Cardiac Drugs

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DIGOXIN (Lanoxin): ↑ force of contraction (inotropic), ↓ rate; for CHF, dysrhythmia – hold for A !"# • • • $oxicity: ↓ or ↑ %lse, dysrhythmia; &' symptoms: ( ) *, a+d, ain, diarrhea; C(-: chan.e in /ision, h0a, yello1 halo, conf%sion, di22iness, m%scle 1ea3ness redisposes to 4i.oxin toxicity: ↓5, li/er and 3idney disease, elderly 6( Actions: chec3 5 (7,8 – 9,8), chec3 di.oxin le/el (#,: – ;,9)

Diuretics: ↓+lood /ol%me, preload, < , con.estion; elders prone to dehydration • $hia2ides: HC$= (>sidrex), chlorothia2ide (4i%ril); inexpensi/e, ↓5, ↑.l%cose, &' symptoms o • 6( Actions: chec3 5 le/els, .i/e s%pplements, hi.h 5 foods

5?-parin.: spironolactone (Aldactone), triamterene (4yreni%m): inhi+it aldosterone  retain 5, ↓(A @ H;A; .ynecomastia; o 6( actions: chec3 5, (a, <B(, Creatinine le/els

Loop: f%rosemide (Lasix), ethacrynic acid (>decrin), +%metanide (<%mex): potent, ↑renal +lood flo1 – so it 1or3s e/en 1ith ↓ renal f%nction; ↓5, &' symptoms; ototoxicity, +lood dyscrasias

Anticoagulants: pre/ent em+ol%s formation – (in A?Fi+, 4*$, >, C'); e,., A,Fi+: atria fi+rillate, +lood sta.nates, em+oli form in atri%m  C*A; A/oid (-A'4s and other anticoa.%lants • • • • Heparin: &i/en '*, -C; Chec3 $$ (D,9 – ; x nl); protamine s%lfate re/erses Earfarin: (Co%madin) – p,o, chec3 $ (D,8 – ;x nl); *itamin 5 re/erses; chec3 '(6 ;?7 can affect platelets A-A: (Aspirin) – anti?platelet (6x: C') LCEH: (Lo/enox) – .i/en -C; actin., more selecti/e antithrom+otic, fe1er side effects, no ro%tine monitorin. o 6( Actions: chec3 +r%isin., petechiae, epistaxis, melena, hemat%ria, +leedin. .%ms, se/ere &' +leed, %se electric ra2ors; ma3e s%re 5 so%rce is constant: leafy .reen /e..ies affect $, a/oid >$AH

Nitrates: dilate peripheral and coronary /essels ? ↓ preload, F afterload • • $ypes: ($&, isodril, nitropaste, transderm nitro 6( Actions: .i/e -L G8m x7, .o to >6 if no relief; sit 1hen ta3in., store in dar3 +ottle, sho%ld +%rn ton.%e if potent, replace G" months; -ide effects: h0a, orthostasis, &' symptoms

Beta-Blockers (?lol dr%.s): <loc3 sympathetic actions  ↓ , ↓ myocardial contractility (ne.ati/e innotrope), ↓< , ↓CA, ↓s%dden death after C', ↓tachycardia

• • •

$ypes: propanolol ('nderal), atenolol ($enormin), nadolol (Cor.ard), metoprolol ($oporol HLI, Lopressor), car/edilol (Core.I) IAnly <eta?<loc3ers appro/ed for CHF -ide effects: fati.%e, +radycardia, HF, &' symptoms, +ronchospasm, depression, di22iness 6( Actions: Chec3 A  hold !"#; A+r%pt 40C co%ld lead to an.ina, C'; +loc3s symptoms of hypo.lycemia; ca%tion in asthma ptJs

Alpha-Blockers: <loc3 alphaD receptors, /asodilation • • $ypes: Hytrin, Card%ra -ide >ffects: post%ral, shrin3 prostate (Flomax)

Calcium-Channel Blockers: +loc3s [email protected]@ across cell mem+ranes  smooth m%scle relaxant, anti? dysrhythmic, /asodilator, pre/ents an.ina +y dilatin. coronary arteries, ↓< • • $ypes: /erapimil ('soptin, Calan), nifedipine ( rocardia), diltia2em (Cardi2em), amlodipine ((or/asc) -ide effects: h0a, di22iness, na%sea, +radycardia,, CHF, heart +loc3

Ace Inhibitors (?pril dr%.s): re/ents an.iotensin '?'' in l%n.s  ↓ /asoconstriction, ↓aldosterone  ↓(a ) H;A retention dieresis, ↓< , ↓ peripheral resistance; %sed for H$( ) HF; (>E 4A$A: pre/ents atherosclerotic plaG%e, C', %nsta+le an.ina • • • $ypes: enalapril (*asotec), captopril (Capoten), lisinopril ( rini/il, =estril), ramipril (Altace) -ide effects: retains 5  do not s%pplement, .ood 1ith thia2ides; dry, irritatin. co%.h 6( Actions: CH>C5 FA6 ↓ 6>(AL FB(C$'A(

Angiotensin receptor blockers (?tan dr%.s): +loc3s %pta3e at receptors  ↓/asc%lar tone /asodilation; enhanced (a ) H;A clearance  dieresis  ↓< • $ypes: losartan (Co2aar, Hy2aar 1ith HC$=), /alsartan (4io/an), ir+esartan (A/apro), candesartan (Atacand)

Anti !srh!thmics: slo1 cond%ction; also +eta ) Ca +loc3ers ) 4i.oxin %sed; • • $ypes: G%inidine, procainamide ( ronestyl), lidocaine -ide effects: fe/er, l%p%s? li3e syndrome, A* +loc3, &' symptoms

Statins: interfere 1ith +odyJs prod%ction of cholesterol, ↓ L4L, ↑ H4L, ↓ cardiac deaths, C*A, an.ina; may ↓ Dst cardiac e/ent in healthy people 1ith ↑ lipids • $ypes: ator/astatin (Lipitor), pra/astatin ( ra/achol), lo/astatin (Ce/acor)

-ide effects: rha+domyelosis, ↑ C 5, -&A$, -& $, dyspepsia, flat%s, cramps

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