Cardiac Drugs

1. 3. Anti-Anginals

1.1. ORGANIC NITRATES & NITRITES

1.1.1. Isosorbide Dinitrate & Isosorbide Mononitrate

1.1.2. NTG - Nitroglycerin

1.1.3. Amyl Nitrate

1.1.4. Sodium Nitroprusside

1.1.5. Others

1.2. NEGATIVE INOTROPES

1.2.1. BETA BLOCKERS - olol

1.2.1.1. Beta-Non-Selective

1.2.1.1.1. Carteolol

1.2.1.1.2. Carvedilol

1.2.1.1.3. Labetalol

1.2.1.1.4. Nadolol

1.2.1.1.5. Penbutolol

1.2.1.1.6. Pindolol

1.2.1.1.7. Propranolol

1.2.1.1.8. Sotalol

1.2.1.2. Beta-1 Selective

1.2.1.2.1. Acebutolol

1.2.1.2.2. Atenolol

1.2.1.2.3. Metoprolol

1.2.1.2.4. Nebivolol

1.2.1.2.5. Esmolol

1.2.1.2.6. Betaxolol

1.2.2. Ca++ CHANNEL BLOCKERS - ipine

1.2.2.1. Amlodipine

1.2.2.2. Dilitazem

1.2.2.3. Felodipine

1.2.2.4. Isradipine

1.2.2.5. Nicardipine

1.2.2.6. Nifedipine

1.2.2.7. Verapamil

1.3. ACE INHIBITORS - pril

1.3.1. Benazepril

1.3.2. Captopril

1.3.3. Enalapril

1.3.4. Lisinopril

1.3.5. Ramipril

1.3.6. Moexipril

1.3.7. Perindopril

1.3.8. Fosinopril

1.3.9. Trandolapril

1.3.10. Quinapril

1.4. OTHER CORONARY VASODILATORS

1.4.1. Hydralazine, Minoxidil

1.4.2. Dipyridamole

1.5. ANTI-THROMBOTIC THERAPY

1.5.1. Anticoagulants

1.5.1.1. Heparins

1.5.1.1.1. Unfractionated LMWH

1.5.1.2. Oral Anticoagulants

1.5.1.2.1. Warfarin

1.5.2. Antithrombotics (Platelet Inhibitors)

1.5.2.1. Acetylsalicyclic Acid

1.5.2.2. ADP Receptor inhibitors

1.5.2.2.1. Clopidogrel

1.5.2.3. Glycoprotein  IIb - IIIa Receptor Inhibitors

1.5.2.3.1. Abciximab

1.5.2.4. Others

1.5.2.4.1. Dipyridamole

1.5.3. Thrombolytics

1.5.3.1. t-PA (Alteplase)

1.5.3.2. Streptokinase

1.5.3.3. Urokinase

2. Anti-Arrhythmics

2.1. Class I - Na+-CHANNEL BLOCKERS

2.1.1. Subclass A

2.1.1.1. Disopryamida

2.1.2. Subclass B

2.1.2.1. Lidocaine

2.1.3. Subclass C

2.1.3.1. Flecainide

2.2. Class II - BETA-ADRENOCEPTOR BLOCKERS

2.2.1. Esmolol

2.2.2. Metoprolol

2.2.3. Propranolol

2.3. Class III - K+ CHANNEL BLOCKERS - Prolong Repolarization

2.3.1. Amiodarone

2.3.2. Dofetilide

2.3.3. Sotalol

2.4. Class IV - Ca++ CHANNEL BLOCKERS

2.4.1. Diltiazem

2.4.2. Verapamil

2.5. OTHERS

2.5.1. Adenosine

2.5.2. Digoxin

2.5.3. Digitalis

2.5.4. Magnesium

3. ADRs of Anti-Anginals of Interest

3.1. Vasodilators induced Orthostatics

3.1.1. Orthostatics

3.1.2. Fainting & Falls

3.1.3. Headaches

3.1.4. GI Upset

3.2. Negative Inotrope induced

3.2.1. Fatigue

3.2.2. Weakness

3.2.2.1. Exercise Intolerance

3.2.3. Reduced Work Capacity

3.2.4. Sexual side-effects in men

3.2.5. Bronchoconstriction if Non-Cardioselective Beta Blocker is used

3.3. ACE Inhibitors induced

3.3.1. Cough

3.3.2. GI Effects

3.3.3. Renal Inssufficiency

3.3.3.1. LABS: Hyperkalemia, BUN

3.4. Anti-Coagulant induced

3.4.1. BLEEDING RISKS

3.4.1.1. Post-tPA

3.4.1.1.1. 24 Hours Bedrest

3.4.1.2. Also Correlate with NSAID induced bleeding risks

4. ADRs of Anti-Arrhythmics of Interest

4.1. Class I - Na++ channel Blocers

4.1.1. Pro-arrhythmic Effect - esp. Class Ia agents

4.1.1.1. Dizzines

4.1.1.2. Visual Disturbances

4.1.1.3. Nausea

4.2. Beta-blockers - See Beta Blocker side-effects

4.2.1. Non-specific beta blockers can cause bronchoconstriction

4.2.1.1. To avoid this, Beta-1 blockers is specifically preferred for heart

4.3. Class III side effects

4.3.1. Proarrhythmic effects

4.3.1.1. Torsades de Pointes

4.3.2. Amiodarone induced Liver damage & Lung toxicity

4.4. Class IV - Ca++ Ch. blocker side effects

4.4.1. Excessive Bradycardia

5. 1. PHYSIOLOGIC CHANGES IN HEART & BLOOD VESSELS in response to Drugs

5.1. INOTROPISM

5.1.1. Positive

5.1.2. Negative

5.2. CHRONOTROPISM

5.2.1. Positive

5.2.2. Negative

5.3. DROMOTROPISM

5.3.1. Positive

5.3.2. Negative

5.4. BATHMOTROPISM

5.5. LUSITROPISM

6. MIND MAP OF DRUG CLASSES & THEIR IMPACT ON DIFFERENT CARDIOVASCULAR CONDITIONS & DIAGNOSES (In Development)

7. 4. Congestive Heart Failure

7.1. CARDIAC GLYCOSIDES

7.1.1. Digitoxin

7.1.2. Digoxin

7.1.3. Ouabain

7.2. BETA BLOCKERS - olol

7.2.1. Beta-Non-Selective

7.2.1.1. Carteolol

7.2.1.2. Carvedilol

7.2.1.3. Labetalol

7.2.1.4. Nadolol

7.2.1.5. Penbutolol

7.2.1.6. Pindolol

7.2.1.7. Propranolol

7.2.1.8. Sotalol

7.2.2. Beta-1 Selective

7.2.2.1. Acebutolol

7.2.2.2. Atenolol

7.2.2.3. Metoprolol

7.2.2.4. Nebivolol

7.2.2.5. Esmolol

7.2.2.6. Betaxolol

7.3. RENIN-ANGIOTENSIN AXIS BLOCKERS

7.3.1. ACE INHIBITORS - pril

7.3.1.1. Benazepril

7.3.1.2. Captopril

7.3.1.3. Enalapril

7.3.1.4. Lisinopril

7.3.1.5. Ramipril

7.3.1.6. Moexipril

7.3.1.7. Perindopril

7.3.1.8. Fosinopril

7.3.1.9. Trandolapril

7.3.1.10. Quinapril

7.3.2. ANGIOTENSIN-I RECEPTOR BLOCERS

7.3.2.1. Condesertan

7.3.2.2. Losartan

7.3.2.3. Telmisartan

7.3.2.4. Valsartan

7.4. DIURETICS

7.4.1. Thiazide

7.4.1.1. Hydrochlorthiazide

7.4.1.2. Metolazone

7.4.2. Loop

7.4.2.1. Furosemide

7.4.2.2. Bumetanide

7.4.3. Potassium Sparing

7.4.4. Others

7.4.4.1. Amilioride

7.4.4.2. Triamterene

7.4.4.3. Spironolactone

7.5. VASODILATORS

7.5.1. Hydralazine

7.5.2. Isosorbide Dinitrate

7.5.3. Sodium Nitroprusside

7.6. Positive INOTROPIC AGENTS

7.6.1. Amrinone

7.6.2. Digitoxin

7.6.3. Digoxin

7.6.4. Dobutamine

7.6.5. Milrinone

7.7. ALDOSTERONE ANTAGONISTS

7.7.1. Spironolactone

7.8. BETA ADRENERGIC AGONISTS (for acute heart failure ONLY)

7.8.1. Dobutamine

7.8.2. Dopamine

7.8.3. Isoprenaline

8. 2. Anti-Hypertensives

8.1. ACE INHIBITORS - pril

8.1.1. Benazepril

8.1.2. Captopril

8.1.3. Enalapril

8.1.4. Lisinopril

8.1.5. Ramipril

8.1.6. Moexipril

8.1.7. Perindopril

8.1.8. Fosinopril

8.1.9. Trandolapril

8.1.10. Quinapril

8.2. ANGIOTENSIN-I RECEPTOR BLOCERS

8.2.1. Irbesartan

8.2.2. Losartan

8.2.3. Telmisartan

8.2.4. Valsartan

8.3. Ca++ CHANNEL BLOCKERS - ipine

8.3.1. Amlodipine

8.3.2. Dilitazem

8.3.3. Felodipine

8.3.4. Isradipine

8.3.5. Nicardipine

8.3.6. Nifedipine

8.3.7. Verapamil

8.4. ALPHA ADRENOCEPTOR BLOCKER

8.5. CENTRALLY ACTING ADRENERGIC DRUGS

8.5.1. Clonidine

8.6. BETA BLOCKERS - olol

8.6.1. Beta-Non-Selective

8.6.1.1. Labetalol

8.6.1.2. Nadolol

8.6.1.3. Propranolol

8.6.2. Beta-1 Selective

8.6.2.1. Atenolol

8.6.2.2. Metoprolol

8.7. DIURETICS

8.7.1. Bumetanide

8.7.2. Furosemide

8.7.3. Hydrochlorthiazide

8.7.4. Metolazone

9. ADRs in CHF Meds of Interest

9.1. Glycosides - Dose Related

9.1.1. Skin - Allergies / Hives / Rash

9.1.2. GI - Diarrhea, Anorexia, Pain

9.1.3. Heart - Arhhythmias, Weakness

9.1.4. Neurologic - Confusion, Depression, Disorientation, Drowsiness, Fainting, Hallucinations, HA, Lethargy, Apathy

9.2. Beta-Blockers - See Negative Inotropes under Anti-Anginals as well

9.2.1. Fatigue

9.2.2. Weakness

9.2.3. Reduced work capacity

9.2.4. Sexual Side-effects in men

9.2.5. Bronchoconstriction if Non-Cardioselective Beta Blocker is used

9.3. Diuretics

9.3.1. Dehydration

9.3.2. Electrolyte impairments

9.3.2.1. Hypokalemia

9.3.2.1.1. Cardiac Arrhythmia

9.3.2.1.2. Weakness

9.3.2.2. Hyperkalemia

9.3.2.2.1. ECG changes - Tenting of T-wave

9.3.2.2.2. Cardiac Arrest

9.3.2.2.3. Weakness

9.3.3. Gout

9.3.3.1. Severe Pain with Immobility

9.3.4. Ototoxicity

9.3.4.1. Balance Disorder

9.4. Vasodilators

9.4.1. Orthostatic Hypotension

9.4.1.1. Falls

9.4.2. Hypotension

9.5. Inotropes

9.5.1. Increased HR

9.5.2. Arrhythmias

9.5.2.1. Falls

9.5.3. Raised Myocardial O2 Demand

9.5.3.1. May trigger underlying ischemic symptoms

10. ADRs of Anti-Hypertensives of Interest

10.1. Beta-Blockers

10.1.1. -ve Inotropes

10.1.2. Orthostatics

10.1.3. Fatigue

10.1.4. GI Disturbance

10.2. Alpha-Blockers

10.2.1. Reflex Tachycardia

10.2.2. Orthostatics

10.2.3. CHF

10.3. Vasodilatiors

10.3.1. Reflex Tachycardia

10.3.2. Orthostatics

10.3.3. Headache

10.3.4. Fluid Retention

10.3.5. Hirsutism

10.4. ACE-I

10.4.1. Dry Cough

10.4.2. Angioedma

10.4.3. Neutropenia

10.4.4. Agranulocytosis

10.5. Ca++ Channel Blockers

10.5.1. -ve Intropism

10.5.2. Myocardial Infarction

10.5.3. Edema of legs

10.5.4. Orthostatics

10.5.5. Tachy-Brady Arrhythmias

10.5.6. Dizziness

10.6. Diuretics

10.6.1. K+ eeffects

10.6.2. Gout

11. 5. Lipid Lowering Agents

11.1. 3-Hydroxy-3-Methylglutaryl (HMG) Coenzyme-A Reductase Inhibitors (STATINS)

11.1.1. Atorvastatin

11.1.2. Fluvastatin

11.1.3. Lovastatin

11.1.4. Pravastatin

11.1.5. Rosuvastatin

11.1.6. Simvastatin

11.2. Bile Acid - Binding Resins

11.2.1. Increases Disposal of Cholesterol in the Intestines - Bind to cholesterol - More Bile produced - Liver needs Chol. to make bile

11.2.1.1. Chlestyramine

11.2.1.2. Colestipol

11.2.1.3. Colesevelam Hcl

11.3. Fibrates

11.3.1. Reduces Triglycerides / Increases HDL / Not much effect on LDL

11.3.1.1. Gemfibrozil

11.3.1.2. Fenofibrate

11.3.1.3. Clofibrate

11.4. Nicotinic Acid / Niacin

11.4.1. Acts in Liver by by affective the production of blood fats

11.5. Cholesterol Absorption Inhibitors

11.5.1. Ezetimibe 2002

11.6. Omega-3 fatty acid Ethyl Esters

11.6.1. Lovaza

11.6.2. Vascepa

12. ADRs of Lipid Lowering Agents

12.1. Statin-induced

12.1.1. Generally Mild

12.1.1.1. GI Disturbances

12.1.2. Muscle Problems

12.1.2.1. Statin-induced Myopathy

12.1.2.2. Spont. Rhabdomyolysis

12.1.3. Liver Problems

12.1.3.1. Liver Toxicity

12.1.3.1.1. Physician monitors Liver Enzymes

12.1.4. Memory Problems

12.1.4.1. Forgetfulness

12.2. Bile Acid Binding Resins

12.2.1. Newer - Side effects not well documented yet

12.3. Cholesterol Absorption Inhibitors

12.3.1. Newer agents - not well documented ADRs yet

12.4. Nicacin

12.4.1. Flushing

12.4.2. Itching

12.4.3. GI Disturbances

12.5. Omega-3 Fatty Acid Ethyl Esters

12.5.1. Can have Serious Allergic Reactions eg those with Shellfish Allergies