Miscellaneous Cardiovascular Meds (8) Flashcards
class and brand name
generic name: metoprolol
class: beta blocker
brand name: lopressor, toprol XL
indication
metoprolol
- heart failure
- angina
- myocardial infarction
- arrhythmias
- hypertension
MOA
metoprolol
beta-adrenergic blocker
black box warnings
metoprolol
abrupt withdrawl in patients with coronary artery disease
common ADRs
metoprolol
- dizziness
- fatigue
- hypotension
- bradycardia
rare but serious ADRs
metoprolol
heart failure (in patients that are fluid overloaded)
key counseling points
metoprolol
- may cause dizziness.
- when starting beta-blockers patients may feel fatigued, though this generally goes away with time.
- Please avoid abruptly stopping this medication because it can cause rebound symptoms
- If you have diabetes, this can mask the feeling of low blood glucose.
class and brand name
clonidine
class: alpha-2 adrenergic agonists
brand name: catapres, kapvay
indication
clonidine
hypertension
MOA
clonidine
Stimulates alpha-2 adrenoceptors in the brain stem, thus activating an inhibitory neuron, resulting in reduced sympathetic outflow from the CNS, producing a decrease in peripheral resistance, renal vascular resistance, heart rate, and blood pressure
common ADRs
clonidine
- dizziness
- drowsiness
- fatigue
- dry mouth
- constipation
rare but serious ADRs
clonidine
heart block and syncope
key counseling points
clonidine
- This drug is for your high blood pressure.
- Side effects of this medication include drowsiness, fatigue, dry mouth, and constipation.
- If you experience severe dizziness or passing out, please call your doctor right way.
- Please avoid abruptly stopping this medication because it can cause rebound symptoms.
class and brand name
hydralazine
class: vasodilator
brand name: apresoline
indication
hydralazine
hypertension and heart failure with reduced ejection fraction
MOA
hydralazine
Direct vasodilation of arterioles (with little effect on veins). Although exact mechanism unknown, arterial vasodilation may occur via inhibition of calcium release from the sarcoplasmic reticulum and inhibition of myosin phosphorylation in arterial smooth muscle cells
major contraindications
hydralazine
coronary artery disease
common ADRs
hydralazine
dizziness and reflex tachycardia
rare but serious ADRs
hydralazine
drug induced lupus erythematosus (DILE)
especially at high doses
key counseling points
hydralazine
- This drug is for your high blood pressure.
- Side effects of this medication include dizziness.
- If you develop a skin rash while on this medication please contact your doctor.
class and brand name
nitroglycerin
class: venodilator
brand name: minitran, nitrostat, nitro-dur
indication
nitroglycerin
- chest pain (angina)
- heart failure with reduced ejection fraction
- hypertension
MOA
nitroglycerin
Forms the free radical nitric oxide which in smooth muscle activates guanylate cyclase which increases guanosine 3’5’ monophosphate (cGMP) leading to smooth muscle relaxation.
Produces a vasodilator effect on the peripheral veins and arteries with more prominent effects on the veins
major contraindication
nitroglycerin
use with phosphodiesterase 5 inhibitors (sildenafil, tadalafil)
common ADRs
nitroglycerin
headaches and dizziness
rare but serious ADR
nitroglycerin
syncope
key counseling points
nitroglycerin
- Sublingual/Spray: This medication is to be used when you feel severe chest pain. Sit before taking this medication. Dissolve one table under your tongue or use spray every 5 minutes for up to 3 doses. Call 911. You may feel dizziness or a burning/tingling in your mouth.
- Tablet: This medication is for your heart failure, chest pain, or hypertension. It may cause dizziness or a headache.
class and brand name
ranolazine
class: antianginal
brand name: ranexa
indication
ranolazine
angina
MOA
ranolazine
Ranolazine inhibits the late phase of the inward sodium channel during cardiac repolarization reducing intracellular sodium concentrations, thereby reducing calcium influx via Na+-Ca2+ exchange that in turn reduces ventricular tension and myocardial oxygen consumption
major contraindications
ranolazine
- hepatic cirrhosis
- concurrent use of strong CYP3A4 inhibitors or inducers
common ADRs
ranolazine
Constipation and nausea
rare but serious ADRs
ranolazine
QT prolongation
key counseling points
ranolazine
- This medication is for your chest pain.
- Swallow the tablet whole, do not crush or chew.
- The medication may cause some constipation and nausea. Many drug interactions exist so please inform your doctor if you have any medication changes.
class and brand name
sacubitril/valsartan
class: ARB/Neprilysin inhibitor
brand name: entresto
indication
sacubitril/valsartan
Heart failure with reduced ejection fraction
MOA
sacubitril/valsartan
- ARB: Selective, reversible competitive antagonist of angiotensin II receptor. The angiotensin II receptor is responsible for vasoconstriction, aldosterone secretion, sympathetic outflow, and simulation of renal sodium reabsorption
- Neprilysin inhibitor: inhibits neprilysin leading to decrease breakdown of natriuretic peptides; inducing vasodilation and natriuresis
major contraindications
sacubitril/valsartan
pregnancy and use of an ACEI within 36 hours
black box warnings
sacubitril/valsartan
pregnancy
common ADRs
sacubitril/valsartan
- hyperkalemia
- hypotension
- acute kidney injury
rare but serious ADRs
sacubitril/valsartan
angioedema
key counseling points
sacubitril/valsartan
- This medication is for your heart failure.
- May cause dizziness (worsens when dehydrated).
- It should be avoided in pregnancy.
- Use potassium supplements/salt substitutes only under medical supervision.
- Stop taking the medication and call your doctor right away if you experience any swelling of the mouth or lips.
class and brand name
digoxin
class: cardiac glycoside
brand name: digitek, lanoxin
indication
digoxin
atrial fibrillation and heart failure with reduced ejection fraction
MOA
digoxin
- Atrial fibrillation: Direct suppression of the AV node conduction to increase effective refractory period and decrease conduction velocity
- Heart Failure: Inhibition of the sodium/potassium ATPase pump in myocardial cells results in a transient increase of intracellular sodium, which in turn promotes calcium influx via the sodium-calcium exchange pump leading to increased contractility
common ADRs
digoxin
anorexia and diarrhea
rare but serious ADRs
digoxin
arrhythmias and heart block
key counseling points
digoxin
- This drug is for your atrial fibrillation or heart failure.
- You may require blood draws to confirm you are receiving a safe an effective dose.
- This drug has many drug interactions so check with your doctor before starting or changing any medications.
class and brand name
amiodarone
class: class III antiarrhythmic
brand name: codarone, pacerone
indication
amiodarone
atrial or ventricular arrythmia
MOA
amiodarone
Class III antiarrhythmic agent which inhibits adrenergic stimulation (alpha- and beta-blocking properties), affects sodium, potassium, and calcium channels, prolongs the action potential
and refractory period in myocardial tissue; decreases AV conduction and sinus node function
black box warnings
amiodarone
- arrhythmias
- hepatotoxicity
- proarryhthmic effects
- pulmonary toxicity
common ADRs
amiodarone
- bradycardia/hypotension
- nausea/vomiting
- photosensitivity
rare but serious ADRs
amiodarone
- hepatotoxicity
- proarrhythmic effects
- pulmonary toxicity
- thyroid disease
key counseling points
amiodarone
- This medication is to treat your heart rhythm.
- There are many side effects and drug interactions associated with this medications so it requires close monitoring with your doctor.
- Always wear sunscreen or cover your skin when in direct sunlight, a blue-greying of your skin can appear.
