Cardiac Pharm Drugs

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Abciximab,
Eptifibatide,
Tirofiban

Platelet Receptor Glycoprotein Inhibitors

Prevents platelet aggregation by competing with
fibrinogen for glycoprotein IIb/IIIa receptors on
platelet surface
Indications - Adjunct to PCI for UA/NSTEMI.
Contraindications - Active internal bleeding,
GI/GU bleeding or recent stroke, coagulation
disorders, platelet count < 100k, INR >1.2

2.

ACE
Inhibitors

Lisinopril (Zestril)

3.

ACS Drugs

Clopidogrel
Dipyridamole
Aspirin
Abciximab
Eptifibatide
Tirofiban
Heparin
Lovenox
Fondaparinux
Bivalirudin
Desiruden
Warfarin
Dabigatran
Rivaroxaban
Alteplase
Reteplase
Tenecteplase
Urokinase
Streptokinase

1.

4.

Adenosine

Antiarrhythmic Agent
Slows AV node conduction time, interrupting AV
node re-entry pathways.
Indications - PSVT
Contraindications - 2nd or 3rd degree AVB w/o
pacer, sinus brady, bronchospasm disorders.
Adverse Effects - Flushing, dyspnea, chest
pressure, lightheadedness, bradycardia,
complete AVB.

5.

Adenosine
Other

6 second half-life.

6.

Adenosine
Trade Name

Adenocard

7.

Alpha2
Agonists

Methyldopa
Clonidine

8.

Alpha
Blockers

Prazosin
Doxizosin
Terazosin

9.

Alteplase

ACS Drug - Fibrinolytic Agent

Binds to fibrin and converts tissue plasminogen
to plasmin, promoting fibrinolysis.
Indications - STEMI, acute thrombotic CVA with
symptoms 3 hours or less, acute PE.
Contraindications - Many, see thrombolytic
protocol.
Adverse Effects - Bleeding, intracranial
hemorrhage, reperfusion arrhythmias.

10.

Alteplase Trade
Name

Activase

11.

Amiodarone

Antiarrhythmic Agent - Class III

Prolongs action potential phase 3,
prolonging repolarization/refractoriness.
NO effect on conduction velocity or
automaticity.
Indications - Life threatening ventricular
arrhythmias.
Contraindications - 2nd or 3rd degree
AVB, Long QT, Pregnancy or
breastfeeding.
Adverse Effects - Corneal deposits,
pulmonary toxicity or peripheral
neuropathy with prolonged use.

12.

Amiodarone
Other

BLACK BOX WARNING

Hospitalize to administer loading dose or
dose changes. Restrict use to life
threatening arrhythmias only due to drug
associated toxicity.

13.

Amiodarone
Trade Name

Cordarone

14.

Amlodapine

Dihydropyridine CCB
Inhibits calcium influx into vascular
smooth muscle and myocardium primarily
reducing peripheral vascular resistance.
Indications - HTN, Angina.
Contraindications - Hypersensitivity
Adverse Effects - Peripheral edema,
fatigue, palpitations, may exacerbate
angina.

15.

Amlodipine Trade
Name

Norvasc

16.

Angiotensin
Receptor Blocker

Losartan (Cozaar)

17.

Antihypertensives

Furosemide
Chlorthalidone
Hydrochlorothiazide
Triamterene

18.

Aspirin

Antiplatelet Agent
Blocks thromboxane synthesis and
inhibits platelet activation and aggregation
for the lifetime of the platelet (5-7 days).
Indications - Anything requiring platelet
aggregation inhibition (ACS, etc.)
Contraindications - ASA or NSAID induced
asthma or urticaria, uncontrolled HTN, GI
bleeding, ASA triad.
Adverse Effects - N/V/D/C other GI
issues, rash, tinnitus.

19.

Atenolol

Beta Blocker
Selectively antagonizes beta-1 adrenergic
receptors in the heart, reducing rate and
contractility.
Indications - Acute MI, HTN, Angina
Contraindications - Uncompensated HF,
cardiogenic shock, bradycardia.
Adverse Effects - Bradycardia, hypotension,
bronchospasm, fatigue, depression,
impotence, loss of libido.

26.

Clonidine

Alpha 2 Agonist
Stimulates alpha 2 adrenergic receptors
(centrally acting antihypertensive), reducing
sympathetic outflow from vasomotor centers in
the brain.
Indications - HTN
Contraindications - abrupt discontinuation
(causes rebound HTN)
Adverse Effects - xerostomia, drowsiness,
hypotension, bradycardia.

20.

Atrovastatin
Trade Name

Lipitor

27.

Clonidine
Trade Name

Catapres

21.

Beta Blockers

Atenolol
Metoprolol
Propranalol

28.

Clopidogrel

22.

Bile Acid
Binding Resins

Cholestyramine
Colestipol
Colesevelam

23.

Bivaliruden

ACS Drug - Direct Thrombin Inhibitor

Directly and reversibly inhibits circulating
thrombin.
Indications - Anticoagulation in patients
undergoing PCI.
Contraindications - IM administration, active
bleeding.
Adverse Effects - Injection site reaction,
hemorrhage.

Anitplatelet Agent
Irriversibly inhibits ADP receptors on the
surface of platelets, reducing platelet
aggregation: augments cGMP production,
dilating coronary arteries.
Indications - Thromboembolism prophylaxis,
NSTEMI, STEMI.
Contraindications - Active bleeding
Adverse Effects - Bleeding and bruising,
pruritis.

29.

Clopidogrel
Other Info.

A prodrug- must be metabolized by CYP2C19 to

become active. Proton Pump Inhibitors,
particularly omeprazole, inhibits activation. It is
important to identify poor metabolizers with
ACS.

30.

Clopidogrel
Trade Name

Plavix

31.

Colestipol
and
Colesevelam

Bile Acid Binding Resins

Bind bile acids and bile salts in the small
intestines, inhibiting their reuptake by the
enterohepatic system. This triggers
hepatocytes to increase conversion of
cholesterol to bile acids to replenish the lost
supply, requireing increased hepatic uptake of
LDL particles form the blood, lowering blood
LDL concentrations.
Indications - Elevated LDL

32.

Dabigatran

ACS Drug - Oral Anticoagulant

Direct thrombin inhibitor that directly and
reversibly inhibits circulating thrombin.
Indications - Thromboembolism and stroke
prophylaxis.
Contraindications - Active bleeding, mechanical
heart valve.
Adverse Effects - GI s/s, bleeding and
bruising. Increased risk of MI over Warfarin.

33.

Dabigatran
Trade Name

Pradaxa

34.

Desirudin

ACS Drug - Direct Thrombin Inhibitor

Directly and reversibly inhibits circulating
thrombin.
Indications - DVT prophylaxis
Contraindications - IM administration, active
bleeding.
Adverse Effects - Injection site reaction,
anemia, hemorrhage, anaphylaxis.

24.

25.

Chlorthalidone
and HCTZ

Cholestyramine

Thiazide Diuretic
Inhibits distal convoluted tubule sodium and
chloride resorption.
Used for HTN and edema.
Contraindications/adverse effects - anuria,
hypokalemia, hyperuricemia, hyperglycemia,
lowered electrolytes and photosensitivity.
Bile Acid Binding Resin
Bind bile acids and bile salts in the small
intestines, inhibiting their reuptake by the
enterohepatic system. This triggers
hepatocytes to increase conversion of
cholesterol to bile acids to replenish the lost
supply, requireing increased hepatic uptake
of LDL particles form the blood, lowering
blood LDL concentrations.
Indications - Elevated LDL, BBW:
cholestasis-associated pruritis and diarrhea
pruritis.
Contraindications - biliary obstruction
Adverse Effects - Abdominal pain, cramps,
distention, constipation, fecal impaction,
may reduce absorption of other drugs, may
lower plasma folate levels.

35.

Digoxin

Antiarrhythmic Agent
Prolongs the effective refractory period and
diminishes conduction velocity in the AV node.
Indications - Rate control of chronic Afib in
systolic heart failure.
Contraindications - Vfib, myocarditis, Acute MI,
IHSS, WPW.
Adverse Effects - NVD, anorexia, bradycardia,
haloes around lights.

36.

Digoxin
Trade Name

Lenoxin

37.

Diltiazem

CCB
Non-dihydropyridine CCB, inhibits calcium ion
influx into vascular smooth muscle and
myocardium, primarily reducing heart rate and
contractility.
Indications - HTN, Angina, SVT, Afib, Aflutter.
Contraindications - 2nd and 3rd degree AV
blocks, cardiogenic Shock, hypotension,
afib/flutter with accessory bypass tract, CHF,
sick sinus syndrome.
Adverse Effects - MC constipation and
peripheral edema. Headache, bradycardia, AV
block.

38.

Diltiazem AA

Antiarrhythmic Agent - Class IV

Non-dihydropyridine CCB - inhibits calcium
channel influx into vascular smooth muscle
and myocardium, primarily reducing heart rate
and contractility by prolonging AV nodal
refractoriness.
Indications - HTN, Angina, Afib, Aflutter.
Contraindications - 2nd or 3rd degree AVB,
cardiogenic shock, hypotension, Afib/Aflutter
with bypass tract.
Adverse Effects - MC is constipation and
peripheral edema. HA and dizziness,
bradycardia, AV block.

39.

Diltiazem
Trade Name

Cardizem

40.

Dipyridamole

Antiplatelet Agent
Inhibits platelet uptake of adenosine and
blocks ADP-induced platelet aggregation;
augments cGMP production, dilating coronary
arteries.
Indications - Thromboembolism prophylaxis.
Contraindications - Hypersensitivity
Adverse Effects - Severe HA and diarrhea,
resolves with continued use.

41.

Dipyridamole
Trade Name

Persantine

42.

Direct
Vasodilators

Hydralazine
Minoxidil
Sodium Nitroprusside

43.

Drug
Contraindication
Pearl

All drugs are contraindicated if the patient

is hypersensitive or has had a previous
reaction to any class or component of the
drug, unless otherwise explained.

44.

Esmolol

Antiarrhythmic Agent - Class II

Selectively antagonizes beta-1 adrenergic
receptors.
Indications - PSVT, Hypertensive
emergency.
Contraindications - 2nd or 3rd degree AVB
w/o pacer, sinus brady, cardiogenic shock,
uncompensated heart failure.
Adverse Effects - Hypotension, bradycadia,
heart block, bronchospasms.

45.

Ezetimibe

Cholesterol Absorption Inhibitor

Selectively inhibits absorption of dietary
and biliary cholesterol at the small intestinal
brush border, causing the liver to have to
use increased amounts of cholesterol from
the blood.
Indications - Hyperlipidemia
Contraindications - Hypersensitivity
Adverse Effects - Diarrhea, URI s/s

46.

Ezetimibe Trade
Name

Zetia

47.

Fibric Acid
Derivative
Other Info.

May lower LDL, but when decreasing

elevated trigs, LDL-C may increase.
Particularly indicated in patients with
hypertriglyceridemia severe enough to be at
risk for pancreatitis and those who have
hypertriglycerideamia with low LDL-C.

48.

Fish Oil

Supplement
Contains eicosapentaenoic acid and
docosahexaenoic acid - which somehow
lower triglycerides.
Indications - Hypertriglyceridemia
Contraindications - Known allergy or
hypersensitivity to fish, fish oil, or omega-3
fatty acid products derived from fish.
Adverse Effects - Nausea and Diarrhea are
MC.

49.

Flecainide

Antiarrhythmic Agent - Class 1c

Stabilizes membranes, depresses action
potential phase 0. Strongly reduces
conduction velocity, decreases
automaticity, has NO effect on
repolarization/refractoriness.
Indications - Prevention of paroxysmal atrial
flutter/fib. Life threatening ventricular
arrhythmias.
Contraindications - 2nd or 3rd degree AVB
w/o pacer, bifascicular block w/o pacer
Adverse Effects - Arrhythmias, QT
prolongation, Torsades.

50.

Flecainide
Other

BLACK BOX WARNING

Increased mortality in asymptomatic non-life
threatening ventricular arrhythmias w/ MI 6
days - 2 years prior. Restrict use to lifethreatening arrhythmias only.

51.

Fondaparinux

ACS Drug - Parenteral Anticoagulant

Synthetic selective factor Xa inhibitor that
selectively binds to antithrombin III,
potentiating factor Xa neutralization and
inhibition of thrombin formation.
Indications - ACS, DVT prophylaxis
Contraindications - Severe thrombocytopenia,
active bleeding, epidural or spinal anesthesia.
Adverse Effects - Injection site reaction,
anemia, hemorrhage, HIT.

52.

53.

54.

55.

56.

Fondaparinux
Other

Furosemide

As effective and safe as UFH and LMWH for

prophylaxis and Tx of VTE, but much less
likely to cause heparin-induced
thrombocytopenia.
Black Box Warning - Spinal/Epidural
hematomas may occur with spinal or epidural
puncture in anticoagulated patients.
Loop Diuretic
Inhibits Loop of Henle and proximal and distal
confoluted tubule sodium and chloride
resorption.
Used for HTN and edema.
Contraindications - anuria, hepatic coma and
electrolyte imbalances or depletion.
Most potent of the antihypertensives

Furosemide
Trade Name

Lasix

Gemfibrozil
and
Fenofibrate

Fibric Acid Derivative

Inhibits peripheral lipolysis, decreases hepatic
free fatty acid extraction, inhibits synthesis
and incrases clearance of VLDL carrier
apolipoprotein B (APOB), mechanism of
increased HDL unknown.
Indications - Hyperglyceridemia
Contraindications - Gallbladder disease,
hepatic impairment, unexplained elevation of
LFTs.
Adverse Effects - Increased AST/ALT, GI
complaints, potentially cholelithiasis, hepatitis
and myositis.

Heparin
Other

Shorter half life, more variable anticoagulant

response, more adverse bleeding than LMW
version. Must be monitored with PTT. Must be
given in hospital.

57.

Heparin
(UFH)

ACS Drug - Parenteral Anticoagulant

Increases rate of action of antithrombin III's
effect on inhibiting clotting factor thrombin and
factor Xa by a 1000 fold.
Indications - Thromboembolism prophylaxis and
Tx, PCI, adjunct Tx for STEMI and NSTEMI.
Contraindications - hypersensitivity to pork
products, IM administartion, severe
thrombocyopenia, hx of HIT, hemorrhage or
active bleeding (except if DIC).
Adverse Effects - Bleeding and bruising, HIT

58.

Hydralazine

Direct Vasodilator
Directly dilates arterioles, not veins, reducing
SVR.
Indications - HTN and hypertensive emergency.
Contraindications - Coronary Artery Disease
Adverse Effects - Headache, tachycardia,
angina, palpitations

59.

Lidocaine

Antiarrhythmic Agent - Class 1b

Inhibits Na ion channels, stabilizing neuronal cell
membranes and inhibiting nerve impulse initiation
and conduction. Primarily decreases
automaticity. Mild decrease in conduction
velocity and repolarization/refractoriness.
Indications - Ventricular arrhythmias.
Contraindications - WPW, Stokes-adams
syndrome, AVB w/o pacemaker.
Adverse Effects - Hypotension, seizures,
respiratory arrest.

60.

Lidocaine
Trade Name

Xylocaine

61.

Lisinopril

ACE Inhibitor
Blocks conversion of angiotensin I to
angiotensin II.
Indications - heart failure, HTN, and as a renal
protectent in DM.
Contraindications - hx of angioedema,
pregnancy.
Adverse Effects - angioedema, hypotension,
cough, hyperkalemia.

62.

Lisinopril
Trade Name

Zestril

63.

Lorsartan
Trade Name

Cozaar

64.

Losartan

ARB
Blocks receptors in peripheral vasculature and
adrenals for angiotensin II.
Indications - HTN, T2DM nephropathy.
Contraindications - pregnancy
Adverse Effects - angioedema, hypotension,
URI s/s.

65.

Lovenox

ACS drug - Parenteral Anticoagulant

Accelerates interaction of antithrombin III with
Factor Xa, but not with thrombin.
Indications - ACS, DVT prophylaxis
Contraindications - Hypersensitivity to pork
products or benzyl alcohol, active major
bleeding, thrombocytopenia history.
Adverse Effects - Local injection site reaction,
anemia, hemorrhage, thrombocytopenia.

66.

Lovenox
Other

Longer half life, less variable anticoagulant

response, fewer adverse bleeding than UFH.
Does not need to be monitored with PTT, may
be given in hospital or out.
Black Box Warning - Spinal/Epidural hematomas
may occur with spinal or epidural puncture in
anticoagulated patients.

72.

Niacin

Nicotinic Acid
Inhibits lipolysis at the cellular level. Lipolysis
produces free fatty acids which the liver uses
to make triglycerides, VLDLs and ultimately
LDLs. Also increases HDL levels.
Indications - Hypercholesterolemia (lowers
trigs and raises HDL mostly, also lowers LDL
somewhat)
Contraindications - Active peptic ulcers or
arterial bleeding, active liver disease.
Adverse Effects - Flushing, pruritis, GI
distress, glucose intolerance, hyperuricemia.

73.

Other Lipid
Lowering
Drugs

Cholestyramine
Colestipol
Colesevelam
Niacin
Gemfibrozil
Fenofibrate
Ezetimibe
Fish Oil
Red Yeast Rice

67.

Low
Molecular
Weight
Heparin
Trade Name

Lovenox

68.

Methyldopa

Alpha 2 Agonist
Stimulates alpha 2 adrenergic receptors
(centrally acting antihypertensive), reducing
sympathetic outflow from vasomotor centers in
the brain.
Indications - HTN
Contraindications - Hepatitis or Cirrhosis
Adverse Effects - sedation, headache, black
tongue, orthostatic hypotension.

74.

Prazosin,
Doxazosin,
Terazosin

Alpha Blockers
Blocks alpha 1 adrenergic receptors, causing
relaxation of arteriole and venous smooth
muscles, reducing PVR.
Indications - HTN, BPH
Contraindications - Hypersensitivity
Adverse Effects - Hypotension with the first
few doses. Headache, dizziness, nausea,
palpitations.

69.

Methyldopa
Trade Name

Aldomet

75.

Procainamide

70.

Metoprolol

Beta Blocker
Selectively antagonizes beta-1 adrenergic
receptors in the heart, reducing rate and
contractility.
Indications - Acute MI, HTN, Angina, Heart
Failure.
Contraindications - Uncompensated HF,
cardiogenic shock, bradycardia.
Adverse Effects - Bradycardia, hypotension,
bronchospasm, fatigue, depression, impotence,
loss of libido.

Antiarrhythmic Agent - Class 1a

Stabilizes membranes, depresses action
potential phase 0. Decreases conductions
velocity, increases repol./refractoriness, and
decreases automaticity.
Indications - Ventricular arrhythmias.
Contraindications - SLE, 2nd and 3rd degree
AV blocks, Torsades, Long QT syndrome,
uncorrected electrolyte abnormalities.
Adverse Effects - hypotension, bradycardia,
QT prolongation, SLE

76.

Propranolol

Beta Blocker
Non-selective. Antagonized Beta-1 and Beta-2
adrenergic receptors (heart and lungs).
Indications - HTN, Angina, SVT, Migraine
prophylaxis.
Contraindications - Uncompensated HF,
cardiogenic shock, bradycardia.
Adverse Effects - Bradycardia, hypotension,
bronchospasm, fatigue, depression,
impotence, loss of libido.

71.

Minoxidil

Direct Vasodilator
Directly dilates arterioles, not veins, reducing
SVR.
Indications - Refractory HTN
Contraindications - hypersensitivity
Adverse Effects - CHF, SJS

77.

Red Yeast
Rice

Supplement
Contains several compounds collectively
known as monacolins, substances known to
inhibit cholesterol synthesis. One of which has
the same chemical structure as lovastatin and
mevinolin, potent HMG-CoA reductase
inhibitors.
Indications - hyperlipidemia
Contraindications - pregnancy and/or breast
feeding.
Adverse Effects - HA, GI complaints.

78.

Reteplase
and
Tenecteplase

ACS Drug - Fibrinolytic Agent

Binds to fibrin and converts tissue
plasminogen to plasmin, promoting fibrinolysis.
Indications - STEMI
Contraindications - Many, see thrombolytic
protocol
Adverse Effects - Bleeding, intracranial
hemorrhage, reperfusion arrhythmias.

79.

Reteplase
Trade Name

Retavase

80.

Rivaroxaban

ACS Drug - Oral Anticoagulant

Direct thrombin inhibitor that directly and
reversibly inhibits circulating thrombin.
Indications - Thromboembolism and stroke
prophylaxis, DVT prophylaxis and Tx.
Contraindications - Acvtive bleeding, Hepatic
impairment.
Adverse Effects - Bleeding, Elevated LFTs,
Thrombocytopenia.

81.

Rivaroxaban
Trade Name

Xerelto

82.

Rosuvastatin,
Atorvastatin,
Simvastatin,
Pravastatin,
Lovastatin

HMG-CoA reductase inhibitor

Inhibits HMG-CoA reductase, the enzyme that
converts HMG-CoA to de novo cholesterol in
cells, which leads to cells increasing the
number of cell-surface LDL receptors that can
bind to circulating LDLs, lowering blood LDL
levels.
Indications - Hyperlipidemia

83.

Rosuvastatin
Trade Name

Crestor

84.

Simvastatin
Trade Name

Zocor

85.

Sodium
Nitroprusside

Direct Vasodilator
Powerful parenteral vasodilator - dilates both
arterioles and venules, reducing both PVR and
venous return.
Indications - Hypertensive emergency
Contraindications - Hypersensitivity (among
many others).
Adverse Effects - Hypotension, cyanide
toxicity, metahemaglobinemia. Can cause
precipitous decrease in BP. Cyanide levels
reach toxic amounts with prolonged use or
high infusion rates.

86.

Sotalol

Antiarrhythmic Agent - Class III

Non-selectively antagonizes beta 1 and beta
2 adrenergic receptors, prolonging action
potential phase 3.
Indications - Ventricular arrhythmias,
symptomatic afib/aflutter.
Contraindications - 2nd or 3rd degree AVB,
sinus brady, cardiogenic shock,
uncompensated heart failure.
Adverse Effects - Hypotension, bradycardia,
heart block, bronchospasms, QT
prolongation, torsades.

87.

Sotalol Other

BLACK BOX WARNING

Administer in facility with EKG until stable
maintenance does x3 days in found.

88.

Sotalol Trade
Name

Betapace

89.

Statin Drugs
(Lipid
Lowering
Drugs)

Lovastatin
Atorvastatin
Rosuvastatin
Simvastatin
Pravastatin

90.

Streptokinase

ACS Drug - Fibrinolytic Agent

Binds to fibrin and converts tissue
plasminogen to plasmin, promoting
fibrinolysis.
Indications - STEMI, PE, and occluded IV
catheters.
Contraindications - Hypersensitivity.
Adverse Effects - Bleeding.

91.

Tenecteplase
Trade name

TNKase

92.

Thriamterene

Potassium-sparing diuretic.
Inhibits sodium reabsorption at the DCT,
decreasing water resorption and increasing
potassium retention.
Indications - HTN and edema.
Contraindications - severe renal disease,
anuria.
Adverse Effects - Fatigue, hyperkalemia.

93.

Urokinase

ACS Drug - Fibrinolytic Agent

Binds to fibrin and converts tissue
plasminogen to plasmin, promoting
fibrinolysis.
Indications - PE and occluded IV catheters.
Contraindications - Hypersensitivity
Adverse Effects - Bleeding

94.

Verapamil

CCB
Non-dihydropyridine CCB, inhibits calcium ion influx into vascular smooth muscle and myocardium, primarily reducing
heart rate and contractility.
Indications - HTN, Angina, SVT, Afib, Aflutter, Migraine prophylaxis
Contraindications - 2nd and 3rd degree AV blocks, cardiogenic Shock, hypotension, afib/flutter with accessory bypass
tract, CHF, sick sinus syndrome.
Adverse Effects - MC constipation and peripheral edema. Headache, bradycardia, AV block.

95.

Warfarin

ACS drug - Oral Anticoagulant

Inhibits vitamin K-dependent coagulation factor synthesis (II, VII, IX, X, protein C and S).
Indications - Anticoagulation in patients for DVT prophylaxis. Thromboembolic complications of Afib. Thromboembolic
prophylaxis with bio synthetic and mechanical heart valves.
Contraindications - Bleeding, malignant HTN, Many more.
Adverse Effects - Bleeding and bruising, abdominal cramps, purple toes syndrome.

96.

Warfarin
Other

Must monitor effectiveness with PT/INR.

Black Box Warning - Major or Fatal Bleeding Risk

97.

Warfarin
Trade Name

Coumadin