Key Takeaways
- Antihypertensives include ACE inhibitors (-pril), ARBs (-sartan), beta-blockers (-olol), calcium channel blockers (-dipine), and diuretics.
- Statins (-statin) lower cholesterol by inhibiting HMG-CoA reductase and should generally be taken at bedtime.
- Warfarin requires INR monitoring; direct oral anticoagulants (DOACs) like apixaban and rivaroxaban do not require routine monitoring.
- Antiplatelet agents (aspirin, clopidogrel) prevent clot formation by inhibiting platelet aggregation.
- Nitroglycerin for chest pain should be stored in original glass container away from light and heat.
Cardiovascular and Anticoagulant Medications
Quick Answer: Cardiovascular drugs treat heart disease, hypertension, and blood clotting disorders. Key classes include antihypertensives (ACE inhibitors, ARBs, beta-blockers), statins for cholesterol, and anticoagulants (warfarin, DOACs) for blood clot prevention.
Antihypertensive Medications
ACE Inhibitors (Suffix: -pril)
| Generic Name | Brand Name | Key Points |
|---|---|---|
| lisinopril | Prinivil, Zestril | Most commonly prescribed ACE inhibitor |
| enalapril | Vasotec | Available in IV form |
| ramipril | Altace | Used post-MI for heart protection |
| benazepril | Lotensin | Often combined with diuretics |
Common Side Effects: Dry cough, hyperkalemia, angioedema Contraindication: Pregnancy (teratogenic)
ARBs (Angiotensin II Receptor Blockers - Suffix: -sartan)
| Generic Name | Brand Name | Key Points |
|---|---|---|
| losartan | Cozaar | Can be used when ACE inhibitor cough occurs |
| valsartan | Diovan | Available in multiple combination products |
| irbesartan | Avapro | Used in diabetic nephropathy |
| olmesartan | Benicar | High potency |
Common Side Effects: Hyperkalemia, dizziness Contraindication: Pregnancy
Beta-Blockers (Suffix: -olol)
| Generic Name | Brand Name | Key Points |
|---|---|---|
| metoprolol | Lopressor, Toprol XL | Cardioselective (beta-1); most prescribed |
| atenolol | Tenormin | Cardioselective; once daily dosing |
| propranolol | Inderal | Non-selective; also used for anxiety/tremors |
| carvedilol | Coreg | Also blocks alpha receptors |
Common Side Effects: Bradycardia, fatigue, cold extremities, masking hypoglycemia symptoms Caution: Do not stop abruptly (can cause rebound hypertension)
Calcium Channel Blockers (CCBs)
| Type | Generic Name | Brand Name | Key Points |
|---|---|---|---|
| Dihydropyridine (-dipine) | amlodipine | Norvasc | Most commonly used; long-acting |
| Dihydropyridine | nifedipine | Procardia, Adalat | Avoid grapefruit juice |
| Non-dihydropyridine | diltiazem | Cardizem, Tiazac | Slows heart rate |
| Non-dihydropyridine | verapamil | Calan, Verelan | Slows heart rate; constipation common |
Key Drug Interaction: Grapefruit juice increases blood levels of many CCBs
Diuretics
| Type | Generic Name | Brand Name | Key Points |
|---|---|---|---|
| Thiazide | hydrochlorothiazide (HCTZ) | Microzide | First-line; may cause hypokalemia |
| Loop | furosemide | Lasix | Potent; "ceiling effect" |
| Loop | bumetanide | Bumex | 40x more potent than furosemide |
| Potassium-sparing | spironolactone | Aldactone | Can cause hyperkalemia; gynecomastia |
| Potassium-sparing | triamterene | Dyrenium | Often combined with HCTZ (Dyazide) |
Cholesterol-Lowering Medications (Statins - Suffix: -statin)
| Generic Name | Brand Name | Key Points |
|---|---|---|
| atorvastatin | Lipitor | High potency; most prescribed statin |
| simvastatin | Zocor | Take at bedtime; grapefruit interaction |
| rosuvastatin | Crestor | High potency; water-soluble |
| pravastatin | Pravachol | Fewer drug interactions |
| lovastatin | Mevacor | Take with evening meal |
Mechanism: Inhibit HMG-CoA reductase enzyme in liver Side Effects: Muscle pain (myalgia), elevated liver enzymes, rhabdomyolysis (rare but serious) Monitoring: Liver function tests, lipid panel
Storage Note: Most statins are stable at room temperature but check individual product requirements.
Anticoagulant Medications
Warfarin
| Detail | Information |
|---|---|
| Brand Name | Coumadin, Jantoven |
| Mechanism | Vitamin K antagonist |
| Monitoring | INR (International Normalized Ratio) |
| Target INR | 2.0-3.0 for most conditions; 2.5-3.5 for mechanical heart valves |
| Antidote | Vitamin K (phytonadione) |
Key Drug/Food Interactions:
- Vitamin K-rich foods (green leafy vegetables) decrease effect
- Many drugs interact (antibiotics, NSAIDs, amiodarone)
Direct Oral Anticoagulants (DOACs)
| Generic Name | Brand Name | Mechanism | Key Point |
|---|---|---|---|
| apixaban | Eliquis | Factor Xa inhibitor | Twice daily; renal adjustment needed |
| rivaroxaban | Xarelto | Factor Xa inhibitor | Take with evening meal; once daily |
| dabigatran | Pradaxa | Direct thrombin inhibitor | Store in original container; requires renal function |
| edoxaban | Savaysa | Factor Xa inhibitor | Once daily |
Advantages over Warfarin: No routine INR monitoring, fewer food interactions, fixed dosing
Heparins
| Type | Generic Name | Administration | Monitoring |
|---|---|---|---|
| Unfractionated heparin (UFH) | heparin | IV or SubQ | aPTT |
| LMWH | enoxaparin (Lovenox) | SubQ only | Anti-Xa (if needed) |
| LMWH | dalteparin (Fragmin) | SubQ only | Usually not required |
Antidote: Protamine sulfate
Antiplatelet Medications
| Generic Name | Brand Name | Mechanism | Key Points |
|---|---|---|---|
| aspirin | Various | COX inhibitor | Low dose (81mg) for prevention |
| clopidogrel | Plavix | P2Y12 inhibitor | Used with aspirin after stent |
| prasugrel | Effient | P2Y12 inhibitor | More potent; higher bleeding risk |
| ticagrelor | Brilinta | P2Y12 inhibitor | Twice daily; reversible |
Cardiac Glycoside
| Generic Name | Brand Name | Key Points |
|---|---|---|
| digoxin | Lanoxin | Narrow therapeutic index; monitor levels |
Therapeutic Range: 0.5-2.0 ng/mL Signs of Toxicity: Nausea, visual disturbances (yellow-green halos), arrhythmias Antidote: Digoxin immune Fab (Digibind)
Nitrates for Angina
| Generic Name | Brand Name | Form | Key Points |
|---|---|---|---|
| nitroglycerin | Nitrostat (SL), Nitro-Dur (patch) | Sublingual, transdermal | Headache common; remove patch at night |
| isosorbide mononitrate | Imdur | Oral | Once daily; take in morning |
| isosorbide dinitrate | Isordil | Oral | Multiple daily doses |
Storage for Nitroglycerin SL: Keep in original dark glass container; replace every 6 months once opened; do not store in plastic
Which anticoagulant requires routine INR monitoring?
A patient taking simvastatin should be counseled to avoid which food?
Which medication is classified as a potassium-sparing diuretic?