Nitroglycerin Isosorbide dinitrate
Class Organic nitrate Class
Use DOC to term. stable & unstable angina; rapidly relax Use
vasospasm (via cGMP inc.) to inc. blood/oxygen delivery
Sec. DOC in prophylaxis of stable & unstable angina (nitrate
tolerance prevents primary use; nitrate-free pd. required)
Beta- & Ca-channel blocker alt. (if intolerant to others)
Side Fx HA, hypotension, reflex tachycardia Side Fx
Misc. Prim. affects lg. diam. veins to inc. cap. (pooling) on vein Misc.
side of heart, thus, dec. heart preload, work, oxygen demand
Extensive first-pass liver metabolism by nitrate reductase
(poor oral bioavail.) requires sublingual or transdermal
delivery, i.e. spray or patch, respectively
Sprays to term. (rapid onset), patch in prophylaxis (long dur.)
Contraindicated w/ Sildenafil (Viagra) use b/c hypotension
Verapamil
Class Ca-channel blocker Class
Use DOC for variant angina prophylaxis b/c directly vaso- Use
dilate & require no drug-free periods
Strongly dec. cardiac contr. (dec. work & oxygen demand)
& gen. of action pot. in SA & AV nodes
Moderately dilates arterioles (dec. afterload)
Relaxes coronary vasospasm (inc. oxygen supply)
Indicated in stable, variant (vasospasm), unstable angina (ltd.
use); HTN; arrhythmia
Side Fx Use w/ drugs that depr. cardiac fct. (beta-blocker, digoxin),Side Fx
or state of low CO (CHF), sick sinus syndrome, AV nodal
block, or hypotension can exacerbate cond. or cause
bradycardia; digoxin levels inc. w/ verapamil use
Amlodipine
Class Ca-channel blocker Class
Use DOC for variant angina prophylaxis b/c directly vaso- Use
dilate & require no drug-free periods
Little effect on cardiac contr. & gen. of action pot. in nodes
Markedly dilates arterioles (dec. afterload)
Relaxes coronary vasospasm (inc. oxygen supply)
Indicated in stable & variant (vasospasm) angina; HTN
(not indicated in arrhythmias b/c don't block Ca-channel)
Side Fx Contraindicated if pre-existing hypotension or other anti- Side Fx
hypertensives being used
Edema, HA, reflex tachycardia
Organic nitrate
DOC to term. stable & unstable angina; rapidly relax
vasospasm (via cGMP inc.) to inc. blood/oxygen delivery
Sec. DOC in prophylaxis of stable & unstable angina (nitrate
tolerance prevents primary use; nitrate-free pd. required)
Beta- & Ca-channel blocker alt. (if intolerant to others)
HA, hypotension, reflex tachycardia
Prim. affects lg. diam. veins to inc. cap. (pooling) on veinous
side of heart, thus, dec. heart preload, work, oxygen demand
Dec. first-pass liver metabolism by nitrate reductase, thus,
oral delivery provides sufficient bioavailability
Oral usage shows slow onset, med. duration effective in
prophylaxis
Never use w/ Sildenafil b/c fatal hypotension
Diltiazem
Ca-channel blocker
DOC for variant angina prophylaxis b/c directly vaso-
dilate & require no drug-free periods
Mod. dec. (thus, easily tolerated) cardiac contr. (dec. work
& oxygen demand) & gen. of action pot. in SA & AV nodes
Moderately dilates arterioles (dec. afterload)
Relaxes coronary vasospasm (inc. oxygen supply)
Indicated in stable, variant (vasospasm), unstable angina;
HTN; arrhythmia
Use w/ drugs that depr. cardiac fct. (beta-blocker, digoxin),
or state of low CO (CHF), sick sinus syndrome, AV nodal
block, or hypotension can exacerbate cond. or cause
bradycardia
Nifedipine
Ca-channel blocker
DOC for variant angina prophylaxis b/c directly vaso-
dilate (esp. arterioles) & require no drug-free periods
Little effect on cardiac contr. & gen. of action pot. in nodes
Markedly dilates arterioles (dec. afterload)
Relaxes coronary vasospasm (inc. oxygen supply)
Indicated in stable & variant (vasospasm) angina; HTN
(not indicated in arrhythmias b/c don't block Ca-channel)
Contraindicated if pre-existing hypotension or other anti-
hypertensives being used
Edema, HA, flushing, reflex tachycardia
Gingival hyperplasia
ivery
(nitrate

veinous
demand
thus,

work
V nodes

oxin),
nodal

nodes

nnel)
 Quinidine (Na-channel blocker)
Class IA (slows Phase 0 depol., dec. slope of Phase 4 spont.Class
inc. ventr. ERP)
Use By widening QRS complex, action pot. cond. slows &Use
synchronous ventr. contr.; apparently also blocks K channel,
prolonging ventricular action potential
Blocks reentry, atrial, ventr., & AV junctional arrhythmias
Inh. ectopic & ventr. arrhythmias a/w inc. normal automaticity
Maintain sinus rhythm after atrial flutter/a-fib cardio
Side Fx Initiate arrhythmia (torsades de pointes) & has neg. i Side Fx
N/V, diarrhea, & cinchonism (tinnitus, anticholinergic & visual fx)
Can inc. digoxin level by displacing protein-bound d Misc.
Misc. Orally absorbed rapidly & completely; binds open & inactivated
Na-channels; has little effect on normal automaticity
Fleicanide (Na-channel blocker)
Class IC (significantly slows Phase 0 depolar. in Purkinje &Class
but has little effect on action pot. duration or ventr Use
Use DOC for prophylaxis of a-fib
Used in tx of refractory ventr. arrhythmias
Side Fx In patients w/ structural heart dz (cardiac hypertrophy or
ischemic damage) proarrhythmias (esp. v-tach) common
In patients w/ dec. ejection fraction, neg. inotropic ef
exacerbate problem
Dizziness, blurred vision, HA Side Fx
Misc. Orally absorbed; prominent effects at even normal HR
Misc.
Amiodarone (K-channel blocker) Sotalol (K-channel blocker & non-selective beta antagonist)
Class III (prolongs Phase 3 repolarization) Class
Use DOC to terminate a-fib & prevent and/or suppress ventr. Use
tachycardia (esp. refr. supraventr. tachy); shotgun effect
via affecting K- & Na-channels, & beta-adrenergic rec.
Tx CHF-pt. arrhythmias if intolerant to other anti-arrhythmics
Side Fx Pulm. Fibrosis (alveolar pneumonitis) that can be reversible
Tremor, ataxia, dizziness, neuropathy
Hypo-, hyperthyroidism (clue is blue-tinged skin) Side Fx
Misc. Used short(iv)- or long(oral)-term; prolongs action pot.
w/o affecting Phase 0 depol. (prolongs ERP); incomplete abs.
w/ oral admin. & full clin. fx achieved >6wks.; clin.
indicate dec. sudden death incidence/prolonged life Misc.
can inc. warfarin & digoxin levels (both used in heart failure tx)
Verapamil (Ca-channel blocker)
Class Class IV (shortens action potential) Class
Use DOC for slowing ventr. rate during a-fib (dec. rate Use of Phase 4
spont. depol. In AV node so atrial beats fail to cross to ventr.)
Useful in tx of re-entrant supraventr. tachycardia
Useful for HTN & angina tx
Side Fx B/c of neg. inotropic fx, may be contraindicated in patients w/
pre-existing cardiac dysfunction
Constipation, flushing, edema Side Fx
Extensively metabolized by liver, thus, patient w/ hepatic dysfct.
may require monitoring
Misc.
Misc. Dec. cond. velocity, inc. ERP, & PR interval
Lidocaine (Na-channel blocker)
IB (slows Phase 0 depol. somewhat, shortens P
thus, decreasing duration of action potential)
Formerly DOC to stop ventr. tachycardia, but b
mia induction, is now used only to stop ventr.
once it appears (especially post-infarct tachyc
Suppresses arrhythmias caused by abnormal au
unlike quinidine
Like all Na-channel blockers, can induce ventr
CNS fx, such as drowsiness, agitation, paresthe
Does not markedly slow cond., thus, has little e
arrhythmia; given iv b/c of extensive first pas
(liver dz. potential tx. issue)
Propranolol (Non-selective beta antagonist)
II (markedly suppresses Phase 4 depolarization
DOC in a-fib rate control; to maintain contro
vs. stopping the atrial arrhythmia), it slows co
node & some atrial beats aren't cond. to ventr
DOC in stable angina prophylaxis & ischem
acute coronary syndrome
Sec. drug to suppress ventr. tachycardia via neg
Protective fx against growth of infarcted area, &
Reduces anginal pain by dec. work of heart &
Contrainidicated in asthmatics b/c can induce r
Diabetics must be closely monitored b/c of fx o
metabolism
NA
III (prolongs Phase 3 repolarization)
DOC for prophylaxis of a-fib & is especially
w/ ischemic heart disease b/c of beta-blocker
Potential torsade de pointes induction
Can induce resp. crisis in asthmatics
Can aggravate co-existing CHF via neg. inotro
fx)
Prolongs action pot., ERP (& QT interval); dec
death following MI (beta-blocker fx)
nnel blocker)
depol. somewhat, shortens Phase 3 repol.,
duration of action potential)
stop ventr. tachycardia, but b/c pot. arrhyth-
now used only to stop ventr. arrhythmia
especially post-infarct tachycardia)
hmias caused by abnormal automaticity,

el blockers, can induce ventr. tachycardia

rowsiness, agitation, paresthesia, confusion
y slow cond., thus, has little effect on AV junct.
n iv b/c of extensive first pass elim. by liver
al tx. issue)
e beta antagonist)
resses Phase 4 depolarization)
control; to maintain control of ventr. rate (vs.
atrial arrhythmia), it slows cond. across AV
ial beats aren't cond. to ventricle
gina prophylaxis & ischemic relief during
yndrome
ess ventr. tachycardia via neg. inotropic fx
nst growth of infarcted area, & repeat MI
ain by dec. work of heart & oxygen needs
n asthmatics b/c can induce resp. crisis
closely monitored b/c of fx on glucose

-selective beta antagonist)

e 3 repolarization)
axis of a-fib & is especially useful in patients
t disease b/c of beta-blocker fx

de pointes induction
risis in asthmatics
existing CHF via neg. inotropism (beta blocker

ot., ERP (& QT interval); dec. rate of sudden

MI (beta-blocker fx)
 Minoxidil Labetalol
Class Arterial selective vasodilator Class Beta blocker (also blocks Alpha1 receptors)
Uses Decrease PVR (via increase of s. muscle cGMP which stimUses Decrease force & rate of myocardial contraction
K channels, hyperpolarizing the cell) Decrease renin secretion
Decrease bp

Side Fx Block Beta2 receptors a/w airway or vascular s. muscle, exacerba

airway diseases (asthma, bronchitis, emphysema) or peripheral v
Side Fx Typical vasodilatory effects (HA, tachycardia, salt & water retention) disease (Raynaud's) ;
which can be combatted via beta blockers & diuretics, respectively Fatigue & possible sedation
Hair growth Plasma lipid & cholesterol increase
Can block gluocose mobil. & mask hypoglycemic tachycardia in
Status Moderate to severe HTN Status Long term tx of HTN & hypertensive emergencies

Carvendilol Prazosin
Class Beta blocker (also blocks Alpha1 receptors) Class Alpha1 agonist
Uses Decrease force & rate of myocardial contraction Uses Relax arterial & venous smooth muscle
Decrease renin secretion Decreases systemic arterial bp b/c of decrease in PVR & venous r
Decrease bp do not significantly increase HR
May have beneficial effects on lipid profiles
Side Fx Block Beta2 receptors a/w airway or vascular s. muscle, ex
airway diseases (asthma, bronchitis, emphysema) or peripheral vasc.
disease (Raynaud's) ; Side Fx First dose syncope
Fatigue & possible sedation Postural hypotension
Plasma lipid & cholesterol increase Water & salt retention (can be alleviated by diuretics)
Can block gluocose mobil. & mask hypoglycemic tachycardia in diabetics
Status Long term tx of HTN & hypertensive emergencies Status Can be used as monotherapy to treat HTN

Clonidine Methyldopa
Class Alpha2 agonist Class Alpha2 agonist
Uses Decrease sympathetic outflow to heart & blood vessels via Uses Decrease sympathetic outflow to heart & blood vessels via action
results in decrease in PVR results in decrease in PVR

Side Fx Sedation, fatigue, dry mouth & sexual dysfunction Side Fx Hemolytic anemia, sedation, fatigue, dry mouth &
sexual dysfunction

Status Second line agent for HTN tx. Status Second line agent for HTN tx.

Guanabenz HTN Treatment Considerations

Class Alpha2 agonist Elderly Metabolism & distribution altered; smaller doses & concurrent be
Uses Decrease sympathetic outflow to heart & blood vessels via action on agonists & diuretics effective
results in decrease in PVR Afr.-Amer.HTN more prevalent than stroke & renal failure; diuretics very eff
CAD Beta antagonists & diuretics increase lipid & cholesterol levels, w
Alpha1 antagonists may improve lipid profiles; hypokalemia a/w
diuretic use could exacerbate rhythm disturbances in acute MI
CHF/LVH ACE inhibitors & AngII antagonists particularly effective
Side Fx Diabetes Diuretics alter blood glucose levels, & Beta antagonists inhibit glu
mobilization & mask hypoglycemia

Status Second line agent for HTN tx.

Class Class
Uses Uses

Side Fx Side Fx

Status Status

Class Class
Uses Uses

Consider Consider

Class Class
Uses Uses

Side Fx Side Fx

Status Status

Class Class
Uses Uses

Side Fx Side Fx

Status Status
Class Class
Uses Uses

Side Fx Side Fx

Status Status

Class Class

Uses Uses

Side Fx Side Fx

Misc. Misc.

Class Class

Uses Uses

Side Fx Side Fx

Misc. Misc.

Class Class

Uses Uses

Side Fx Side Fx

Misc. Misc.
e, exacerbating
peripheral vasc.

hycardia in diabetics

& venous return;

s via action on NTS;

oncurrent beta

tics very effective

rol levels, while
kalemia a/w
acute MI

ts inhibit glucose
 Captopril Enalapril
Class ACE Inh. (dec. vasc. res., venous tone, bp, & CO) Class ACE Inh. (dec. vasc. res., venous tone, bp, & CO)
Uses Dec. circ. AngII, aldosterone, epinephrine Uses Dec. circ. AngII, aldosterone, epinephrine
Dec. PVR (w/o HR effect) via dec. in bradykinin inact. Dec. PVR (w/o HR effect) via dec. in bradykinin inact.
Block hypertrophic growth effects of AngII Block hypertrophic growth effects of AngII
Do NOT completely block AngII Do NOT completely block AngII
Dec. elevated serum levels Dec. elevated serum levels
Also effective in HTN Also effective in HTN
Side Fx Persistent cough Side Fx Persistent cough
Can dec. renal fct. in those w/ renal artery stenosis Can dec. renal fct. in those w/ renal artery stenosis
Angioedema Angioedema
Postural HTN Postural HTN
Status CHF (DOC), HTN, MI patients long-term, various Status CHF (DOC), HTN, MI patients long-term, various
stages of LVF; contraindicated in pregnant stages of LVF; contraindicated in pregnant
Losartan Valsartan
Class AngII Receptor Antagonist (Competitive) Class AngII Receptor Antagonist (Non-competitive)
Uses Block AT1 rec., blocking AngII from stim. vasc. s. Uses Block AT1 rec., blocking AngII from stim. vasc. s.
muscle contr., aldosterone release, & hypertrophy muscle contr., aldosterone release, & hypertrophy

Side Fx Persistent cough (dec. in bradykinin breakdown ?) Side Fx Persistent cough (dec. in bradykinin breakdown ?)

Status First line for chronic tx of CHF; also used for HTN; Status First line for chronic tx of CHF; also used for HTN;
shown to inc. survival following MI shown to inc. survival following MI
Hydralazine Sodium Nitroprusside
Class Arterial selective vasodilator Class Balanced vasodilator
Uses Dec. PVR via cGMP inc. in smooth muscle Uses Dec. peripheral vascular resistance via cGMP inc. in
Vasodilation decreases afterload on heart s. muscle
In CHF patient, used in conjunction w/ isosorbide Vasodilation dec. preload & afterload to inc. CO &
dinitrate when patient is ACE inhibitor- dec. pulm. Congestion
intolerant Ultra short duration, thus, hypertensive emergency

Side Fx Lupus-like symptoms Side Fx Hypotension can lead to reflex tachycardia

HA & tachycardia (fx dec. by beta blockers) Metabolization to cyanide & thiocyanate after
Salt & water retention (fx dec. by diuretics) prolonged infusion can overwhelm body's ability to
buffer; cyanide poisoning can occur
Status Dec. w/ introduction of safer agents (ACE inh. & Status Light-sens. & hi maint.; b/c of potent vasodilatory fx
AngII rec. antagonist) is used in acute CHF & HTN to rapidly dec. bp
Nesiritide Milrinone
Class Human B-type natriuretic peptide Class Phosphodiesterase inh. (heart & blood vessels only)
Uses A balanced vasodilator via inc. levels of s. muscle Uses Inhibitor of cAMP phosphodiesterase
cGMP Inc. contractile force & CO (via hi intracell. calcium)
Dec. PVR, MAP, pulm. art. press., & rt. atrial BP Dec. PVR via vasodilation (hi intracell. calcium)
Inc. CO & SV w/o inc. HR
Promotes natriuresis & diuresis Side Fx Arrhythmia induction
Thrombocytopenia
Side Fx Prolonged hypotension GI fx (N/V, etc.)
**Toxic effects less pronounced than w/ inamrinone**

Status DO inc. CO & dec. PVR, but DO NOT dec. morbidity

& mortality a/w heart failure; no tolerance induced;
Status Used in decompensated CHF to prod. rapid dec. of effective via IV infusion for short-term tx of CHF
PVR & BP; does not induce tolerance in those not responding well to other tx
 Carvedilol Metoprolol
Class Beta blocker (Beta1, Beta2, Alpha1) Class Beta1 blocker
Uses Decrease PVR Uses Decreases HR, contractility, SV
Decrease left ventricular hypertrophy
May up-regulate beta receptors
Beneficial effects on lipid profiles

Side Fx Non-selectivity of beta-blockade leads to broncho- Side Fx Low potential for activity @ Beta2 receptors
constr., potential arrhythmias, metabolic disturb-
ance of glycogenolysis & glucagon secretion

Status Approved for use in HTN, ischemic heart disease,
mild CHF, post-MI CV event prevention
Digoxin
Class Cardiac glycoside, i.e., digitalis
Uses Rev. inh. Na-K ATPase, leading to inc. intracell. Na;
inc. intracell. Na inc. Na-Ca exchange, drawing Ca
into cell & creating pos. ino. Fx
Acts @ carotid arch & barorec. to inc. vagal outflow to
myo.; fx include inc. SA & AV node refr. pd. & dec.
SA & AV node cond. vel.; thus, myo. oxygen demand
Consider 30-100% GI abs.; 36-48 hr. half-life; dec. clear. w/
renal dz. or quinidine, verapamil, amiodarone use;
dec. bioavail. w/ cholestyramine use; hypoxia & hypo-
kalemia inc. toxicity; aged more sens., toxicity clues
are N/V, "halo" fx, arrhythmia; use in severe LVF
after diuretic & vasodil. ther., b/c of rapid onset is
useful in emergency; tx. w/ phenytoin, K, Fab frag.
Status Lowers bp in HTNives & inc. exercise tolerance
in angina patients; useful for HTNives w/ COPD
Digitoxin
Class Cardiac glycoside, i.e., digitalis
Uses Rev. inh. Na-K ATPase, leading to inc. intracell. Na;
inc. intracell. Na inc. Na-Ca exchange, drawing Ca
into cell & creating pos. ino. Fx
Acts @ carotid arch & barorec. to inc. vagal outflow to
myo.; fx include inc. SA & AV node refr. pd. & dec.
SA & AV node cond. vel.; thus, myo. oxygen demand
Consider 90-100% GI abs.; 4-6 day half-life; dec. bioavailabil-
ity w/ cholestyramine use; hypoxia & hypokalemia
inc. toxicity; aged more sensitive; toxicity clues are
N/V, "halo" fx, arrhythmia; extensively metabolized
in liver before feces excretion, thus, hepatic dz. May
require dec. dosage; tx w/ phenytoin, K, Fab
fragments

Class Class
Uses Uses

Side Fx Side Fx

Status Status

Class Class
Uses Uses

Side Fx Side Fx

Status Status
Class Class
Uses Uses

Side Fx Side Fx

Status Status

Class Class

Uses Uses

Side Fx Side Fx

Misc. Misc.

Class Class

Uses Uses

Side Fx Side Fx

Misc. Misc.

Class Class

Uses Uses

Side Fx Side Fx

Misc. Misc.