TY - CHAP M1 - Book, Section TI - Key Medications and Interventions in Cardiology A1 - Huppert, Laura A. A1 - Dyster, Timothy G. PY - 2021 T2 - Huppert’s Notes: Pathophysiology and Clinical Pearls for Internal Medicine AB - Table Graphic Jump LocationTable 1.13Common Medications used in CardiologyView Table||Download (.pdf)Table 1.13Common Medications used in CardiologyClassExamplesMechanismsTypical UsesSide EffectsDiureticsSee Nephrology Chapter 6Calcium channel blockers (CCB)Dihydropyridine:amlodipineclevidipinenicardipinenifedipinenimodipineBlock voltage-dependent L-type Ca2+ channels → muscle contractility; acts on vascular smooth muscleHypertensionAngina [including Prinzmetal)Raynaud’sNimodipine: Prophylaxis against vasospasm in SAHPeripheral edemaFlushingDizzinessNon-DHP:diltiazemverapamilBlock voltage-dependent L-type Ca2+ channels → muscle contractility; acts on heartHypertensionAnginaAfib/flutterCardiac depressionAV blockHyperprolactinemiaConstipationGingival hyperplasiaACE-inhibitors (ACEi)CaptoprilenalaprillisinoprilramiprilInhibition of ACE lowers angiotensin II, with reduction in GFR due to relaxation of efferent arteriole; prevents inactivation of bradykinin (i.e., a vasodilator)HypertensionHeart failureLV hypertrophyDiabetic nephropathyCoughHyperkalemiaAngioedemaTeratogen (contraindicated in pregnancy)Angiotensin receptor blockers (ARB)LosartancandesartanvalsartanBlocks binding of angiotensin II; does not increase bradykinin levelsSame as ACEi aboveOften used second line if the patient develops cough with ACEiAs with ACE inhibitor, but cough/angioedema much more rareVasodilatorhydralazineRelaxes smooth muscle via cGMP; arteriole dilatation > venodilationAcute severe hypertensionCombination therapy with organic nitrates for hypertensionCompensatory tachycardia (contraindicated in CAD)HeadacheSLE-like syndromeNitrodilatorsnitroprussideVasodilation via direct action; arteriole dilatation > venodilationHypertensive emergencyADHF (afterload reduction)Cyanide toxicityCareful in renal failureOrganic nitrates:nitroglycerinisosorbide dinitrateisosorbide mononitrateVasodilation via increased nitrous oxide; venodilation >> arteriole dilatationAnginaACSContraindication: Right ventricular MIReflex tachycardia, hypotensionFlushing, headacheRanolazine–Inhibits late phase Na+ current particularly in ischemic cardiomyocytes; thereby decreases wall tension and O2 consumptionRefractory anginaDizziness, headacheNauseaQT prolongationMilrinone–Selective PDE-3 inhibitor; increases inotropy/chronotropy via Ca2+ influx to cardiomyocytes; also relaxes vascular smooth muscleAcute, decompensated HFHypotensionArrhythmiaGlycosidesDigoxinInhibits Na+/K+ ATPase, which indirectly inhibits Na+/Ca2+ exchanger, resulting in increased inotropy; also slows HR via vagal nerve stimulationHeart failureAfibCholinergic effectsHyperkalemiaToxicity, particularly in renal failureClass I antiarrhythmic (Na+ channel blockers)A: quinidine procainamide disopyramideB: lidocaine mexiletineC: flecainide propafenoneSlows or blocks phase 0 conduction, particularly for depolarized cellsA: Atrial/ventricular arrhythmiaB: Post-MI ventricular arrhythmia, digitalis-induced arrhythmiaC: SVT, including AfibA: QT prolongation, SLE-like syndrome (procainamide)B: CNS effectsC: Proarrhythmic, particularly post-MIClass II antiar-rhythmic (β blockers)MetoprololpropranololesmololatenololtimololcarvedilolDecreases SA