Mechanism: ACE inhibitor, decreased synthesis of aldosterone and decreased degradation of bradykinin

CV affects: decreased PR, decreased afterload, increased cardiac efficiency, increased CO and ejection fraction

Local effects on heart, brain and kidneys

Treatment: CHF, used in conjunction with diuretics and digitalis, MI

Side effects:  dry cough and angioneurotic edema (increased bradykinin), hypotension, hyperkalemia (low aldosterone), renal failure, fetal deformities

Mechanism: ARBs

AT1: G-protein linked receptor and increases cytosolic free calcium

AT2: increases cGMP formation (CNS and heart)

Same effect as ACE inhibitors

Treatment: CHF

Side effects: hypotension, oliguria, progressive azotemia, acute renal failure, hyperkalemia in patients with renal disease, taking K+ supplements or K-sparing diuretics

Mechanism: renin blocker, orally available

Treatment: hypertension; HF

Mechanism: calcium sensitizer, inotropic agent - binds to cardiac troponin C in a calcium dependent manner; vasodilation through opening of ATP-sensitive potassium channels - increases CO without increasing oxygen demand

Treatment: acutely decompensated severe chronic heart failure

Mechanism: Digitalis glycoside, reversibly inhibits Na+/K+-ATPase by preventing the binding of ATP to the enzyme which increases calcium influx and promotes cardiac contractility --> increases CO, decreases heart size, decreases VP, decrease EDV, produces diuresis and decreases blood/ECF volum, binding inhibited by K+

Treatment: HF, atrial arrhythmias

Side effects: arrhythmias

Contraindications: WPW and atrial fibrillation

Mechanism: racemic mixture - nonselective beta blocker and alpha1 blockade; short term: vasodilation, long term: prevents deterioration of myocardial function, prevents remodeling, unlike metoprolol, does not effect number of beta1 receptors; reduces arrhymogenesis

 Treatment: HF

Side effects: symptomatic hypotension and heart block, bradycardia

Contraindications: asthma and bradycardia

Mechanism: Cardioselective cAMP phosphodiesterase inhibitors, orally or IV available, IV is safer and more efficacious, given when other treatment are failing

Treatment: HF, acute basis

Side effects: milrinone - fatal arrhythmias, inamrinone - bone marrow and liver toxicity, nausea, vomiting, arrhythmias, thrombocytopenia and liver enzyme changes