Drugs used for congestive heart failure
t
m Drug name Classification Mode of action Adverse effects
ir Enalapril/ ACEI/ ARB • Prevents formation of angiotensin IIà reduce Dry cough,
s
Neu Losartan afterload hyperkalemia, renal
• Reduce aldosterone productionà reduce dysfunction,
rohu angioneurotic
preload
mor • Prevent cardiac remodelling edema
First dose
al hypotension
mod
ulatiMetropolol Beta-blocker • Block the effects of the hormone epinephrine -
• cause the heart to beat more slowly and with
on less force, which lowers blood pressure.
• help widen veins and arteries to improve blood
flow.
Spironolactone Potassium sparing • block aldosterone receptor in renal collecting Hyperkalemia,
diuretics tubeà increase Na and decrease K excretion gynaecomastia
(aldosterone
antagonists)
Furosemide Loop diuretics • block Na/K/2Cl transporter in renal loop of Electrolyte
Henleà reduce blood volume imbalance,
a dehydration,
c Prel hypokalemia
i oad Thiazide Diuretics • inhibits Na-Cl symporter in DCT Hypokalemia,
magnesium
• vasodilation
redu depletion, impair
glucose tolerance,
ctio increased serum
n lipid and uric acid
Nesiritide Natriuretic peptide • diuresisà reduce blood volume Short half life
• increases cGMP in smooth muscle cellsà
vasodilation and reduces venous and
arteriolar tone
c Isosorbide Venodilator • NO stimulate guanylyl cyclaseà increase Hypotension,
a dinitrate cGMPà decrease Ca levelà venodilation dizziness, headache,
DLE
Hydralazine Arteriolar dilator • Increase release of EDRF and guanylate
Afte cyclase, GTPà cGMPà smooth muscle
relaxation
rloaDigoxin Low concà treat • Inhibition of cardiac Na+/K+ ATPase pump -- Anorexia, nausea,
d Afib > ↑ intracellular Na+ -- vomiting, diarrhea
High concà cause Visual disturbance,
redu > ↓Na+/Ca++ exchange(sodium in calcium
Inot arrhythmia out)-->↑ intracellular Ca++ -- CG toxicityà
ctio > ↑Ca++ release from SR--> ↑Actin-myosin ventricular
ropi interaction --> ↑ Contractile force (without arrhythmia
, increase in O2 consumption)--> increase Severe bradycardia
nc FOC --> increase CO
age • Increase vagal toneà reduce heart rate
nts Dopamine • Low doseà stimulate D2 receptorà incraese Tachycardia,
renal blood flow and maintain GFR and increase myocardial
cause diuresis O2 consumption
• Intermediate doseà stimulate β1 receptorà
enhance myocardial contractility
• High doseà stimulate α receptorà arterial and
venous constriction
Milrinone Bipyridines • Inhibits phosphodiesterase isozyme (PDE-3)à -
decrease cAMP degradationà positive
inotropic and chronotropic effects
• Dilation of vesselsà decrease preload and
afterload
Levosimendan Calcium sensitizer • Sensitizes troponin C to calciumà increasing -
the effects of calcium on cardiac
myofilaments during systole and improving
contraction
• Open ATP-sensitive K channels on vascular
smooth muscleà coronary and systemic
vasodilation
Ivabradine Selective inhibitor • Inhibit If currentà reduce HR -
of cardiac • Used in patients not tolerating β blockers
pacemaker channels
Sacubitril Neprilysin inhibitors • Neprilysin is a neutral endopeptidase(NEP) -
enzyme which degrades BNP
• Inhibitionà less degradation of BNPà
vasodilation and diuresis
Drugs for asthma
Drug name classification Mode of action Adverse effects
Salbutamol Β agonist • Activates β receptor on bronchiole Tremor, tachycardia,
smooth muscleà stimulate palpitations
adenylyl cyclaseà increase
cAMPà reduce Caà
bronchodilation
Salmeterol has longer onset of action and longer duration of action, it is used for maintenance therapy (use
with or without attacks), inhalation, no adverse effects
Methylxanthine Phosphodiester • Block adenosine receptorà Tachycardia,
inhibitor bronchodilation palpitations, increase
(has narrow therapeutic • Inhibits phosphodiesteraseà reduce gastric acid, mild
range) degradation of cAMPà decrease diuresis, insomnia,
Caà bronchodilation anorexia, vomiting
t
m Drug name Classification Mode of action Adverse effects
ir Enalapril/ ACEI/ ARB • Prevents formation of angiotensin IIà reduce Dry cough,
s
Neu Losartan afterload hyperkalemia, renal
• Reduce aldosterone productionà reduce dysfunction,
rohu angioneurotic
preload
mor • Prevent cardiac remodelling edema
First dose
al hypotension
mod
ulatiMetropolol Beta-blocker • Block the effects of the hormone epinephrine -
• cause the heart to beat more slowly and with
on less force, which lowers blood pressure.
• help widen veins and arteries to improve blood
flow.
Spironolactone Potassium sparing • block aldosterone receptor in renal collecting Hyperkalemia,
diuretics tubeà increase Na and decrease K excretion gynaecomastia
(aldosterone
antagonists)
Furosemide Loop diuretics • block Na/K/2Cl transporter in renal loop of Electrolyte
Henleà reduce blood volume imbalance,
a dehydration,
c Prel hypokalemia
i oad Thiazide Diuretics • inhibits Na-Cl symporter in DCT Hypokalemia,
magnesium
• vasodilation
redu depletion, impair
glucose tolerance,
ctio increased serum
n lipid and uric acid
Nesiritide Natriuretic peptide • diuresisà reduce blood volume Short half life
• increases cGMP in smooth muscle cellsà
vasodilation and reduces venous and
arteriolar tone
c Isosorbide Venodilator • NO stimulate guanylyl cyclaseà increase Hypotension,
a dinitrate cGMPà decrease Ca levelà venodilation dizziness, headache,
DLE
Hydralazine Arteriolar dilator • Increase release of EDRF and guanylate
Afte cyclase, GTPà cGMPà smooth muscle
relaxation
rloaDigoxin Low concà treat • Inhibition of cardiac Na+/K+ ATPase pump -- Anorexia, nausea,
d Afib > ↑ intracellular Na+ -- vomiting, diarrhea
High concà cause Visual disturbance,
redu > ↓Na+/Ca++ exchange(sodium in calcium
Inot arrhythmia out)-->↑ intracellular Ca++ -- CG toxicityà
ctio > ↑Ca++ release from SR--> ↑Actin-myosin ventricular
ropi interaction --> ↑ Contractile force (without arrhythmia
, increase in O2 consumption)--> increase Severe bradycardia
nc FOC --> increase CO
age • Increase vagal toneà reduce heart rate
nts Dopamine • Low doseà stimulate D2 receptorà incraese Tachycardia,
renal blood flow and maintain GFR and increase myocardial
cause diuresis O2 consumption
• Intermediate doseà stimulate β1 receptorà
enhance myocardial contractility
• High doseà stimulate α receptorà arterial and
venous constriction
Milrinone Bipyridines • Inhibits phosphodiesterase isozyme (PDE-3)à -
decrease cAMP degradationà positive
inotropic and chronotropic effects
• Dilation of vesselsà decrease preload and
afterload
Levosimendan Calcium sensitizer • Sensitizes troponin C to calciumà increasing -
the effects of calcium on cardiac
myofilaments during systole and improving
contraction
• Open ATP-sensitive K channels on vascular
smooth muscleà coronary and systemic
vasodilation
Ivabradine Selective inhibitor • Inhibit If currentà reduce HR -
of cardiac • Used in patients not tolerating β blockers
pacemaker channels
Sacubitril Neprilysin inhibitors • Neprilysin is a neutral endopeptidase(NEP) -
enzyme which degrades BNP
• Inhibitionà less degradation of BNPà
vasodilation and diuresis
Drugs for asthma
Drug name classification Mode of action Adverse effects
Salbutamol Β agonist • Activates β receptor on bronchiole Tremor, tachycardia,
smooth muscleà stimulate palpitations
adenylyl cyclaseà increase
cAMPà reduce Caà
bronchodilation
Salmeterol has longer onset of action and longer duration of action, it is used for maintenance therapy (use
with or without attacks), inhalation, no adverse effects
Methylxanthine Phosphodiester • Block adenosine receptorà Tachycardia,
inhibitor bronchodilation palpitations, increase
(has narrow therapeutic • Inhibits phosphodiesteraseà reduce gastric acid, mild
range) degradation of cAMPà decrease diuresis, insomnia,
Caà bronchodilation anorexia, vomiting
