CV Drugs

amiodarone

Cordarone, Pacerone

digoxin

Lanoxin

atenolol

Tenormin

bisoprolol

Zebeta

carvedilol

Coreg, Coreg CR

clonidine

Catapres

hydralazine

Apresoline

isosorbide mononitrate

Imdur

labetalol

Normodyne

metoprolol

Lopressor, Toprol XL

nebivolol

Bystolic

nitroglycerin

Minitran, Nitro-Dur, Nitrostat, Transderm-Nitro

propanolol

Inderal, Inderal LA, Inderal XL

sacubitril/valsartan

Entresto

ranolazine

Ranexa

β-blocker (-olol) indications

• heart failure

• angina

• MI

• arrhythmia

• hypertension

β-blocker (-olol) mechanism of action

β-adrenergic blocker

β-blocker (-olol) contraindications

none

β-blocker (-olol) black box warnings

abrupt withdrawal in pts with coronary artery disease

β-blocker (-olol) ADRs (common)

• DZ

• fatigue

• hypotension

• bradycardia

β-blocker (-olol) ADRs (rare but serious)

• heart failure (pts who are fluid-overloaded)

β-blocker (-olol) key counseling points

• this medication may cause DZ

• may feel fatigued when starting this med, but this generally goes away with time

• avoid abruptly stopping this medication

  • rebound symptoms can occur

• this may mask the feeling of low BG (for diabetic pts)

α-2 adrenergic agonists (clonidine/Catapres) indications

hypertension

α-2 adrenergic agonists (clonidine/Catapres) mechanism of action

• stimulates α-2 adrenoreceptors in brain stem

  • activates inhibitory neuron

Decreases:

• sympathetic outflow from CNS

• peripheral resistance

• renal vascular resistance

• HR

• BP

α-2 adrenergic agonists (clonidine/Catapres) major contraindications

none

α-2 adrenergic agonists (clonidine/Catapres) black box warnings

none

α-2 adrenergic agonists (clonidine/Catapres) ADRs (common)

• DZ

• drowsiness

• fatigue

• dry mouth

• constipation

α-2 adrenergic agonists (clonidine/Catapres) ADRs (rare but serious)

• heart block

• syncope (fainting)

α-2 adrenergic agonists (clonidine/Catapres) key counseling points

• this drug is for high BP

• side effects may include DZ, fatigue, dry mouth, and constipation

• if you experience severe DZ or passing out, call doctor right away

• avoid stopping this med abruptly, it may cause rebound symptoms

vasodilator (hydralazine/Apresoline) indications

• hypertension

• HFrEF

α-2 adrenergic agonists (clonidine/Catapres) mechanism of action

• exact mechanism unknown

• direct vasodilation of arterioles (little effect on veins)

• possibly inhibition of calcium release and myosin phosphorylation in arterial smooth muscle

α-2 adrenergic agonists (clonidine/Catapres) major contraindications

coronary artery disease

α-2 adrenergic agonists (clonidine/Catapres) black box warnings

none

α-2 adrenergic agonists (clonidine/Catapres) ADRs (common)

• DZ

• reflex tachycardia

α-2 adrenergic agonists (clonidine/Catapres) ADRs (rare but serious)

• drug-induced lupus erythematosus (especially at high doses)

α-2 adrenergic agonists (clonidine/Catapres) key counseling points

• this drug is for high BP

• DZ is a side effect

• contact doctor if you develop a skin rash

venodilator (nitroglycerin/Minitran) indications

• angina

• HFrEF

• hypertension

venodilator (nitroglycerin/Minitran) mechanism of action

• forms free radical which activates guanylate cyclase

• vasodilation effect on peripheral veins and arteries (emphasis on veins)

Increases:

• guanosine 3’5’ monophosphate

• smooth muscle relaxation

venodilator (nitroglycerin/Minitran) major contraindications

concurrent use of phosphodiesterase 5 inhibitors (sildenafil, tadalafil)

venodilator (nitroglycerin/Minitran) black box warnings

none

venodilator (nitroglycerin/Minitran) ADRs (common)

• headaches

• DZ

venodilator (nitroglycerin/Minitran) ADRs (rare but serious)

• syncope (fainting)

venodilator (nitroglycerin/Minitran) key counseling points

SL/Spray:

• this medication is to be used when you feel severe chest pain

• sit before taking

• dissolve 1 tab SL Q 5 minutes for UT 3 doses

• call 911

• you may feel DZ or burning/tingling in mouth

Tablet:

• this medication is for heart failure, chest pain, or hypertension

• may cause DZ or headache

antianginal (ranolazine/Ranexa) indications

angina

antianginal (ranolazine/Ranexa) mechanism of action

• inhibits late phase of the inward sodium channel during cardiac repolarizations

Decreases:

• calcium influx via Ca and Na exchange

• ventricular tension

• myocardial oxygen consumption

antianginal (ranolazine/Ranexa) major contraindications

• hepatic cirrhosis

• concurrent use of strong CYP3A inhibitors

• concurrent use of CYP3A inducers

antianginal (ranolazine/Ranexa) black box warnings

none

antianginal (ranolazine/Ranexa) ARDs (common)

• constipation

• nausea

antianginal (ranolazine/Ranexa) ADRs (rare but serious)

QT prolongation (irregular heartbeat)

antianginal (ranolazine/Ranexa) key counseling points

• this medication is for chest pain

• swallow whole

• this medication may cause constipation and nausea

• many DDIs exist for this med, notify your doctor of any med changes

ARB / neprilysin inhibitor (sac/val, Entresto) indications

HFrEF

ARB / neprilysin inhibitor (sac/val, Entresto) mechanism of action

Drug #1:

• selective antagonist of angiotensin II receptor

  • results in vasodilation

Drug #2:

• inhibits nepilysin

  • results in decreased breakdown of natriuretic peptides

  • increased vasodilation and natriuresis (excretion of sodium)

ARB / neprilysin inhibitor (sac/val, Entresto) major contraindications

• pregnancy

• use of an ACEI within 36 hours

ARB / neprilysin inhibitor (sac/val, Entresto) black box warnings

pregnancy

ARB / neprilysin inhibitor (sac/val, Entresto) ADRs (common)

• hyperkalemia

• hypotension

• AKI

ARB / neprilysin inhibitor (sac/val, Entresto) ADRs (rare but serious)

angioedema

ARB / neprilysin inhibitor (sac/val, Entresto) key counseling points

• this medication is for heart failure

• may cause DZ, worsens when dehydrated

• avoid in pregnancy

• only use potassium subs with doctor approval

• call doctor right away upon swelling of mouth or lips

cardiac glycoside (digoxin / DIgitek) indications

• atrial fibrillation

• HFrEF

cardiac glycoside (digoxin / DIgitek) mechanism of action

• suppression of AV node

• inhibition of sodium/potassium ATPase pump

  • increase in intracellular sodium

  • increased contractility

cardiac glycoside (digoxin / DIgitek) major contraindications

none

cardiac glycoside (digoxin / DIgitek) black box warnings

none

cardiac glycoside (digoxin / DIgitek) ADRs (common)

• anorexia

  • diarrhea

cardiac glycoside (digoxin / DIgitek) ADRs (rare but serious)

• arrhythmias

• heart block

cardiac glycoside (digoxin / DIgitek) key counseling points

• this drug is for your atrial fibrillation or heart failure

• blood draws may be required to ensure your dose is safe

• this drug has many DDIs

class III antiarrhythmic (amiodarone / Codarone) indications

• atrial arrhythmia

  • ventricular arrhythmia

class III antiarrhythmic (amiodarone / Codarone) mechanism of action

• inhibits adrenergic stimulation

• decreases AV conduction and sinus node function

class III antiarrhythmic (amiodarone / Codarone) major contraindications

none

class III antiarrhythmic (amiodarone / Codarone) black box warnings

• arrhythmia

• hepatotoxicity

• proarrhythmic effects

• pulmonary toxicity

class III antiarrhythmic (amiodarone / Codarone) ADRs (common)

• bradycardia/hypotension

• N/V

• photosensitivity

class III antiarrhythmic (amiodarone / Codarone) ADRs (rare but serious)

• hepatotoxicity

• proarrhythmic effects

• pulmonary toxicity

• thyroid disease

class III antiarrhythmic (amiodarone / Codarone) key counseling points

• this medication is used to treat your heart rhythm

• monitor side effects

• always wear sunscreen or your skin may turn blue