Top 300 -Misc CV Meds (wk 4)

Metoprolol

Lopressor (tartrate, IR), Toprol XL (succinate, ER) -Beta Blocker

Atenolol

Tenormin -Beta-Blocker

Bisoprolol

Zebeta -Beta-Blocker

Carveldilol

Coreg, Coreg CR -Beta-Blocker

Labetalol

Normodyne -Beta-Blocker

Nebivolol

Bystolic -Beta-Blocker

Propranolol

Inderal, Inderal LA, Inderal XL -Beta-Blocker

Beta-Blocker Indications

• heart failure

• angina

• myocardial infarction

• arrhythmias

• hypertension

Beta-Blocker MOA

Beta-adrenergic blocker (prevent epinephrine/norepinephrine from binding so decrease HR and contractility)

Beta-Blocker Contraindications

N/A

Beta-Blocker Black Box

Abrupt withdrawal in patients with coronary artery disease

Beta-Blocker ADRs

Common:

• dizziness

• fatigue

• hypotension

• bradycardia

Rare:

• heart failure (in pts that are fluid overloaded)

Beta-Blocker Key Points

• this medication may cause dizziness

• often when starting B-blockers, pts feel fatigued though this generally goes away

• avoid abruptly stopping this medication b/c it can cause rebound symptoms

• if you have diabetes, this can mask the feeling of low blood glucose

Clonidine

Catapres, Kapvay -Alpha-2 Adrenergic Agonist

Alpha-2 Adrenergic Agonist Indication

hypertension (2nd line)

Alpha-2 Adrenergic Agonist MOA

Stimulates alpha-2 adrenoceptors in the brain stem, 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

Alpha-2 Adrenergic Agonist Contraindications

N/A

Alpha-2 Adrenergic Agonist Black Box

N/A

Alpha-2 Adrenergic Agonist ADRs

Common:

• dizziness

• drowsiness

• fatigue

• dry mouth

• constipation

Rare:

• heart block

• syncope

Alpha-2 Adrenergic Agonist Key Points

• this drug is for your high blood pressure

• side effects include drowsiness, fatigue, dry mouth, and constipation

• if you experience severe dizziness or passing out, contact your doctor

• avoid stopping abruptly b/c it can cause rebound symptoms

Nitroglycerin

Minitran, Nitrostat, Nitro-dur, Transderm Nitro -Venodilator

Isosorbide Mononitrate

Imdur, Venodilator

Venodilator Indications

• Chest pain/angina

• heart failure with reduced ejection fraction

• hypertension

Venodilator MOA

Forms the free radical nitric oxide which in smooth muscle activates guanylate cyclase which increases guanosine 3’5’ monophosphate (cGMP) leading to smooth muscle relaxation.

Produces a vasodilator effect on the peripheral veins and arteries with more prominent effects on the veins

Venodilator Contraindications

Use with phosphodiesterase 5 inhibitors (sildenafil, tadalifil)

Venodilator Black Box

N/A

Venodilator ADRs

Common:

• headaches

• dizziness

Rare:

• syncope

Venodilator Key Points

Sublingual/Spray:

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

• sit before taking

• dissolve 1 tablet under tongue or use spray every 5 minutes for up to 3 doses, call 911

• you may fell dizziness or a burning/tingling in your mouth

Tablet:

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

• may cause dizziness/headache

Hydralazine

Apresoline -Vasodilatior

Vasodilatior Indications

• hypertension

• heart failure with reduced ejection fraction

Vasodilatior MOA

Direct vasodilation of arterioles (with little effect on veins). Arterial vasodilation may occur via inhibition of calcium release from the sarcoplasmic reticulum and inhibition of myosin phosphorylation in arterial smooth muscle cells

Vasodilatior Contrainidaction

Coronary artery disease

Vasodilatior Black Box

N/A

Vasodilatior ADRs

Common:

• dizziness

• reflex tachycardia

Rare:

• drug induced lupus erythematosus (DILE, especially at high doses)

Vasodilatior Key Points

• this drug is for your high blood pressure

• side effects include dizziness

• if you develop a skin rash while on this medication, contact your doctor

Ranolazine

Ranexa -Antianginal

Antianginal Indication

angina (chest pain)

Antianginal MOA

inhibits the late phase of the inward sodium channel during
cardiac repolarization, reducing intracellular sodium concentrations, thereby reducing calcium influx via Na+-Ca2+ exchange that in turn reduces ventricular tension and myocardial oxygen consumption

Antianginal Contraindications

• hepatic cirrhosis

• concurrent use of strong CYP3A inhibitors

• concurrent use of CYP3a inducers

Antianginal Black Box

N/A

Antianginal ADRs

Common:

• constipation

• nausea

Rare:

• QT prolongation

Antianginal Key Points

• this medication is for your chest pain

• swallow tablet whole, do not chew/crush

• may cause constipation and nausea

• many drug interactions exist so inform your doctor of any medication changes

Sacubitril/Valsartan

Entresto -ARB/Neprilysin Inhibitor

ARB/Neprilysin Inhibitor Indication

heart failure with reduced ejection fraction

ARB/Neprilysin Inhibitor MOA

ARB: Selective, reversible competitive antagonist of angiotensin II receptor. The angiotensin II receptor is responsible for vasoconstriction, aldosterone secretion, sympathetic outflow, and simulation of renal sodium reabsorption (prevents these effects)

Neprilysin inhibitor: inhibits neprilysin leading to decrease breakdown of natriuretic peptides (peptides →) inducing vasodilation and natriuresis (peeing out Na+)

ARB/Neprilysin Inhibitor Contraindications

• pregnancy

• use of an ACEI within 36 hours

ARB/Neprilysin Inhibitor Black Box

pregnancy

ARB/Neprilysin Inhibitor ADRs

Common:

• hyperkalemia

• hypotension

• acute kidney injury

Rare:

• angioedema

ARB/Neprilysin Inhibitor Key Points

• this medication is for your heart failure

• may cause dizziness, worsens if dehydrated

• avoid in pregnancy

• use potassium supplements or salt substitutes only under doctor supervision

• stop taking the medication and call your doctor right away if you experience any swelling of the mouth or lips

Digoxin

Digitek, Lanoxin -Cardiac Glycoside

Cardiac Glycoside Indications

• Atrial fibrillation

• heart failure with reduced ejection fraction

Cardiac Glycoside MOA

Atrial fibrillation: Direct suppression of the AV node conduction to increase effective refractory period and decrease conduction velocity

Heart Failure: Inhibition of the sodium/potassium ATPase pump in myocardial cells results in a transient increase of intracellular sodium, which in turn promotes calcium influx via the sodium-calcium exchange pump leading to increased contractility.

Cardiac Glycoside Contraindication

N/A

Cardiac Glycoside Black Box

N/A

Cardiac Glycoside ADRs

Common:

• anorexia

• diarrhea

Rare:

• arrhythmias

• heart block

Cardiac Glycoside Key Points

• this drug is for your atrial fibrillation or heart failure

• you may require blood draws to confirm you are receiving a safe and effective dose

• this drug has many interactions so check with your doctor before starting/changing any medications

Amiodarone

Codarone, Pacerone -Class III Antiarrhythmic

Class III Antiarrhythmic Indications

• atrial arrhythmia

• ventricular arrhythmia

Class III Antiarrhythmic MOA

inhibits adrenergic stimulation (alpha- and beta-blocking properties), affects sodium, potassium, and calcium channels, prolongs the action potential and refractory period in myocardial tissue; decreases AV conduction and sinus node function

Class III Antiarrhythmic Contraindications

N/A

Class III Antiarrhythmic Black Box

• Arrhythmias

• hepatotoxicity

• proarrhythmic effects

• pulmonary toxicity

Class III Antiarrhythmic ADRs

Common:

• bradycardia

• hypotension

• nausea

• vomiting

• photosensitivity

Rare:

• hepatotoxicity

• proarrhythmic effects

• pulmonary toxicity

• Thyroid disease

Class III Antiarrhythmic Key Points

• this medication is to treat your heart rhythm

• there are many side effects and drug interactions associated with this medication so it requires close monitoring by your doctor

• always wear sunscreen or cover your skin when in direct sunlight, a blue greying of your skin can occur