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nitroglycerin (Nitro-Bid®, Transderm Nitro®, Nitro stat®)

isosorbide (Isordil® or Ismo®)

MOA:

Dilate smooth muscle in vessels

Decrease venous return to heart, decrease BP, decrease cardiac work

Uses:

HF, angina, HTN, MI

Side Effects/Patient teaching:

Headaches, faintness, lightheadedness, tachycardia, orthostatic hypotension

Use caution with position changes

Contraindications:

No ED meds

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propranolol (Inderal®)

metoprolol (Lopressor®)

nadolol (Corgard®)

atenolol (Tenormin®)

nebivolol (Bystolic®)

carvedilol (Coreg®)- alpha 1 blocker too

MOA:

Reverse excessive sympathetic activation of beta-1 receptors (compensatory from CHF)

Blocks beta-1 receptors → decrease HR, decrease FOC, decrease oxygen consumption (nonselectives block beta 1 & 2)

Uses:

Angina, CHF arrythmias-tachycardia, migraines, glaucoma

Side effects/Patient teaching:

Drowsiness, GI upset, CNS depression, bradycardia, monitor serum lipid levels, mental depression

Contraindications:

Monitor glucose levels in diabetics

Avoid using nonselectives with asthma patients-bronchoconstriction

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Non-dihydropyridines
Act on cardiac muscle, heart's conduction cells, and smooth muscle
Vasodilators & Antiarrhythmics

verapamil (Calan®)

diltiazem (Cardizem®)

MOA:

1. Block calcium at SA and AV node, decrease rate of the SA node, decrease conduction velocity of the AV node (Tx: tachyarrhythmias)

2. Block entry of calcium into the cardiac muscles, decrease FOC, decrease O2 demand by the heart

3. Block entry of calcium into the smooth muscles, muscles relax → vasodilation, decrease in bp

Uses:

Angina, HTN, tachyarrhythmias

Dihydropyridines
Vasodilating effect

nifedipine (Procardia®)

amlodipine (Norvasc®)

nisoldipine (Sular®)

MOA:

1. Block entry of calcium into the cardiac muscle, decrease FOC, decrease O2 demand by the heart

2. Block entry of calcium into the smooth muscles, muscles relax → vasodilate, decreases bp

Uses:

Angina, HTN

Side effects/Patient teaching:

HA, facial flushing, dizziness, hypotension, reflex tachycardia, constipation, xerostomia

Contraindications:

CCB plus a BB will slow the HR and depress cardiac activity leading to CHF

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digoxin (Lanoxin®)

MOA:

Decrease heart rate, slow conduction through AV node

Increases force of contraction, accelerates entry of CA++ into cardiac muscle cells; kidney fxn will increase due to added blood flow → eliminates excess fluid and electrolytes that cause edema

Uses:

1. CHF

2. Arrhythmias:

Atrial fibrilation

Atrial Tachycardia

Side effects/Patient teaching:

Hypokalemia → arrhythmias, nausea, headache, visual disturbances

Interferes with Na++/K+ pump

Toxicity:

Cardiac: slow pulse-irregular pulse

CNS: confusion, HA, delirium, visual changes–halos around dark objects

GI: NVD

Antidote for toxicity:

digoxin immune fab (Digibind®)-antidote

Toxicity tx: give K+ to strengthen heart's ability to contract, d/c drug, serum blood levels

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Class I

quinidine (Quingulate®)

procainamide (Pronestyl®)

lidocaine (Xylocaine®)

MOA:

Blocks the Na+ channels, interferes with Na+ influx during depolarization, slows conduction, prolongs refractory period, slows HR

Uses:

Ventricular and supraventricular arrhythmias

Side effects/Patient teaching:

Nausea, diarrhea, anorexia, tremors, restlessness

Class II = Beta blockers

propranolol (Inderal®)

MOA:

Bind to beta-1 adrenergic receptors, decrease HR, decrease conduction velocity

Uses:

Arrhythmias caused by excessive sympathetic activity, ventricular and supraventricular tachyarrhythmias

Side effects/Patient teaching:

Drowsiness, GI upset, CNS depression, bradycardia, monitor serum lipid levels, mental depression

Contraindications:

Monitor glucose levels in diabetics

Avoid using nonselectives with asthma patients-bronchoconstriction

Class III

amiodarone (Cardarone®)

bretylium (Bretylol®)

MOA:

Blocks the K+ channels, prolongs refractory period, delays repolarization

Uses:

Vtach, V fib

Side effects/Patient teaching:

Can affect thyroid function-contains iodine, hypotension, dizziness, tremors, GI upset, skin discoloration

Class IV = Calcium channel blockers (nondihydropyridines)

verapamil (Calan®)

diltiazem (Cardizem®)

MOA:

Decrease Ca++ entry into cells, decrease HR and conduction velocity, decrease FOC (watch out for CHF)

Uses:

Tachyarrhythmias (SVT)

Side effects/Patient teaching:

Hypotension, facial flushing, headache, xerostomia, constipation, dizziness

Other

adenosine (Adenocard®)

MOA:

Decreases Ca++ activity in SA and AV nodes, slows rate and conduction

Uses:

SVT

Side effects/Patient teaching:

Respiratory difficulty/bronchospasm, hypotension

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prazosin (Minipress®)

terazosin (Hytrin®)

doxazosin (Cardura®)

MOA:

Block NE from binding to alpha-1 adrenergic receptors → vasodilation

Uses:

HTN, angina, BPH

Side effects/Patient teaching:

Orthostatic hypotension-caution with position changes, reflex tachycardia, GI upset, increased urination

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clonidine (Catapres®)

methyldopa (Aldomet®)

MOA:

Inhibits CNS activity and lowers bp, acts on alpha-2 receptors → vasodilates

Uses:

HTN, angina

Side effects/Patient teaching:

flushing, headache, hypotension, rapid heartbeat, N/V

Contraindications:

Cannot be used with ED meds

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hydralazine (Apresoline®)

minoxidil (Loniten®, Rogaine®)

nitroprusside (Nipride®, Nitropress®)

MOA:

Relaxes smooth muscle in vessels

Uses:

CHF, HTN, CAD

Side effects/Patient teaching:

Flushing, headache, hypotension, rapid heartbeat, N/V

Contraindications:

Cannot be used with ED meds

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Thiazide type

hydrochlorothiazide (Hydrodiuril®)

Thiazide-like

chlorthalidone (Hygroton®)

indapamide (Lozol®)

metolazone (Zaroxolyn®)

MOA:

Block reabsorption of sodium, intense diuresis, Na+ and H2O loss

Side effects/Patient teaching:

Hypercalcemia, Hyperlipidemia, Hyperglycemia, Hyperuricemia, Hypokalemia (may need dietary supplement), leg cramps, muscle weakness, constipation, arrhythmias, feeling of lethargy, decreased mental alertness

Contraindications:

If allergic to sulfonamides, these are contraindicated because they're a sulfa derivative

Osmotic Diuretic

mannitol (Osmitrol®)

MOA:

Decreases ICP (water on brain), pulls water from tissues (changes plasma osmolarity)

Uses:

CHF, HTN, edema, anuria, renal disease

Loop

furosemide (Lasix®)

torsemide (Demadex®)

MOA:

Inhibit Na+ and Cl- transport in Loop of Henle → increase Na+, H2O, Cl-, excretion

Uses:

Edema, CHF, HTN, liver and renal disease, pulmonary congestion

K+ sparing – Aldosterone Receptor Antagonist

triamterene (Dyrenium®)

amiloride (Midamor®)

spironolactone (Aldactone®)

MOA:

Inhibit K+ secretion in DCT, increase potassium retention, increase sodium excretion

Uses:

Edema, HTN, acne

Side effects:

Hypotension, reflex tachycardia, dizziness (orthostatic), nausea, increased urination, thirsty, dry mouth, dehydration

Patient teaching:

Take medication exactly as perscribed

Taking medications as perscribed helps better control high BP and prevents complications

Syncope can be experienced

Fainting due to volume depletion, or low BP, causing decreased O2 and blood flow

An increase in HR should be reported to physician

If on a diuretic and a cardiac glycoside, patient will be shown how to monitor their pulse

Orthostatic hypotension can result from diuretic therapy; caution when changing positions

Patient should journal or log their daily weight; monitor for fluid gain

Monitor intake and output amounts in hospital for patients

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captopril (Capoten®)

enalapril (Vasotec®)

lisinopril (Zestril®)

benazepril (Lotensin®)

quinapril (Accupril®)

ramipril (Altace®)

MOA:

Inhibits ACE

Decrease in Aldosterone release, decrease in Na+ and H2O absorption

Decrease in blood volume

Vasodilation

Uses:

HTN

Side effects/Patient teaching:

K+ levels increase in the blood → hyperkalemia, arrhythmias, hypotension, coughing, angioedema, HA, dissiness, GI upset, rash

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losartan (Cozaar®)

valsartan (Diovan®)

irbesartan (Avapro®)

olmesartan (Benicar®)

MOA:

Block effects of angiotensin II by blocking receptors, decrease in aldosterone release, vasodilation

No significant effects on K+; no angioedema

Uses:

HTN

Side effects/Patient teaching:

Hypotension, monitor potassium, headache, dizziness, drowsiness, nausea, cough

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aliskiren (Tekturna®)

MOA:

Block actions of renin

Uses:

HTN

Side effects/Patient teaching:

Headache, cough, dizziness, upset stomach, lightheadedness, hypotensions

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Nicotinic Acid

niacin (Slo-Niacin® or Niaspan®)

MOA:

Reduces cholesterol, LDL and VLDL, removes triglycerides, HDL is increased

Side effects/Patient teaching:

Skin flushing and pruritis, GI distress, hyperuricemia-gout symptoms, hepatoxicity

Contraindications:

Glucose intolerance-not recommended for diabetics

HMG CoA reductase inhibitors (statins)

pravastatin (Pravachol®)

simvastatin (Zocor®)

atorvastatin (Liptor®)

lovastatin (Mevacor®)

rosuvastatin (Crestor®)

fluvastatin (Lescol®)

MOA:

inhibits enzyme responsible for synthesis of cholesterol by the liver; reduces triglycerides, LDL, VLDL, cholesterol; HDL increases (reduces C-reactive protein/ inflammation that occurs during plaque forming)

Side effects/Patient teaching:

Mild GI distress, headache, myalgia, photosensitivity, alteration of taste, rarely rhabdomyolysis leading to renal failure, evaluate LFTs at baseline and repeat as needed, avoid grape fruit juice-enzyme inhibitor, increase levels/effects

Bile Acid Sequestrants

cholestyramine (Questran®)

MOA:

Binds with cholesterol in intestines, prevents absorption and increases elimination of cholesterol, decreases LDL and cholesterol

Side effects/Patient teaching:

Constipation, bloating, flatulence, nausea

Fiber supplement may reduce GI side effects

Fibric Acid Derivatives

gemfibrozil (Lopid®)

fenofibrate (Triglide®)

MOA:

Inhibits production of triglycerides, decreases triglycerides in bloodstream, decreases cholesterol

Side effects/Patient teaching:

GI distress, N/V/D, flatulence, gall stones

Contraindications:

Rhabdomyolysis is increased when combined with a statin

Cholesterol Absorption Inhibitor

ezetimibe (Zetia®)

MOA:

Lowers total cholesterol by selectively inhibiting absorption of cholesterol in the small intestine, also increases HDL levels, blocks VLDL particles in turn lowering LDL

Side effects/Patient teaching:

Mild GI distress, abdominal pain, coughing, fatigue, diarrhea, back/joint pain

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Parenteral
High molecular weight

heparin

MOA:

Interferes with platelet aggregation

inhibits thrombin formation by binding to clotting factors and thromboplastin

Side effects/Patient teaching:

Risk for hemorrhage, petechiae, fever, alopecia, osteoporosis, thrombocytopenia, do not massage at injection site, rotate injection site, do not administer where there is bruising from previous injections, epistaxis, easy bruising

Low molecular weight

enoxaparin (Lovenox®)

MOA:

Binds factor x

Side effects/Patient teaching:

Risk for hemorrhage, petechiae, do not massage at injection site, rotate injection site, do not administer where there is bruising from previous injections, epistaxis, easy bruising

Oral: Vitamin K antagonists (VKAs)

warfarin (Coumadin®)

MOA:

Prevents the synthesis of clotting factors and prothrombin

Slow onset, long duration of action (oral)

Side effects/Patient teaching:

Easy bruising, bleeding of the gums, hematuria, nausea, diarrhea, fatigue, headache, cannot be used in pregnancy, nosebleeds

NEWER ORAL agents: (NOACs)

Oral direct thrombin inhibitors (DTIs)

dabigatran (Pradaxa®)

Oral direct factor Xa inhibitors

rivaroxaban (Xarelto®)

apixaban (Eliquis®)

edoxaban (Savaysa®)

Uses:

Used against clot formation when clotting mechanism becomes too active

Deep vein thrombosis, thrombophlebitis, Stroke, MI, Pulmonary embolus, atrial fibrillation

Contraindications:

Active bleeding tendencies, uncontrolled HTN, ulcers, recent surgery on brain and spinal cord, no surgery unless labs checked

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Vitamin K for warfarin

Protamine sulfate for heparin

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asprin ASA

dipyridamole (Persantine®)

clopidogrel (Plavix®)

prasugrel (Effient®)

ticlopidine (Ticlid®)

MOA:

Inhibit platelet aggregation so platelets no longer stick together or to vessel walls

Side effects/Patient teaching:

Headache, dizziness, vomiting, rash, diarrhea, easy bruising, thrombocytopenia, monitor labs for WBC counts, nosebleeds, bleeding gums

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streptokinase (Streptase®)

alteplase (tPA®)

MOA:

To stimulate plasminogen to change into plasmin to cause fibrinolysis to occur

Uses:

MI causing coronary artery thromboses, pulmonary emboli (PE), stroke, DVT

Side effects/Patient teaching:

Arrhythmias

Contraindications:

risk for hemorrhage when used with anticoagulants

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Iron deficiency anemia

iron (fumarate, gluconate, sulfate)

Side effects:

Gastric irritation, constipation, nausea, discoloration of teeth, may caused darkened stools

Folic acid deficiency anemia

folic acid

Uses:

Cell growth, cell reproduction, protein synthesis

Side effects/Patient teaching:

May lead to megaloblastic anemia (large RBCs form, short lifespan)

Vitamin B12 deficiency anemia

vitamin B12 (cyanocobalamin)

Uses:

DNA synthesis and cell division, myelin sheath protection, production of RBCs

Side effects/Patient teaching:

Invasive, injections required for lifetime, monitor for injection site reactions

May lead to megaloblastic anemia