Cardiovascular agents Flashcards
amiodarone
Brand - Cordarone
Class - Antiarrhythmic
Indication - Atrial fibrillation, Supraventricular arrhythmia, Maintenance of sinus rhythm
Pregnancy: Risk
Contraindication - Severe bradycardia, severe sinus node dysfunction, 2nd- or 3rd-degree AV block, and cardiogenic shock
Black Box - Arrhythmias, hepatotoxicity, proarrhythmic effects, pulmonary toxicity
Counseling - Ensure adequate hydration. Seek medical attention if decreased urination, unusual bruising or bleeding, blistering skin rash, or shortness of breath.
Counseling - use sunscreen, avoid UV, avoid grapefruit juice, report signs or symptoms of cardiac arrhythmias, pulmonary toxicity, or liver toxicity. Multiple drug interactions so inform providers about all medications you are taking; dispense medication guide
MoA - Type III antiarrhythmic that prolongs the effective refractory period of atrial and ventricular tissue by blocking potassium conductance
amlodipine
Brand - Norvasc
Class - Ca2+ channel blocker, antiHTN
Indications - HTN, Stable/variant
MoA: long-acting dihydropyridine calcium-channel bloacking drug with potent arterial and coronary vasodilating properties
Pregnancy - mod risk
Counseling points: Report signs of hypotension or exacerbation of angina w/ initial dosing and dose changes; signs of peripheral edema, fatigue, hypotension, or hepatic dysfunction; avoid alcohol. May cause dizziness, Avoid activities that could be dangerous if dizziness occurs at initiation of therapy. Dizziness may be worse if too much water is lost from the body.
apixaban
Brand - Eliquis
Class - Factor Xa Inhibitor
Indication - Atrial fibrilation, Hip or knee replacement surgery, DVT or PE
Contraindication - Active bleeding
Black Box - Premature discontinuation increases risk of thrombotic events, increased risk of spinal hematoma with spinal puncture or neuraxial anesthesia
Counseling - Seek medical attention if any unexpected bleeding or trouble bleeding, avoid NSAIDS since they increase bleed risk, do not stop taking apixaban without talking to your HCP, stopping early may increase the risk of stroke, especially in patients with atrial fibrilation. Apixaban should be interrupted 24-48 hours in prior to dental and surgical procedures and re-started after homeostasis
MoA - Selective inhibitor of factor Xa, decreases thrombin generation and thrombus development.
atenolol
Brand - Tenormin
Class - Beta-blocker, antihypertensive
Indication - Angina (chronic), HTN, AMI
Pregnancy - Risk
Contraindications: sinus bradycardia, 2nd-/3rd-degree AV block, overt heart failure or cardiogenic shock
Black Box - Avoid abrupt withdrawal
Counseling points: Tk on an empty stomach. Avoid abrupt discontinuation. Report signs/symptoms of bradycardia, hypotension, heart failure, or exacerbation of angina with initial dosing and dose changes. May cause dizziness/drowsiness. Diabetic patients to carefully follow blood sugar levels as β-blockers may mask symptoms of hypoglycemia. Drug may cause sexual side effects, fatigue, and depression.
MoA: cardio selective beta-adrenergic that decreases AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmias
atorvastatin
Brand - Lipitor
Class - HMG-CoA Reductace Inhibitor
Indication - Hyperlipidemia, Primary and secondary prevention of atherosclerotic cardiovascular disease, Secondary prevention of cardiovascular events in patients with or at high risk for CAD, Familial hypercholesterolemia (homozygous)
Contraindications - Use in breastfeeding, active liver disease, unexplained persistent elevations of serum transaminases
Pregnancy - Contraindicated
Counseling -Avoid excessive alcohol, grapefruit, and grapefruit juice (>1 L/d), does not take the place of lifestyle changes to lower cholesterol levels. Notify prescriber if unexplained muscle tenderness or weakness occurs.
MoA -HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results.
carvedilol
Brand name: Coreg (CR)
Class: Alpha/Beta blocker, antihypertensive
Indications - Heart failure with reduced ejection fraction, HTN, Impaired ventricular function post-MI
MoA: selective alpha1 and nonselective beta-adrenergic blocker that can decrease AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmia.
Pregnancy - Risk
Contraindications: bronchial asthma, severe sinus bradycardia, 2nd- / 3rd-degree AV block, sick sinus syndrome, overt heart failure, cardiogenic shock, severe hepatic impairment
Counseling points - Tk w/ food. Report signs of heart failure, bradyarrhythmias, bronchospasm, hypotension, syncope, or exacerbation of angina with initial dosing and dose changes. Avoid abrupt discontinuation, may cause rebound HTN. Avoid driving. Diabetic patients should carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.
benazepril
Brand - Lotensin
Class - Ace inhibitor, antihypertensive
Indication: HTN
MoA: Competitive ACE-I, also reduces serum aldosterone, leading to decreased Na+ retention, potentiates the vasodilator kallikrein–kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system.
Pregnancy - Toxic
Contraindications: history of angioedema; anuria; concomitant use with aliskiren (in diabetes) or sacubitril
Counseling points: Avoid pregnancy. Seek medical attention immediately if you experience any facial swelling. Most common adverse effect is dry cough. Use potassium supplements or salt substitutes only under medical supervision. May cause dizziness that may worsen if dehydrated. Take at the same time daily.
chlorthalidone
Brand - Hygroton, Thalitone
Class - Diuretic/“Water pill”
Indication(s): HTN, Edema
MoA: increases Na+ and Cl- excretion by interfering with their reabsorption in the cortical-diluting segment of the nephron.
Contraindications: anuria
Counseling points: Tk in the morning w/ food. Instruct patient to report signs of dyspnea, hypotension, gout, or heart failure. Avoid alcohol (may cause hypotension) and NSAIDs (may decrease effectiveness). This medicine may cause dizziness or blurred vision. Avoid driving
clonidine
Brand - Catapres, Kapvay
Class - Alpha-blocker
Indications - ADHD, HTN
Pregnancy - Risk
Black Box: Epidural Use
Counseling points: Avoid alcohol, CNS depressants. Use caution with driving. May cause nausea, vomiting, insomnia, constipation, fatigue, or dry mouth. Apply patch to hairless area of intact skin on upper outer arm or chest; rotate patch location. If patch loosens during the 7-d wearing, secure adhesive cover. Report signs/symptoms of hypotension, exacerbation of angina peripheral edema, fatigue, hypotension, or hepatic dysfunction with initial dosing and dose changes. Avoid abrupt discontinuation to avoid rebound HTN.
MoA: Clonidine simulates presynaptic alpha2-adrenergic receptors and blocks postsynaptic alpha2-adrenergic receptors in the CNS by activating inhibitory neurons to decrease sympathetic outflow. Clonidine is not a complete agonist, so some of its effects might result from antagonist actions at presynaptic alpha-receptors. These actions reduce peripheral vascular resistance, renal vascular resistance, HR, and BP.
clopidogrel
Brand - Plavix
Class - Platelet Aggregation Inhibitor
Indications - Acute ST segment elevation MI managed medically and non-ST segment elevation MI, Thrombosis prevention in arteriosclerotic vascular disease, following stroke, in peripheral arterial occlusive disease
Contraindication -active bleeding
Black Box: Reduced CYP2C19 function
Counseling Points: Report signs of bleeding, Do not stop therapy abruptly without first talking with prescriber
MoA: Clopidogrel is an antiplatelet agent that prevents platelet aggregation by direct inhibition of ADP binding to receptor sites, inhibiting subsequent activation of the glycoprotein IIb/IIIa complex (irreversible)
digoxin
Brand - Digitek, Digox
Class - Digitalis Glycoside
Indication - Atrial fibrillation, heart failure, Supraventricular tachyarrhythmia
Contraindications - ventricular fibrillation
Counseling -Tk after morning meals (and after evening meals if giving in divided doses). Report signs of bradycardia. Do not discontinue drug suddenly.
MoA - Digitalis glycosides exert positive inotropic effects through improved availability of calcium to myocardial contractile elements, thereby increasing cardiac output in heart failure. Antiarrhythmic actions are caused primarily by an increase in AV nodal refractory period via increased vagal tone, sympathetic withdrawal, and direct mechanisms.
diltiazem
Brand - Cardizem, Cartia XT
Class - Calcium Channel Blocker
Indication - HTN, Stable, chronic angina, Atrial arrhythmia and paroxysmal supraventricular tachycardia
Contraindication - hypotension, 2nd- or 3rd-degree AV block, sick sinus syndrome
Counseling - Report symptomatic hypotension, bradyarrhythmia, peripheral edema, or syncope. This drug is available in multiple brand names with varying properties by brand. Instruct patient to follow administration instructions specific to the prescribed brand with regards to meals and timing. Do not drink alcohol. Administer at same time of day, either morning or evening.
MoA - Calcium-channel-blocking drug that decreases HR, prolongs AV nodal conduction, and decreases arteriolar and coronary vascular tone. It also has negative inotropic properties.
doxazosin
Brand - Cardura (XL)
Class - Alpha1-adrenergic blocker
Indication - Benign prostatic hyperplasia, HTN
Pregnancy - Mod risk
Counseling - Initial dose should be taken with breakfast, particularly with sustained-release products may cause vertigo/dizziness, rise slowly from sitting/lying, may cause syncope in first dose, Report priapism to HCP immediately
MoA - Selectively block postsynaptic alpha1, reduces peripheral resistance through dilation; increase urine flow in BPH by relaxing smooth muscle tone in the bladder neck and prostate
enalapril
Brand - Vasotec
Class - ACE-I
Indications - Heart failure, HTN, Kidney disease (nondiabetic)
Pregnancy - Contraindicated
Contraindications: history of angioedema, concurrent sacubitril
Counseling points: Use K+ supplements only under medical supervision. Report signs of angioedema. May cause dizziness that may worsen if dehydrated. Use caution rising from sitting or lying position, especially when initiating treatment.
MoA: prodrug that is rapidly converted to its active metabolite, enalaprilat, a competitive ACEI. It reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and inhibits the sympathetic nervous system and tissue renin-angiotensin system. The net effect is reduction in total peripheral resistance and BP in hypertensive patients and reduction in elevated afterload in patients with heart failure.
ezetimibe
Brand - Zetia
Class - Antihyperlipidemic, Cholesterol Absorption Inhibitor
Indications - Familial hypercholesterolemia-homozygous, (w/ statin), Mixed hyperlipidemia, Primary hypercholesterolemia
Pregnancy - Unknown, contraindicated in breastfeeding
Contraindications: gallbladder disease, severe hepatic dysfunction
Counseling points: Tk w/ or w/o food and may be taken at the same time as a concurrent statin. In patients receiving a bile acid sequestrant concurrently, ezetimibe should be taken at least 2 h before or 4 h after the bile acid sequestrant is taken.
MoA - Ezetimibe localizes at the brush border of the small intestine and inhibits the absorption of cholesterol, leading to a decrease in the delivery of intestinal cholesterol to the liver. This causes a reduction of hepatic cholesterol stores and an increase in clearance of cholesterol from the blood; this distinct mechanism is complementary to that of statins and of fenofibrate.
fenofibrate
Brand - Antara
Class - Antihyperlipidemic
Indications -Hypercholesterolemia, Hypertriglyceridemia
Pregnancy - limited data
Contraindications - gallbladder disease, severe renal or hepatic dysfunction, nursing mothers
Counseling points: Fenoglide tablets and Lipofen R capsules should be given with food; others can be taken without food. Take 1 h before or 4-6 h after a bile acid binding resin. Products are not interchangeable.
MoA - Fibric acid derivatives activate peroxisome proliferator-activated receptor α (PPARα), which increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III (an inhibitor of lipoprotein lipase activity). The resulting fall in triglycerides produces an alteration in the size and composition of LDL from small, dense particles to large buoyant particles. These larger particles have a greater affinity for cholesterol receptors and are catabolized rapidly.
furosemide
Brand - Lasix
Class - Diuretic/”Waterpill”
Indications - Edema related to heart failure, renal failure, HTN
Pregnancy Category: Human data suggests low risk for pregnancy. Limited human data (prob compatible) for breastfeeding
Contraindications - anuria
Black Box - Fluid and electrolyte loss
Counseling points: Avoid alcohol, NSAIDs, and UV (wear sunscreen). Report signs of hypotension, decreased urine output, or ototoxicity; severe skin reactions. Eat high-potassium foods, as directed by HCP. Realize drug effects (dizziness/vision) before driving.
MoA -Loop diuretic that is actively secreted via the nonspecific organic acid transport system into the lumen of the thick ascending limb of Henle’s loop, where it decreases sodium reabsorption by competing for the chloride sites on the Na+ -K+ -2Cl- cotransporter
gemfibrozil
Brand - Lopid
Class - Antihyperlipidemic, Fibric Acid
Indication - Coronary arteriosclerosis; prophylaxis, Familial type V hyperlipoproteinemia-Fredrickson type IV hyperlipoproteinemia
Contraindications - concurrent repaglinide or simvastatin, gallbladder disease, severe renal or hepatic dysfunction
Pregnancy - Risk
Counseling - Take 30 min before breakfast and dinner. Instruct patient to report signs/symptoms of rhabdomyolysis, jaundice (yellowing of skin or eyes), or renal failure
MoA - Fibric acid derivatives activate PPAR-α, which increases lipolysis and elimination of triglyceride-rich particles from plasma by activating lipoprotein lipase and reducing production of apoprotein C-III (an inhibitor of lipoprotein lipase activity). Activation of PPAR-α also induces an increase in the synthesis of apoproteins A-I and A-II and HDL-cholesterol.
hydralazine
Brand - Apresoline
Class - Peripheral Vasodilator
Indication - HTN
Pregnancy - Risk
Contraindications - dissecting aortic aneurysm; coronary artery disease; mitral valve rheumatic heart disease
Counseling points: Avoid alcohol, sudden discontinuation of drug; may cause dizziness. Report chest pain, palpitations, signs of tachyarrhythmia, hypotension, agranulocytosis, systemic lupus erythematosus, or hepatotoxicity.
MoA- Hydralazine is a vasodilator that reduces total peripheral resistance by direct action on vascular smooth muscle, with an effect greater on arterioles than on veins.
hydrochlorothiazide
Class - Diuretic/”Waterpill”
Indications - Edema, HTN
Contraindications - concomitant to dofetilide therapy or anuric patients
Counseling points: tk w/ or w/o food. Tk early in the day to avoid nocturia, even if taken more than once/d (bid administration at 8 AM and 2 PM). May cause dizziness. Report signs of hypotension and eat high-K+ foods during therapy; avoid alcohol and NSAIDs.
MoA: Thiazides increase Na + and Cl-excretion by interfering with their reabsorption in the cortical diluting segment of the nephron.
irbesartan
Brand - Avapro
Class - Angiotensin Receptor Blocker
Indication - Diabetic nephropathy in patients with DM2 and HTN
Pregnancy - Contraindicated
Contraindications - concomitant use with aliskiren in diabetics
Counseling points: Seek medical attention if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, jaundice, or skin rash occurs. Avoid abrupt discontinuation. Use K+ supplements only under medical supervision. This medicine may cause dizziness, avoid alcohol or driving.
MoA - selective, reversible, competitive antagonist of angiotensin II receptor (AT1), which is responsible for the physiologic effects of angiotensin II including vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal sodium reabsorption
isosorbide (mononitrate)
Brand - Imdur
Class - Long acting nitrate, antianginal
Indication - Angina prophylaxis
Pregnancy Category: Limited human data
Contraindication - concurrent use with PDEIs, concurrent use with nociguat
Counseling Points: Best to take this medicine on an empty stomach w/ at least half a glass of water; may cause headaches (use acetaminophen), or dizziness, avoid driving and stand up slowly if this medicine causes light-headedness from orthostatic hypotension. Do not stop using medicine suddenly without asking a HCP. Avoid contaminant use of PDEIs as this may increase risk of hypotension; avoid alcohol. Doses of immediate release formulation should be taken at least 7 hours apart.
labetalol
Brand - Normodyne
Class - Alpha/Beta-Blocker
Indication - HTN
Pregnancy Category: Human data suggest low risk
Contraindications - bronchial asthma, severe sinus bradycardia, 2nd-or 3rd degree AV block, sick sinus syndrome, overt heart failure, cardiogenic shock, severe hepatic impairment
Counseling points: Report signs of hypotension w/ initial dosing and dose changes. Avoid alcohol; may cause dizziness. Rise slowly from a sitting/supine position. Report signs of bronchospasm, slow HR, hepatotoxicity, or syncope. Advise diabetic patients to carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia. Avoid sudden discontinuation.
MoA: Selective alpha1 and nonselective beta-adrenergic blocker that can decrease AV nodal conduction in supra-ventricular tachycardias and blockade of catecholamine-induced dysrhythmia.
lisinopril
Brand - Prinivil, Zestril
Class - ACE-I
Indications - ST-segment elevation MI, heart failure with reduced ejection fraction, HTN
Pregnancy - High Risk
Contraindications - history of ACEI-induced angioedema, and hereditary or idiopathic angioedema, concurrent use with aliskiren in diabetic patients, concurrent use with sacubitril
Counseling points: Use K+ supplements only under medical supervision. May cause dizziness that may worsen if dehydrated.
MoA: Competitive ACEI, also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator kallikrein–kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system
lisinopril / HCTZ
Brand - Zestoretic, Prinzide
Class - ACE-I & Diuretic combo
Indications - Hypertension, Edema
Pregnancy - High Risk
Contraindications - concomitant dofetilide therapy, or anuric patients
Counseling points - May be taken w/ or w/o food. Tk early in the day to avoid nocturia, even if taken more than once/d (bid administration at 8 AM and 2 PM). May cause dizziness, Report signs of hypotension. Eat high-K+ foods during therapy, Avoid alcohol and NSAIDs.
MoA: Lisinopril is a competitive ACEI, also reduces serum aldosterone, leading to decreased sodium retention, potentiates the vasodilator killikrein - kinin system, and can alter prostanoid metabolism, inhibit the sympathetic nervous system, and inhibit the tissue renin-angiotensin system. Thiazides increase Na+ and Cl- excretion by interfering with their reabsorption in the cortical diluting segment of the nephron.
losartan
Brand - Cozaar
Class - Angiotensin Receptor Blockers
Indications - HTN, Reduce risk of cerebrovascular accident, in hypertensive patients w/ left ventricular hypotrophy (prophylaxis), diabetic nephropathy
Pregnancy - Contraindicated
Counseling points: Avoid sudden discontinuation; Use K+ supplements only under medical supervision. May cause dizziness that may worsen if dehydrated. Seek medical attention if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, or jaundice occurs.
MoA: Losartan is a selective, reversible, competitive antagonist of the angiotensin II receptor (AT1), which is responsible for the physiologic effects of angiotensin II including vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal sodium reabsorption.
losartan / hydrochlorothiazide
Brand - Hyzaar
Class - Angiotensin Receptor Blocker
Indications - HTN w/ or w/o left ventricular hypertrophy, stroke prevention
Pregnancy - Contraindicated (breastfeeding too)
Counseling points - Seek medical attention of angioedema, excessive fluid loss, hyperkalemia, reduction in urination, jaundice, or skin rash occurs. Avoid abrupt discontinuation. Use K+ supplements only under medical supervision. This medicine may cause dizziness. Avoid alcohol or driving
MoA - Selectively antagonizes angiotensin Ii receptors + inhibits covoluted tubule Na+ and Cl- reabsorption
lovastatin
Brand - Altoprev
Class - HMG-CoA Reductase Inhibitor
Indication - Coronary arteriosclerosis, hypercholesterolemia, primary/mixed, familial hypercholesterolemia, heterozygous
Contraindications - Active liver disease, use in breastfeeding, concomitant use with strong CYP3A4/5 inhibitors, and unexplained persistent elevation of liver enzymes
Pregnancy -Contraindicated
Counseling - Immediate-release tablets should be taken with the evening meal. Extended-release tablets should be taken at bedtime. Avoid alcohol, grapefruit, and grapefruit juice. Report signs of rhabdomyolysis, jaundice (yellowing of skin or eyes), or renal failure. There are multiple significant drug-drug interactions with lovastatin. Consult a HCP prior to starting any new medications.
MoA - HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol decreases because of decreased production of VLDL-cholesterol or increased VLDL removal by LDL receptors.
metoprolol
Brand - Lopressor, Troprol XL
Class - Beta-blocker
Indications - Angia, Heart failure w/ reduced ejection fraction, HTN, AMI
Pregnancy - Risk
Contraindications - severe bradycardia, 2nd- or 3rd-degree AV block, sick sinus syndrome; decompensated heart failure; cardiogenic shock
Black Box - Ischemic heart disease w/ abrupt withdrawal
Counseling points: Tk on an empty stomach and avoid alcohol. Avoid abrupt discontinuation, exacerbations of angina may occur. Instruct patients to report signs/symptoms of hypotension, heart failure, or exacerbation of angina with initial dosing and dose changes. Advise diabetic patients to carefully follow blood sugar levels as beta-blockers may mask symptoms of hypoglycemia.
MoA: Cardio selective beta-adrenergic blocker used in arrhythmias, HTN, angina pectoris, and heart failure. It is also effective in decreasing post-MI mortality.
nebivolol
Brand - Bystolic
Class - Beta-Blocker
Indication - HTN
Pregnancy - Risk
Contraindications - severe bradycardia, 2nd- or 3rd-degree AV block, sick sinus syndrome; decompensated heart failure, cardiogenic shock; severe hepatic impairment
Counseling points: Report signs of hypotension, worsening heart failure, or bronchospastic disease. Diabetic patients should carefully monitor blood sugar levels as beta-blockers may mask symptoms of hypoglycemia. Do not discontinue drug abruptly!
MoA - Long-acting B1-adrenoceptor antagonist without intrinsic sympathomimetic activities. Possible mechanisms include decreased HR, decreased myocardial contractility and vasodilation, and decreased peripheral vascular resistance.
niacin
Brand - Niaspan, Slo-Niacin
Class - Antihyperlipidemic
Indication - Coronary arteriosclerosis, hypercholesterolemia; Dyslipidemia; AMI, secondary prophylaxis
Contraindications - active liver disease, PUD, arterial hemorrhage
Counseling - Start with a low dose and titrate based on tolerability (primarily flushing). Avoid alcohol and warm beverages with niacin to reduce flushing. If discontinued for several days, may need to restart on a lower dose and retitrate. Aspirin or NSAID 30 min prior to niacin may reduce flushing. Take at bedtime with a low-fat snack to help with flushing.
MoA - May involve partial inhibition of release of free fatty acids from adipose tissue, and increased lipoprotein lipase activity, which may increase the rate of chylomicron triglyceride removal from plasma. Niacin decreases the rate of hepatic synthesis of VLDL and LDL.
nifedapine
Brand - Adlat CC, Procardia XL
Class - Calcium Channel Blocker
Indications - HTN, Stable chronic/variant angia
Contraindications - cardiogenic shock, STEMI, concomitant use of CYP3A4/5 inducers
Counseling points: tk Adalat CC on an empty stomach. Report signs of hypotension, exacerbation of angina, peripheral edema, fatigue, or hypotension. Avoid sudden discontinuation! May cause dizziness; avoid driving until effects are known. Avoid grapefruit juice. May see tablet or shell of dosage form in stool.
MoA: Ca++ ion influx inhibitor that selectively inhibits the transmembrane influx of calcium ions into cardiac muscle and smooth muscle.
nitroglycerin
Brand - Nitrostat, Minitran
Drug - Nitrate, Antiangial
Indication: Angina, Anal fissure
Pregnancy - Low risk
Contraindication: Concurrent use with PDEIs, symptomatic hypotension, marked bradychardia or tachycardia, severe anemia or increased intracranial pressure
Counseling Points: Sit prior to sublingual tablets, lingual aerosol or spray. Rise slowly from a sitting position in order to prevent light-headedness. Tablets should be dissolved under tongue or buccal pouch at firs sign of angina; do not swallow or chew tablet. Do not eat or drink after placement of tablets. Spray should be sprayed onto or under tongue, do not inhale, do not spit out of rinse mouth after use. Allow a 10-12 h/d drug free interval to avoid concurrent use of alcohol, CNS depressants, antihypertensives, or other drugs that cause hypotension. Do not use PDEIs, which may result in hypotension. This ointment may stain clothing. When treating acute angina, instruct patient to call 911 if symptoms are not resolved by the first dose
MoA: Nitroglycerin is believed to be converted to nitric oxide (NO) by vascular endothelium. NO activates guanylate cyclase, increasing cyclic GMP that in turn decreases intracellular calcium, resulting in direct relaxation of vascular smooth muscle.
olmesartan
Brand - Benicar
Class - Angiotensin Receptor Blocker
Indication - HTN
Pregnancy - Contraindicated
Contraindications: Concurrent use with aliskiren in patients with DM
Counseling points: Use K+ supplements only under medical supervision. May cause dizziness that may worsen if dehydrated. Seek care if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, or jaundice occurs. May cause orthostatic hypotension.
MoA - selective, reversible, competitive antagonist of the angiotensin II receptor (AT1)
omega-3-acid ethyl esters
Brand - Lovaza
Class - Antihyperlipidemic, Omega-3 Fatty Acids
Indication - Hypertriglyceridemia
Contraindications - fish/shellfish allergy
Counseling - Swallow the whole capsule; take with food. Seek medical attention if severe rash, chest pain, heart palpitations, or shortness of breath
MoA - Potential mechanisms of action include inhibition of acyl-CoA:1,2-diacylglycerol acyltransferase, increased mitochondrial and peroxisomal β-oxidation in the liver, decreased lipogenesis in the liver, and increased plasma lipoprotein lipase activity. Lovaza may reduce the synthesis of triglycerides in the liver because eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are poor substrates for the enzymes responsible for TG synthesis, and EPA and DHA inhibit esterification of other fatty acids.
pravastatin
Brand - Pravachol
Class - HMG-CoA Reductace Inhibitor
Indication - Cerebrovascular accident (prevention), Familial hypercholesterolemia, Hyperlipidemia
Contraindications - do not use in breastfeeding
Pregnancy - Contraindicated
Counseling - Take in the evening. Avoid concurrent heavy alcohol use.
MoA - HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol decreases because of decreased production of VLDL-cholesterol or increased VLDL removal by LDL receptors.
prazosin
Brand - Minipress, Prazin, Prazo
Class - Alpha-Blocker
Indication - HTN
Pregnancy - Risk, tk only if benefits»_space; risk
Contraindications: MINIPRESS is contraindicated in patients with known sensitivity to quinazolines, prazosin, or any of the inert ingredients.
Counseling points: Do not take more or less of it or take it more often than prescribed by your doctor. Your doctor will probably start you on a low dose of prazosin and gradually increase your dose. Do not stop taking prazosin without talking to your doctor. Tk this medication by mouth w/ or w/o food, usually 2 or 3 times daily or as directed by your doctor. If stomach upset occurs, take w/ food.
MoA - Inhibits the postsynaptic alpha1-adrenoceptors. This inhibition blocks the vasoconstriction effect of catecholamines on the vessels, leading to peripheral blood vessel dilation through blood vessel constriction by adrenergic receptor activation, epinephrine and norepinephrine normally try to increase blood pressure
propranolol
Brand - Inderal (LA, XL)
Class - Beta-Blocker
Indications - Angia (chronic), cardiac dysrhythmia, HTN, Migraine (prophylaxis)
Pregnancy - Risk
Contraindications - asthma; sinus bradycardia, AV block, sick sinus syndrome, cardiogenic shock
Black Box - Avoid abrupt withdrawal
Counseling points: Take immediate-release tablets on an empty stomach; ER can be taken with or without food but consistently. Avoid alcohol. Report signs of hypotension, CHF, or exacerbation of angina with initial dosing and dose changes. This medicine may cause dizziness. Diabetic patients should carefully follow blood glucose as beta-blockers may mask symptoms of hypoglycemia.
MoA: Nonselective β-adrenergic blocker that competitively blocks β1 and β2 receptors, thereby preventing β-adrenergic stimulation.
ramipril
Brand - Altace
Class - ACE Inhibitor
Indications - Heart failure, HTN, Reduce risk of MI/stroke, and death from CV
Pregnancy - Contraindicated
Contraindications - history of ACEI-induced angioedema; concurrent sacubitril
Key patient counseling points: Use K+ supplements only under medical supervision. May cause dizziness that may worsen if dehydrated.
MoA: Competitive ACEI, also a prodrug for the more potent ACEI ramiprilat. ACEI prevents conversion of angiotensin I to angiotensin II (a vasoconstrictor). It also reduces serum aldosterone, leading to decreased Na+ retention, potentiates the vasodilator kallikrein–kinin system, and inhibits the tissue renin-angiotensin system.
rivaroxaban
Brand - Xarelto
Class - Anticoagulant , Factor Xa inhibitor
Indication - Prevention of thromboembolism in patients after orthopedic surgery or patients with nonvalvular atrial fibrillation; Treatment and secondary prevention of DVT or pulmonary embolism; Coronary artery disease or peripheral artery disease
Pregnancy category: Limited data
Contraindication: Active bleeding
Black Box: Premature discontinuation increases risk of thrombotic risk, risk of spinal/epidural hematoma
Counseling Points: Educate patient on signs and symptoms of bleeding and interactions with other anticoagulant or antiplatelet medications, including OTC medications. Warn of risks of epidural (spinal), anesthesia while taking rivaroxaban. Doses greater than or equal to 15 mg should be taken with food. If taking for nonvalvular atrial fibrillation, take with evening mean.
MoA: Orally bioavailable factor Xa inhibitor that selectively blocks the active site of factor Xa and does not require a cofactor (such as antithrombin III) for activity. Activation of factor X to factor Xa via the intrinsic and extrinsic pathways plays a central role in the cascade of blood coagulation.
rosuvastatin
Brand - Crestor
Class - HMG-CoA Reductace Inhibitor
Indication - Hyperlipidemia, Disorder of cardiovascular system (primary prophylaxis), familial hypercholesterolemia (homozygous), hypertriglyceridemia, mixed dyslipidemia
Contraindications - Active liver disease, use in breastfeeding
Pregnancy - Contraindicated
Counseling - Do not drink alcohol.
MoA - HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol can also decrease because of decreased production of VLDL-cholesterol or increased VLDL removal by LDL receptors.
simvastatin
Brand - Zocor
Class - HMG-CoA Reductace Inhibitor
Indication - Hyperlipidemia, Primary and secondary preventions of atherosclerotic cardiovascular disease, Secondary prevention of cardiovascular events, Familial hypercholesterolemia (homozygous)
Contraindications - Active liver disease, use in breastfeeding
Pregnancy - Contraindicated
Counseling - Avoid excessive alcohol. There are multiple significant drug-drug interactions with simvastatin. Consult a health-care professional prior to starting any new medications
MoA - HMG-CoA reductase inhibitors competitively inhibit conversion of HMG-CoA to mevalonate, an early rate-limiting step in cholesterol synthesis. A compensatory increase in LDL receptors, which bind and remove circulating LDL-cholesterol, results. Production of LDL-cholesterol also can decrease because of decreased production of VLDL-cholesterol or increased VLDL removal by LDL receptors.
spironolactone
Brand - Aldactone, Carospir
Class - Diuretic
Indications - Heart failure, HYHA class III-IV, Edema associated with heart failure, nephrotic syndrome, HTN, Hypokalemia
Contraindications - anuria, acute renal insufficiency, hyperkalemia
Counseling points: May cause dizziness, Avoid driving. Report signs of hyperkalemia and hyponatremia. Avoid K+ supplements and rich foods. Avoid alcohol and NSAIDs.
MoA: Steroidal competitive aldosterone antagonist that acts from the interstitial side of the distal and collecting tubular epithelium to block Na+-K+ exchange, producing a delayed and mild diuresis. The diuretic effect is maximal in states of hyperaldosteronism. Excretion of Na+ and Cl- excretion is increased; excretion of K+ and Mg++ is decreased. Spironolactone has mild antihypertensive activity and has demonstrated a beneficial effect in NYHA class III and IV heart failure.
tamsulosin
Brand - Flomax
Class - Alpha1-adrenergic blocker
Indication - Benign prostatic hyperplasia
Counseling - Admini 30 min after the same meal (fasting increases bioavailbility), may cause vertigo/dizziness, rise slowly from sitting/lying, may cause syncope in first dose
MoA - Selectively block postsynaptic alpha1, reduces peripheral resistance through dilation; increase urine flow in BPH by relaxing smooth muscle tone in the bladder neck and prostate
terazosin
Brand - Hytrin
Class - Alpha1-adrenergic blocker
Indication - Benign prostatic hyperplasia, HTN
Counseling - Tk at bedtime, may cause vertigo/dizziness, rise slowly from sitting/lying, may cause syncope in first dose, avoid alcohol and sudden discontinuation of drug
MoA - Selectively block postsynaptic alpha1, reduces peripheral resistance through dilation; increase urine flow in BPH by relaxing smooth muscle tone in the bladder neck and prostate
timolol
Brand - Betimol
Class - Beta-blocker, Antiglaucoma agent
Indication - Ocular hypertension and open-angle glaucoma
Contraindications - Asthma, COPD, sinus bradycardia, heart failure, cardiogenic shock
Pregnancy - Risk
Counseling - Drop into the pocket between lower lid and eyeball, close eye and hold for 1 min. Put cap on bottle asap, reinsert contacts after 15 min or wait 5 min for other drops
MoA - Blocks beta-1 & 2 receptors and reduces intraocular pressure by reducing aqueous humor production.
triamterene / HCTZ
Brand - Dyazide, Maxzide
Class - Diuretic
Indications: Edema, HTN
Pregnancy Category: Risk?, tk if benefits»_space; risk
Contraindications: concomitant use of K+ supplements or other potassium-sparing diuretics; or in patients with anuria, acute/chronic renal insufficiency, or hyperkalemia
Black Box - Hyperkalemia
Counseling points: May cause dizziness. Rise slowly from a sitting or lying position to avoid dizziness. Avoid foods that are high in K+, Avoid alcohol and NSAIDs. May cause photosensitivity; use sunscreen. Use with caution in patients with sulfonamide allergy.
MoA: Triamterene acts directly from the distal tubular lumen on active Na+ exchange for K+ and H+, producing a mild diuresis that is independent of aldosterone concentration. Antihypertensive activity is inconsistent and less pronounced than with thiazides or spironolactone. Hydrochlorothiazide is a thiazide diuretic that increases Na+ and Cl- excretion by interfering with their reabsorption in the cortical diluting segment of the nephron; a mild diuresis of slightly concentrated urine results.
valsartan
Brand - Diovan
Class - Angiotensin Receptor Blockers
Indications - Heart Failure, HTN, MI
Pregnancy - Contraindicated
Contraindications: Concurrent use with aliskiren in patients with DM
Counseling points: Do not discontinue abruptly. Use K+ supplements only under medical supervision. This medicine may cause dizziness. Avoid driving, alcohol, and NSAIDs while taking this drug.
MoA: Selective, reversible, competitive antagonist of the angiotensin II receptor, which is responsible for the physiologic effects of angiotensin II, including vasoconstriction, aldosterone secretion, sympathetic outflow, and stimulation of renal sodium reabsorption.
verapamil HCl
Brand - Calan SR
Class - Calcium Channel Blocker
Indication: Angina, Atrial arrhythmia or paroxysmal supraventricular tachycardia (prophylaxis), HTN
Contraindication: symptomatic hypotension, 2nd or 3rd degree AV heart block, sick sinus syndrome; severe left ventricular dysfunction, atrial fibrillation/flutter associated with accessory bypass tract
Counseling Points: Signs-symptoms of heart failure, decrased HR, signs/symptoms of liver toxicity. Exacerbations of angina pectoris or acute coronary insufficiency; while tapering chronic therapy, especially in patients with ischemic heart disease. Monitor LFTs, ECG, and vital signs.
MoA: Inhibits calcium “slow channels” on vascular smooth muscle and myocardium producing relaxation of muscle and vasodilation. Increases myocardial oxygen delivery and slow conduction through the AV node.
warfarin
Brand - Coumadin
Class: Anticoagulant, Vitamin K Antagonist
Indications: Atrial fibrillation; MI, prosthetic cardiac valve component embolism; pulmonary embolism; thrombosis, post-myocardial infarction; venous thromboembolism
Pregnancy - Contraindicated
Contraindication: Bleeding tendencies recent or potential surgery, uncontrolled HTN; pericarditis or pericardial effusion; bacterial endocarditis; noncompliant patients, eclampsia/preeclampsia, threatened abortion
Black Box: Bleeding
Counseling Points: Report signs of hemorrhage, skin and tissue necrosis.
Avoid situations/activities in which cuts, bruising, or injury is likely. Many significant drug-drug interactions, consult health-care professional prior to new prescription or OTC use. Avoid alcohol, cranberry products, and drastic changes in vitamin K consumption from diet (cruiferous vegetables).
MoA: Warfarin prevents the conversion of vitamin K back to its active form from vitamin K epoxide. This impairs formation of the vitamin K–dependent clotting factors II, VII, IX, and X (prothrombin) and proteins C and S (physiologic anticoagulants).
candesartan
Brand - Atacand
Class - Angiotensin II Receptor antagonist
Indication - Heart failure, HTN
Contraindications - Pregnancy
Pregnancy - Risk
Black Box - Pregnancy
Counseling - No prergrnant! Only use K+ under medical supervision. May cause dizziness if dehydrated. Seek care if angioedema, excessive fluid loss, hyperkalemia, reduction in urination, or jaundice occurs.
MoA - Selective, reversible competitive antagonist of the angiotensin II receptor type 1
bisoprolol
Brand - Zebeta
Class - Cardioselective β-Adrenergic Blocker
Indication - HTN
Contraindications - severe sinus bradycardia, 2nd- or 3rd-degree AV block, overt heart failure, cardiogenic shock
Pregnancy - Risk
Counseling - report signs of dyspnea, hypotension, or heart failure. May cause dizziness, depression, or sexual dysfunction. May mask signs of low blood sugar. Avoid activities that require alertness during initiation. Rise slowly from a sitting/supine position. Avoid abrupt discontinuation.
MoA - cardioselective β-adrenergic blocker that decreases AV nodal conduction in supraventricular tachycardia and blockade of catecholamine-induced dysrhythmias