 agonist, beta 1, beta 2 agonist (catecholamine)

MOA: epinephrine

Action on alpha receptors causes peripheral vasoconstriction of blood vessels to maintain blood pressure and heart function.

Action on beta receptors, it increases heart rate and contractility & also relaxes smooth muscles in the lungs to relieve SOB and wheezing (dueing anaphylaxis)

counseling info: epinephrine

anxiety, disorientation, headache, restlessness

use: epinephrine

acute treatment of allergic reactions, treats low blood pressure during septic shock & use in eye surgery to maintain pupil dilation

generic: dopamine HCl

brand: varies

pharmacologic category: dopamine HCl

alpha 1 agonist, beta 1 agonist, dopamine agonist, catecholamine (inotrope)

MOA: dopamine HCl

Dose dependent pharmacology:

Lower doses (0.5 - 2 mcg/kg/min activates D1 and D2 receptors in renal, mesenteric, and coronary vasculature (vasociation)- used for renal perfusion in AKI and HF

Intermediate doses 2 - 10 mcg/kg/hr it activates beta-1 receptors enhancing heart rate and contractility. Used in shock for inotropic effect.

Doses > 10 mcg/kg/hr - primarily impacts alpha-1 receptors causing vasoconstriction. - Used for hypotension in shock

counseling info: dopamine HCl

monitor for tachycardia, arrythmias, and excessive vasoconstriction (can compromise organ perfusion)

use: dopamine HCl

increase or maintain blood pressure during acute medical situations

generic: doxazosin

brand: cardura, cardura XL

pharmacologic category: doxazosin

alpha1 antagonist

MOA: doxazosin

Hypertension: Competitively inhibits postsynaptic alpha-adrenergic receptors which results in vasodilation of veins and arterioles and a decrease in total peripheral resistance and blood pressure

BPH: Antagonist of alpha(1A)-adrenoreceptors in the prostate, leads to relaxation of smooth muscle in the bladder neck and prostate causing an improvement of urine flow and decreased symptoms of BPH

counseling info: doxazosin

may cause low BP, causing dizziness or fainting (orthostatic hypotension), tachycardia, sexual dysfunction, some weakness. usually resolves within 2 weeks.

uses: doxazosin

BPH, hypertension

generic: clonidine

brand: catapres

pharmacologic category: clonidine

alpha2 agonist

black box: clonidine

epidural use (dilute 500 mcg/ml prior to use)

MOA: clonidine

Stimulates alpha-2 adrenoceptors in the brain stem, thus activating an inhibitory neuron, resulting in reduced sympathetic outflow from the CNS, producing a decrease in peripheral resistance, renal vascular resistance, heart rate, and blood pressure

counseling info: clonidine

drowsiness, headache, dizziness, rash, dry mouth

uses: clonidine

ADHD, hypertension

generic: irbesartan

brand: avapro

pharmacologic category: irbesartan

ARB

box warning:  irbesartan

fetal toxicity

MOA: irbesartan

block binding of Ang II to AT1 receptor (vasoconstrictor) on blood vessel walls promoting vasodilation

counseling info: irbesartan

dizziness, fatigue, hypotension, headache, raise K (be careful with K rich foods)

use: irbesartan

diabetic nephropathy, hypertension

generic: losartan

brand: cozaar

pharmacologic category: losartan

ARB

box warning: losartan

fetal toxicity

MOA: losartan

block binding of Ang II to AT1 receptor (vasoconstrictor) on blood vessel walls promoting vasodilation

counseling info: losartan

dizziness fatigue, hypotension, headache, raise K

use: losartan

hypertension, diabetic nephropathy

generic: olemsartan

brand: benicar

pharmacologic category: olmesartan

ARB

box warning: olemsartan

fetal toxicity

MOA: olmesartan

block binding of Ang II to AT1 receptor (vasoconstrictor) on blood vessel walls promoting vasodilation

counseling info: olmesartan

dizziness, fatigue, hypotension, headache, raise K

use: olmesartan

hypertension

generic: valsartan

brand: diovan

pharmacologic category: valsartan

ARB

box warning: valsartan

fetal toxicity

MOA: valsartan

block binding of Ang II to AT1 receptor (vasoconstrictor) on blood vessel walls promoting vasodilation

counseling info: valsartan

dizziness, fatigue, headache, hypotension, raise K

use: valsartan

HFrEF, hypertension, post-MI

generic: adenosine

brand: adenocard

pharmacologic category: adenosine

antiarrhythmic agent

MOA: adenosine

slow conduction time through AV node, vasodilation and increases blood flow in normal coronary arteries

counseling info: adenosine

immediately after administration may experience sudden but transient chest pressure or sense of impending doom 

use: adenosine

paroxysmal supraventricular tachycardia

generic: amiodarone

brand: pacerone

pharmacologic category: amiodarone

antiarrhythmic agent

box warning: amiodarone

arrythmias, pulmonary toxicity, hepatotoxicity

MOA: amiodarone

Inhibits adrenergic stimulation, affects sodium, potassium, and calcium channels, prolongs the action potential and refractory period in myocardial tissue; decreases AV conduction and sinus node function

counseling info: amiodarone

epithelial keratopathy (eyes), hypotension, N/V

uses: amiodarone

ventricular arrythmias

generic: flecainide

brand: tambocor

pharmacologic category: flecainide

antiarrhythmic agent (class Ic)

MOA: flecainide

Class Ic antiarrhythmic; slows conduction in cardiac tissue by altering transport of ions across cell membranes; causes slight prolongation of refractory periods; decreases the rate of rise of the action potential without affecting its duration; increases electrical stimulation threshold of ventricle, His-Purkinje system

counseling info: flecanide

dizziness, ventricular arrythmia, visual disturbances

uses: flecanide

paroxysmal afib/flutter & SVT prevention, ventricular arrythmias prevention