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Diuretics Increase water and sodium excretion and decrease circulating blood volume, thereby decreasing preload, SV and CO. For hypertension, heart failure and oedema. Frusemide Loop diuretic for oedema and heart failure. To avoid hypokalemia, use in conjunction with potassium sparing diuretics or supplements. DO NOT use with digoxin (increases toxicity) Perindopril ACE inhibitor (vasodilator) for hypertension and heart failure. ADRs include hypotension, cough and renal failure Irbesartan Angiotensin receptor agonist (vasodilator) for hypertension. No cough! Atenolol Beta-blocker and anti-arrhythmic drug that decreases heart rate by decreasing sympathetic drive to heart. For angina, hypertension and atrial fibrillation. Selective beta1 therefore a-okay for asthmatics. Adenosine Anti-arrhythmic drug that slows pacemaker activity at AV node for the treatment of supraventricular tachycardia. Can cause bronchospasms in asthmatics. DO NOT USE for atrial fibrillation (slows heart too much) Amiodarone Anti-arrhythmic drug (class 3) that treats supra ventricular and ventricular arrhythmias. It blocks potassium channels and therefore prolongs the AP and refractory period. It is very toxic and has a pro-inflammatory effect. Verapamil Anti-arrhythmic drug and Ca channel blocker that treats atrial fibrillation and prevents recurrence of paroxysmal supraventricular tachycardia. It slows AV conduction and reduces contractile force. ADRs include oedema and bradycardia. Hydrochlorothiazide Thiazide diuretic that inhibits Na/CL transport system and is used for hypertension, CHF and oedema. ADRs include hypokalaemia, hypocalcaemia, rash and hypotension. Spironolactone Potassium sparing diuretic, aldosterone antagonist and sodium channel blocker that is fairly weak but prevents K+ loss. Used for CHF, oedema, hypertension or hypokalaemia. Digoxin Positive ionotrope that inhibits Na/Cl ATPase thereby increasing intracellular calcium. Increases contractibility and CO. Central vagal (PNS) stimulation used for atrial fibrillation and arrhythmias. ADRs include bradycardia, tachuycardia, nausea and confusion. Very low therapeutic window and therefore use as a last resort (unless MI - then use first) Glyeryl trinitrate Nitrate (vasodilator) that is converted to NO to increase intracellular [cyclic GMP] and cause vasodilation in vascular smooth muscle. Used for angina, especially prophylaxis if stressful activity is about to take place. ADRs include headache and hypotension. Calcium channel blockers Block L-type (voltage operated) calcium channels for angina, hypertension and tachyarrhythmias. DO NOT USE for heart failure or in combination with beta-blockers Warfarin Anticoagulant for stroke prevention, especially in individuals with atrial fibrillation Spironolactone It protects the heart and blood vessels from fibrosis caused by excess aldosterone ACE inhibitors Decrease preload by reducing aldosterone secretion (reduces salt and water retention) and decrease afterload by reducing peripheral resistance. They also protect against adverse remodelling of the heart Beta-1 Receptors Chronic stimulation of these receptors can cause cardiac damage CHF therapy warning DO NOT USE calcium channel blockers as symptoms of heart failure may worsen as the drugs reduce the ability of the heart to pump blood. Unstable angina Use aspirin and statins Nitrates Only take intermittently during angina attack or prophylaxis, not for constant use. They reduce preload through ventilation Variant angina Use Ca channel blockers (not beta blockers) Verapamil warnings DO NOT USE with beta-blockers and do not take if you have ventricular hypertrophy, ischemic heart disease or CHD (as it increases preload and makes the heart work harder)