Cardiovascular Drugs — AI Study Guide

Mastering Cardiovascular Drugs

Cardiovascular pharmacology covers the drug classes that modulate heart rate, contractility, vascular tone, blood pressure, rhythm, and coagulation. Antihypertensives are classified by mechanism: diuretics (reduce blood volume), beta-blockers (reduce cardiac output), ACE inhibitors/ARBs (reduce vasoconstriction and aldosterone), calcium channel blockers (reduce vascular resistance or cardiac rate), and alpha-1 blockers (reduce peripheral resistance). Each class has distinct advantages and contraindications.

Antiarrhythmic drugs are classified by the Vaughan Williams classification. Class I (sodium channel blockers) reduce conduction velocity in the His-Purkinje system. Class II (beta-blockers) reduce automaticity and AV nodal conduction. Class III (potassium channel blockers: amiodarone, sotalol) prolong repolarization and action potential duration. Class IV (calcium channel blockers: diltiazem, verapamil) slow AV nodal conduction. Digoxin inhibits Na+/K+ ATPase, increasing vagal tone at the AV node.

Heart failure drugs target the neurohormonal activation that exacerbates cardiac dysfunction: ACE inhibitors and ARBs block the renin-angiotensin-aldosterone system (RAAS), reducing afterload and preventing ventricular remodeling. Beta-blockers (carvedilol, metoprolol succinate, bisoprolol) reduce sympathetic drive, improving survival despite initially reducing contractility. Diuretics reduce preload and symptoms. Sacubitril/valsartan (ARNI) combines neprilysin inhibition with ARB for additional mortality benefit.

Anticoagulants prevent thrombus formation or extension. Heparin (activates antithrombin III, inhibiting thrombin and factor Xa) and warfarin (inhibits vitamin K-dependent clotting factor synthesis — II, VII, IX, X) are traditional anticoagulants. Direct oral anticoagulants (DOACs: rivaroxaban, apixaban inhibit factor Xa; dabigatran inhibits thrombin) have more predictable pharmacokinetics and fewer drug interactions. Antiplatelet agents (aspirin, clopidogrel, ticagrelor) prevent platelet aggregation.

Frequently Asked Questions: Cardiovascular Drugs

What are the major antihypertensive drug classes and their mechanisms?

Major antihypertensive classes: (1) Diuretics — reduce blood volume via increased urine output (thiazides most common for HTN). (2) Beta-blockers — reduce cardiac output by blocking beta-1 adrenergic receptors. (3) ACE inhibitors — block conversion of angiotensin I to II, reducing vasoconstriction and aldosterone. (4) ARBs — block angiotensin II receptor directly. (5) Calcium channel blockers — dihydropyridines (amlodipine) reduce vascular resistance; non-dihydropyridines (diltiazem, verapamil) also slow heart rate.

What drugs are used for heart failure with reduced ejection fraction?

Evidence-based mortality-reducing drugs for HFrEF (four pillars): (1) ACE inhibitor or ARB (or ARNI — sacubitril/valsartan) — reduce afterload and ventricular remodeling. (2) Beta-blocker (carvedilol, metoprolol succinate, bisoprolol) — reduce sympathetic drive. (3) Aldosterone antagonist (spironolactone, eplerenone) — reduce ventricular remodeling. (4) SGLT2 inhibitor (dapagliflozin, empagliflozin) — recently shown to reduce hospitalizations and death.

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