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Cardiac Drugs
by Sujoy Bose 07/06/2016
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
