captopril (Capoten)

ACE inhibitor

Use: HTN, heart failure, MI; neropathy

Effects: ↓ angiotensin II, vasodilation, ↓ in blood volume, prevents breakdown of bradykinin (vasodilation, cough, angioedema)

ADRs: 1st dose hypotension, cough, hyperkalemia (dysrhythmia); renal failure; fetal injury; angioedema(serious- hives, histamine release)

DD: diuretics (hypotension); other antihypertensives; drigs that ↑ K levels; lithium (↑ lithium levels)

 RN: monitor BP = 80/40-hold med, retake BP, call Dr

Enalapril

Benazepril

Fosinopril

Lisinopril

Moexipril

Ramipril

 losartan (Cozaar)

angiotensin II receptor blockers (ARB's)

Use: HTN, diabetic neropathy, heart failure

Effects: similar to ACE inhibitor but doesn't 

cause hyperkalemia or cough, less incidence of angioedema

ADRs: renal failure w/ Hx of renal stenosis; fetal injury

DD: additive effects with other antihypertensives

 aliskiren (Tekturna)

direct renin inhibitor

Use: HTN

ADRs: at high does D

 low incidence angioedema, cough or hyperkalemia

 verapamil (Calan)

calcium channel blocker (CCB)

Use: angina pectoris - vasodilation, essential HTN(genetic)- arteriole dilation, cardiac dysrhythmias- suppress impulse conduction SA node

Effect: dilation of arterioles, ↓ arteriole pressure, ↑ coronary perfusion, ↓ HR, ↓ force of contraction

ADRs: constipation, dizziness, facial flushing, HA, edema of ankles/feet, bradycardia, partial or complete AV block

DD: digoxin( ↑ risk of AV block, ↑ digoxin levels); beta-adrenergic blockers( ↓ HR and AV conduction

nifedipine (Procardia)

dihydropyridines (CA channel blocker)

Use: angina pectoris, HTN

Effects: vasodilation, ↓ BP, ↑ HR, ↑ contractile force

ADRs: similar to verapamil, but ↓ constipation and AV block; reflex ↑ HR

nicardipine

isradipine

nimodipine

clevidipine

amiodipine

felodipine

nisoldipine

 hydralazine (Apresoline)

vasodilator

  arteriol dilation from vascular smooth muscle relaxation

Use: essential HTN, hypertensive crisis, heart failure

Effects: ↓ BP, ↑ HR

ADRs: reflex tachycardia, ↑ blood volume, SLE-like syndrome (a rheumatoid syndrome)

DD: caution w/ other antihypertensives

 sodium nitroprusside (Nitropres)

vasodilator

 arteriole and venous dilation by nitric oxide

Use: hypertensive emergencies

Effects: rapid ↓ in BP

ADRs: excessive hypotension, cyanide toxicity/ thiocynate toxicity (blood levels will be monitored for several days)

 nitroglycerin

angina pectoris(prganic nitrates)

      venous dilation by vascular smooth muscle dilation, via nitric oxide

Use: stable angina, variant angina

Effects: stable angina: ↓ pain by ↓ O2 demand; variant angina: ↑ O2 supply by relaxing coronary arteries

ADRs: HA, orthostatic hypotension; reflex tachycardia

DD: ↑ effect of other hypotensive drugs, drugs for erectile dysfunction

• tolerance develops rapidly(in a day) w/ cross-tolerance to other nitrates and vice versa
• D/C slowly to avoid vasospasm
• transdermal: "wash out period." On for 12 off for 12

isosorbide dinitrate

isosorbide mononitrate (long acting form)

propranolol(Inderal)

metoprolol (Lopressor)

angina pectoris (Beta blocker)

Use: for stable angina

Effects: ↓ cardiac O2 demand reduces pain ( ↓ HR and contractility) by blocking beta receptor in ♥

ADRs: bradycardia, ↓ AV conduction, ↓ contractility (not used in pts w/ HF or AV block); bronchospasm in asthma, masks s/s hypoglycemia

verapamil (Calan)

angina pectoris CA channel blocker

Use: stable and variant angina

Effects: variant angina: ↑ cardiac O2 supply; stable angina: ↓ cardiac O2 demand (dilates arteriolesm which ↓ afterload, and by ↓ HR and contractility)

ADRs: hypotension, reflex tachycardia

antiplatelet drugs(Aspirin; Plavix) - ↓ platelet aggregation and ↓ risk of thrombus formation in cardiac arteries 

cholesterol lowering drugs - ↓ coronary atherosclerosis

ACE inhibitors - ↓ adverse outcomes (stroke, MI, death)

diuretics

ACE inhibitors (captopril, enalapril)

angiotensin II receptor blockers (ARB's)

aldosterone antagonists (epieranone)

direct renin inhibitors (Tekturna)

beta blockers (carvedilol, bisprolol, metoprolol)

inotropic agents

digoxin (Lanoxin)

inotropic agent

        ↑ force of ventricular contraction, from accumulating CA in cardiac cells

Use: heart failure

Effects: ↑ cardiac output ( ↓ dose for renal pts, check apical pulse for 1 minute before administering(if pulse

ADRs: cardiotoxicity (dysrhythmias); GI (anorexia, N, V); CNS (fatigue, visual disturbances)

DD: diurectics (promote loss of K, ↑ risk of digoxin-induced dysrhythmias); ACE inhibitors and ARB's ( ↑ K levels and ↓ effectiveness of digoxin); verapamil and quinidine ( ↑ levels of digoxin)

 Fab Antibody fragments (Digibind)

digoxin antidote

binds to digoxin molecules then is exreted by kidneys

optimal plasma range 0.5-0.8 ng/ml (normal 0.5-2.0 ng/ml)

narrow therapeutic range

 quinidine (Duraquin)

antidysrhythmic drug

Class I: NA channel blocker

block cardiac NA channels, ↓ conduction velocitiy

Use: suppressing dysrhythmias

ADRs: D; cinchonism (tinnitus, HA, dizziness, disturbed vision; early sign of toxicity); cardiotoxicity (sinus arrest, AV block, ventricular tachycardia, asystole); arterial embolitism

DD: digoxin (↑ in digoxin levels); may need a ↓ in dose if on both

lidocaine (Xylocaine)

antidysrhythmic

Class I: NA channel blocker

slowing conduction rate in heart muscle

Use: short-term Tx of dysrhythmias; local anesthetic

Effects: stabilize cardiac rhythms

ADRs: drowsiness, confusion; paresthesias; toxic doses convulsions, respiratory arrest

propranolol (Inderal)

antihypertensive

Class II: beta blocker

↓ conduction velocity (slows ↓ ♥)

↓ myocardial contractility

contraindicated in pts w/ respiratory disease

amiodarone (Cordarone)

antidysrhythmic

Class III: K channel blocker

prolong PR and QT intervals on EKG

Use: arterial fibrillation and life threatening ventricular dysrhythmias, refractory to safer agents (this is used only when other antidysrhythmics don't work)

Effects: stabilizes cardiac rhythms

ADRs: pulmonary, cardiac, thyroid and liver toxicity; optic neuropathy; toxic in pregnancy and breastfeeding; photosensitivity; CNS (dizziness, ataxia, mood alterations, hallucinations); GI (anorexia, N, V)

DD: macrolides, ketoconazole

verapamil (Calan)

diltiazem (Cardizem)

antidysrhythmic

Class IV: CA channel blocker

only 2 that block cardiac CA channels

Use: Tx of a fib and atrial flutter

Effects: slows conduction and ↓ myocardial contractility

ADRs: bradycardia, AV block, HF, peripheral edema

DD: digoxin (↑ levels), beta-blockers (↑ risk bradycardia)

 lovastatin (Mevacor)

prophylaxis of coronary artery disease (CAD)

statin

        reduction of LDL by inhibiting HMG-CoA reductase; ↑ of HDL, ↓ triglycerides

Use: high LDL levels

Effects: alter lipid levels; reduce inflammation @ plaque sites, reduce risk of thrombosis

ADRs: hepatoxicity; myopathy (muscle aches, tenderness); fetal malformation; rhabdomyolysis (potentially fatal destruction of muscle)

 nicotinic acid aka niacin (Niaspan

prophylaxis of CAD

nicotinic acid

↓ production of VLDLs (LDLs and plasma TG)

Use/Effects: ↓ LDL and TG(triglycerides) levels, ↑ HDL

ADRs: flushing, itching; hepatoxicity; ↑ uric acid levels; hyperglycemia

colesevelam (Welchol)

cholestyramine (Questran)

phrophylaxis of CAD

bile acid-binding resins

causes liver to utilize more cholesterol

Use: high LDL levels

Effects: lower LDL levels

ADRs: constipation, flatulence, bloating, cramping, indigestion, N

DD: thiazide diuretics, digoxin, warfarin, some antibiotics (form complexes w/) (give 1 hr before or 4 hr after)

Ezetimibe (Zetia)

prophylaxis of CAD

ezetimibe

       blocks cholesterol absorption from sm intestine (excreted in stool) 

Use: reduce cholesterol, LDL, TG's

ADRs: myopathy; rhabdomyolysis; hepatitis; pancreatitis; thrombocytopenia (reduction in platelets)

DD: caution w/ other LDL reducing drugs

gemfibrozil (Lopid)

prophylaxis of CAD

fibrates from fibric acid

↓ lipolysis in fatty tissue, ↓ hepatic synthesis of TG's

Use: reduce high levels of plasma TG's (VLDLs)

Effects: reduction in VLDL levels

ADRs: gallstones; myopathy; hepatoxicity

DD: warfarin (↑ anticoagulant effects- requires frequent prothrombin levels); statins (↑ risk of rhabdomylosis)