Cardiology > Cardiology Medications

Background 

 
Cardiology medications encompass a broad range of pharmacological agents used in the prevention, management, and treatment of cardiovascular diseases (CVD). These drugs are essential in controlling hypertension, heart failure, arrhythmias, coronary artery disease, and thromboembolic disorders. They modulate hemodynamics, myocardial oxygen demand, cardiac rhythm, vascular tone, and thrombogenesis to optimize cardiovascular function and improve outcomes. 

Classification 

By Therapeutic Category: 

• • Antihypertensives 
    ACE inhibitors, ARBs, beta-blockers, calcium channel blockers, diuretics 

• • Antiarrhythmics 
    Class I–IV agents, adenosine, digoxin 

• • Antiplatelets and Anticoagulants 
    Aspirin, clopidogrel, warfarin, DOACs, heparin 

• • Lipid-Lowering Agents 
    Statins, ezetimibe, PCSK9 inhibitors, fibrates 

• • Heart Failure Medications 
    ARNI, beta-blockers, aldosterone antagonists, loop diuretics, SGLT2 inhibitors 

• • Vasodilators and Antianginals 
    Nitrates, ranolazine, hydralazine 

• • Inotropes 
    Dobutamine, milrinone, digoxin 

By Mechanism of Action: 

• • Neurohormonal modulation (e.g., ACE inhibitors, beta-blockers) 

• • Ion channel blockade (e.g., antiarrhythmics) 

• • Platelet inhibition or coagulation cascade suppression 

• • Diuresis and preload/afterload reduction 

• • Vasodilation and coronary flow improvement 

Mechanism of Toxcicity 

Cardiology medications aim to correct or modulate pathophysiologic abnormalities such as elevated systemic vascular resistance, impaired myocardial contractility, arrhythmogenic triggers, platelet aggregation, and neurohormonal overactivation. Chronic cardiovascular diseases like hypertension or heart failure activate maladaptive systems (e.g., RAAS, sympathetic nervous system), leading to progressive organ dysfunction unless pharmacologically counteracted. 

Prevalence 

• • Cardiovascular diseases are the leading cause of death worldwide 

• • Over 70% of adults aged ≥65 use at least one cardiology-related medication 

• • Polypharmacy is common in patients with multimorbid conditions (e.g., diabetes, heart failure, CAD) 

 Indications for Use 

• • Primary and secondary prevention of myocardial infarction and stroke 

• • Management of acute coronary syndrome and heart failure 

• • Blood pressure and lipid control 

• • Rhythm and rate control in atrial fibrillation and ventricular arrhythmias 

• • Relief of angina 

• • Prevention of thromboembolic events 

Drug-Specific Side Effects 

• • Beta-blockers: Bradycardia, fatigue, bronchospasm 

• • ACE inhibitors: Cough, hyperkalemia, angioedema 

• • Diuretics: Electrolyte disturbances, volume depletion 

• • Statins: Myalgia, elevated liver enzymes 

• • Anticoagulants: Bleeding complications 

Essential Tests 

Baseline/Monitoring Labs: 

• • Electrolytes, BUN/Cr (diuretics, ACE inhibitors) 

• • LFTs (statins, amiodarone) 

• • INR or anti-Xa levels (warfarin, heparin) 

• • ECG (QT interval, arrhythmias with antiarrhythmics) 

• • Lipid panel (statins) 

• • BNP (response to HF meds) 

• • Echocardiogram: To assess HF therapy response 

• • Drug levels: e.g., digoxin 

Indications 

• • ACS: Dual antiplatelet therapy, beta-blockers, statins, anticoagulation 

• • CHF exacerbation: Loop diuretics, vasodilators, inotropes 

• • Arrhythmias: IV amiodarone, adenosine, rate control 

• • Hypertensive emergency: IV nitroprusside, labetalol 

• • Hypertension: ACE inhibitors, thiazides, calcium channel blockers 

• • Heart Failure: ARNI, beta-blockers, MRA, SGLT2i 

• • CAD: Statins, aspirin, beta-blockers 

• • AFib: Anticoagulation, rhythm vs. rate control strategy 

• • Hyperlipidemia: High-intensity statins ± ezetimibe or PCSK9 inhibitors 

Medications 

Monitoring 

• • BP monitors: For antihypertensive dose titration 

• • INR monitoring devices: For patients on warfarin 

Patient Education 

• • Medication adherence is crucial; encourage use of pill organizers, apps 

• • Monitor for drug side effects (e.g., muscle pain, bleeding) 

• • Regular screening of BP, lipids, glucose, renal function 

• • Counsel on lifestyle changes: diet, exercise, smoking cessation 

• • Recommend influenza, COVID-19, and pneumococcal vaccines 

Consults 

• • Cardiologist: For complex therapy optimization or device consideration 

• • Pharmacist: For polypharmacy management and medication reconciliation 

• • Electrophysiologist: If antiarrhythmics fail or device therapy needed 

• • Nephrologist: If renal function limits medication options