Cardiac Drugs

by Sujoy Bose

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. 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

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. 4. Congestive Heart Failure

2.1. CARDIAC GLYCOSIDES

2.1.1. Digitoxin

2.1.2. Digoxin

2.1.3. Ouabain

2.2. BETA BLOCKERS - olol

2.2.1. Beta-Non-Selective

2.2.1.1. Carteolol

2.2.1.2. Carvedilol

2.2.1.3. Labetalol

2.2.1.4. Nadolol

2.2.1.5. Penbutolol

2.2.1.6. Pindolol

2.2.1.7. Propranolol

2.2.1.8. Sotalol

2.2.2. Beta-1 Selective

2.2.2.1. Acebutolol

2.2.2.2. Atenolol

2.2.2.3. Metoprolol

2.2.2.4. Nebivolol

2.2.2.5. Esmolol

2.2.2.6. Betaxolol

2.3. RENIN-ANGIOTENSIN AXIS BLOCKERS

2.3.1. ACE INHIBITORS - pril

2.3.1.1. Benazepril

2.3.1.2. Captopril

2.3.1.3. Enalapril

2.3.1.4. Lisinopril

2.3.1.5. Ramipril

2.3.1.6. Moexipril

2.3.1.7. Perindopril

2.3.1.8. Fosinopril

2.3.1.9. Trandolapril

2.3.1.10. Quinapril

2.3.2. ANGIOTENSIN-I RECEPTOR BLOCERS

2.3.2.1. Condesertan

2.3.2.2. Losartan

2.3.2.3. Telmisartan

2.3.2.4. Valsartan

2.4. DIURETICS

2.4.1. Thiazide

2.4.1.1. Hydrochlorthiazide

2.4.1.2. Metolazone

2.4.2. Loop

2.4.2.1. Furosemide

2.4.2.2. Bumetanide

2.4.3. Potassium Sparing

2.4.4. Others

2.4.4.1. Amilioride

2.4.4.2. Triamterene

2.4.4.3. Spironolactone

2.5. DIRECT VASODILATORS

2.5.1. Hydralazine

2.5.2. Isosorbide Dinitrate

2.5.3. Sodium Nitroprusside

2.6. Positive INOTROPIC AGENTS

2.6.1. Amrinone

2.6.2. Digitoxin

2.6.3. Digoxin

2.6.4. Dobutamine

2.6.5. Milrinone

2.7. ALDOSTERONE ANTAGONISTS

2.7.1. Spironolactone

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

2.8.1. Dobutamine

2.8.2. Dopamine

2.8.3. Isoprenaline

3. Anti-Arrhythmics

3.1. Class I - Na+-CHANNEL BLOCKERS

3.1.1. Subclass A

3.1.1.1. Disopryamida

3.1.2. Subclass B

3.1.2.1. Lidocaine

3.1.3. Subclass C

3.1.3.1. Flecainide

3.2. Class II - BETA-ADRENOCEPTOR BLOCKERS

3.2.1. Esmolol

3.2.2. Metoprolol

3.2.3. Propranolol

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

3.3.1. Amiodarone

3.3.2. Dofetilide

3.3.3. Sotalol

3.4. Class IV - Ca++ CHANNEL BLOCKERS

3.4.1. Diltiazem

3.4.2. Verapamil

3.5. OTHERS

3.5.1. Adenosine

3.5.2. Digoxin

3.5.3. Digitalis

3.5.4. Magnesium

4. 2. Anti-Hypertensives

4.1. ACE INHIBITORS - pril

4.1.1. Benazepril

4.1.2. Captopril

4.1.3. Enalapril

4.1.4. Lisinopril

4.1.5. Ramipril

4.1.6. Moexipril

4.1.7. Perindopril

4.1.8. Fosinopril

4.1.9. Trandolapril

4.1.10. Quinapril

4.2. ANGIOTENSIN-I RECEPTOR BLOCERS

4.2.1. Irbesartan

4.2.2. Losartan

4.2.3. Telmisartan

4.2.4. Valsartan

4.3. Ca++ CHANNEL BLOCKERS - ipine

4.3.1. Amlodipine

4.3.2. Dilitazem

4.3.3. Felodipine

4.3.4. Isradipine

4.3.5. Nicardipine

4.3.6. Nifedipine

4.3.7. Verapamil

4.4. ALPHA ADRENOCEPTOR BLOCKER

4.5. CENTRALLY ACTING ADRENERGIC DRUGS

4.5.1. Clonidine

4.6. BETA BLOCKERS - olol

4.6.1. Beta-Non-Selective

4.6.1.1. Labetalol

4.6.1.2. Nadolol

4.6.1.3. Propranolol

4.6.2. Beta-1 Selective

4.6.2.1. Atenolol

4.6.2.2. Metoprolol

4.7. DIURETICS

4.7.1. Bumetanide

4.7.2. Furosemide

4.7.3. Hydrochlorthiazide

4.7.4. Metolazone

5. ADRs of Anti-Anginals of Interest

5.1. Vasodilators induced Orthostatics

5.1.1. Orthostatics

5.1.2. Fainting & Falls

5.1.3. Headaches

5.1.4. GI Upset

5.2. Negative Inotrope induced

5.2.1. Fatigue

5.2.2. Weakness

5.2.2.1. Exercise Intolerance

5.2.3. Reduced Work Capacity

5.2.4. Sexual side-effects in men

5.2.5. Bronchoconstriction if Non-Cardioselective Beta Blocker is used

5.3. ACE Inhibitors induced

5.3.1. Cough

5.3.2. GI Effects

5.3.3. Renal Inssufficiency

5.3.3.1. LABS: Hyperkalemia, BUN

5.4. Anti-Coagulant induced

5.4.1. BLEEDING RISKS

5.4.1.1. Post-tPA

5.4.1.1.1. 24 Hours Bedrest

5.4.1.2. Also Correlate with NSAID induced bleeding risks

6. ADRs in CHF Meds of Interest

6.1. Glycosides - Dose Related

6.1.1. Skin - Allergies / Hives / Rash

6.1.2. GI - Diarrhea, Anorexia, Pain

6.1.3. Heart - Arhhythmias, Weakness

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

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

6.2.1. Fatigue

6.2.2. Weakness

6.2.3. Reduced work capacity

6.2.4. Sexual Side-effects in men

6.2.5. Bronchoconstriction if Non-Cardioselective Beta Blocker is used

6.3. Diuretics

6.3.1. Dehydration

6.3.2. Electrolyte impairments

6.3.2.1. Hypokalemia

6.3.2.1.1. Cardiac Arrhythmia

6.3.2.1.2. Weakness

6.3.2.2. Hyperkalemia

6.3.2.2.1. ECG changes - Tenting of T-wave

6.3.2.2.2. Cardiac Arrest

6.3.2.2.3. Weakness

6.3.3. Gout

6.3.3.1. Severe Pain with Immobility

6.3.4. Ototoxicity

6.3.4.1. Balance Disorder

6.4. Vasodilators

6.4.1. Orthostatic Hypotension

6.4.1.1. Falls

6.4.2. Hypotension

6.5. Inotropes

6.5.1. Increased HR

6.5.2. Arrhythmias

6.5.2.1. Falls

6.5.3. Raised Myocardial O2 Demand

6.5.3.1. May trigger underlying ischemic symptoms

7. ADRs of Anti-Arrhythmics of Interest

7.1. Class I - Na++ channel Blocers

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

7.1.1.1. Dizzines

7.1.1.2. Visual Disturbances

7.1.1.3. Nausea

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

7.2.1. Non-specific beta blockers can cause bronchoconstriction

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

7.3. Class III side effects

7.3.1. Proarrhythmic effects

7.3.1.1. Torsades de Pointes

7.3.2. Amiodarone induced Liver damage & Lung toxicity

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

7.4.1. Excessive Bradycardia

8. ADRs of Anti-Hypertensives of Interest

8.1. Beta-Blockers

8.1.1. -ve Inotropes

8.1.2. Orthostatics

8.1.3. Fatigue

8.1.4. GI Disturbance

8.2. Alpha-Blockers

8.2.1. Reflex Tachycardia

8.2.2. Orthostatics

8.2.3. CHF

8.3. Vasodilatiors

8.3.1. Reflex Tachycardia

8.3.2. Orthostatics

8.3.3. Headache

8.3.4. Fluid Retention

8.3.5. Hirsutism

8.4. ACE-I

8.4.1. Dry Cough

8.4.2. Angioedma

8.4.3. Neutropenia

8.4.4. Agranulocytosis

8.5. Ca++ Channel Blockers

8.5.1. -ve Intropism

8.5.2. Myocardial Infarction

8.5.3. Edema of legs

8.5.4. Orthostatics

8.5.5. Tachy-Brady Arrhythmias

8.5.6. Dizziness

8.6. Diuretics

8.6.1. K+ eeffects

8.6.2. Gout

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

9.1. INOTROPISM

9.1.1. Positive

9.1.2. Negative

9.2. CHRONOTROPISM

9.2.1. Positive

9.2.2. Negative

9.3. DROMOTROPISM

9.3.1. Positive

9.3.2. Negative

9.4. BATHMOTROPISM

9.5. LUSITROPISM

10. 5. Lipid Lowering Agents

10.1. 3-Hydroxy-3-Methylglutaryl (HMG) Coenzyme-A Reductase Inhibitors (STATINS)

10.1.1. Atorvastatin

10.1.2. Fluvastatin

10.1.3. Lovastatin

10.1.4. Pravastatin

10.1.5. Rosuvastatin

10.1.6. Simvastatin

10.2. Bile Acid - Binding Resins

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

10.2.1.1. Chlestyramine

10.2.1.2. Colestipol

10.2.1.3. Colesevelam Hcl

10.3. Fibrates

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

10.3.1.1. Gemfibrozil

10.3.1.2. Fenofibrate

10.3.1.3. Clofibrate

10.4. Nicotinic Acid / Niacin

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

10.5. Cholesterol Absorption Inhibitors

10.5.1. Ezetimibe 2002

10.6. Omega-3 fatty acid Ethyl Esters

10.6.1. Lovaza

10.6.2. Vascepa

11. ADRs of Lipid Lowering Agents

11.1. Statin-induced

11.1.1. Generally Mild

11.1.1.1. GI Disturbances

11.1.2. Muscle Problems

11.1.2.1. Statin-induced Myopathy

11.1.2.2. Spont. Rhabdomyolysis

11.1.3. Liver Problems

11.1.3.1. Liver Toxicity

11.1.3.1.1. Physician monitors Liver Enzymes

11.1.4. Memory Problems

11.1.4.1. Forgetfulness

11.2. Bile Acid Binding Resins

11.2.1. Newer - Side effects not well documented yet

11.3. Cholesterol Absorption Inhibitors

11.3.1. Newer agents - not well documented ADRs yet

11.4. Nicacin

11.4.1. Flushing

11.4.2. Itching

11.4.3. GI Disturbances

11.5. Omega-3 Fatty Acid Ethyl Esters

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

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