Cardiovascular Drugs: A Comprehensive Overview, Lecture notes of Cardiology

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1

CARDIOVASCULAR DRUGS

1.ANTI-HYPERTENSIVE AGENTS

2. DRUGS USED IN HEART FAILURE
3. ANTI-ANGINA DRUGS
4. DRUGS USED IN DYSLIPIDEMIA
5. DRUGS FOR ARRHYTHMIAS

a) Angiotensin Converting Enzyme (ACE)

inhibitors

e.g. Enalapril, captopril, lisinopril,

ramipril.

Mxn : inhibit conversion of angiotensin I

to angiotensin II.

Adm : all administered per oral.

Effects:

i) reduce peripheral vascular resistance

ii) reduce circulating blood volume.

S/E: hypotension, acute renal failure,

hyperkalemia, dry cough, allergic skin

rashes.

C/I: Renal failure; pregnancy

10/22/2025 compiled by PMM 4

c) Calcium channel blockers

E.g. amlodipine, nifedipine, felodipine,

verapamil, diltiazem.

Adm: per oral.

Mxn: inhibit influx of calcium into

arterial smooth muscle cells hence

reducing contraction.

Effect: reduce peripheral vascular

resistance.

S/E: hypotension, palpitation,

perspiration, dizziness, headache, GIT

disturbance.

C/I: cardiogenic shock, hypotension,

pregnancy (except nifedipine)

d)Sympatholytic agents

Mxn: generally they reduce symphathetic

effects on arteries and the heart.

Effects: reduce peripheral vascular resistance,

reduced cardiac conractility, heart rate &

cardiac output.

 Centrally acting e.g. Methyldopa

S/E : sedation, depression, nightmares,

hemolytic anaemia, vertigo.

 Beta-blockers e.g. propranolol, metoprolol,

esmolol, atenolol

S/E: bradycardia, bronchospasm, heart failure,

hypoglycemia, GIT disturbance.

f) Diuretics

Mxn : reduce the circulating blood volume by

inducing diuresis.

• Classified according to predominant point of

action on the nephron.

 Carbonic anhydrase inhibitors

Mxn: inhibit carbonic anhydrase in the PCT,

blocking reabsorption of NaHCO 3

. E.g.

acetazolamide.

Uses : (rarely used in hypertension)

• Glaucoma, metabolic alkalosis.

S/E : renal stone formation, hypokalemia,

paresthesias, metabolic acidosis.

C/I : hepatic cirrhosis

Loop diuretics

E.g. furosemide, torsemide, bumetanide,

ethacrynic acid.

Mxn : inhibit NaCL re-absorption in the thick

ascending limb of loop of henle.

Uses : hypertension, hyperkalemia, acute

renal failure, heart failure, edema &

ascites.

S/E : hypokalemia, hyperuricemia,

ototoxicity, nephrotoxicity, dehydraton,

hypomagnesemia.

C/I: allergy to sulphonamides, anuria, early

in pregnancy.

Potassium sparing diuretics

E.g. spironolactone, triamterene, amiloride.

Mxn : antagonise the effects of aldosterone

at late DCT & collecting tubules.

Uses : (usually combined with other

diuretics to prevent hypokalemia)

• hyperaldosteronism, hypokalemia.

S/E : hyperkalemia, metabolic acidosis,

gynecomastia, acute renal failure, kidney

stones.

C/I : chronic renal insufficiency.

10/22/2025 compiled by PMM 11

Osmotic diuretics

E.g. Mannitol

Mxn : promote water diuresis by

osmosis.

Adm : I.V infusion.

Use: (rarely used in hypertension)

To reduce intracranial pressure

Glaucoma (to reduce intraocular

pressure)

S/E : dehydration, hyperkalemia,

hypernatremia.

10/22/2025 compiled by PMM 13

b) Vasodilators

Generally vasodilators reduce the

workload of the heart by reducing both

the preload & afterload.

Arterial vasodilators reduce afterload

i.e peripheral vascular resistance

Venodilators reduce the preload i.e. the

venous return.

Venodilators & arterial dilators reduce

both preload and afterload.

NB : a general side effect is postural

hypotension.

c) Beta blockers( beta-receptor

antagonists)

Effects:

Slow down the heart rate

Decrease the force of contraction

Prevent remodeling such as

hypertrophy of ventricular walls.

NB : Usually combined with diuretics or

ACE inhibitors.

Uses

Heart failure in atrial fibrillation



Usually added to diuretics, ACE

inhibitors, & beta-blockers.

Dose: 0.125-0.25mg OD. (PO).

Toxicity

Sinus bradycardia

Sino-atrial arrest

Hyperkalemia

Heart block

NB : it has a narrow therapeutic index

hence requires ECG & electrolyte

monitoring.

3. DRUGS USED IN ANGINA

PECTORIS

Angina is a vice-like chest pain caused

by accumulation of metabolites

resulting from myocardial ischemia.

a) Nitrates : Nitroglycerine is the

prototype drug. Its derivatives include:

• Isosorbide dinitrate (sublingual; per oral)
• Isosorbide mononitrate (sublingual; per

oral)

• Amyl nitrate (inhalant)

Mxn: converted to nitric oxide which

induces smooth muscle relaxation &

4. DRUGS USED IN DYSLIPIDEMIA

Low density (LDL) & very low density

lipoproteins (VLDL) are rich in

cholesterol and triglycerides –

associated with cardiac diseases &

atherosclerosis.

High density lipoproteins (HDL)

facilitate transport of cholesterol &

triglycerides for metabolism in the liver

hence they have a beneficial role.

NB: Drugs used either lower the levels

of VLDL & LDL or increase the levels of

HDL.

a).HMG-CoA reductase inhibitors (“statins”)

• E.g. simvastatin, lovastatin, fluvastatin,

rosuvastatin.

Mxn: inhibit HMG-CoA reductase which

catalyses the initial steps in cholesterol

synthesis.

Effect : reduces LDL, small increase in HDL.

Adm: per oral with evening meal.

S/E: Rhabdomyolysis, myopathy,

hypersensitivity reactions.

C/I: pregnancy & lactation, hypersensitivity,

impaired liver or renal function, children

less than 18 years.