Pharmacology
Cardiovascular Pharmacology
Cardiovascular drugs for MBBS and NEET-PG: ACE inhibitors, beta blockers, digoxin, nitrates, statins and antiarrhythmics, mapped to NMC codes.
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Cardiovascular Pharmacology
Cardiovascular drugs for MBBS and NEET-PG: ACE inhibitors, beta blockers, digoxin, nitrates, statins and antiarrhythmics, mapped to NMC codes.
This chapter covers the drugs used in hypertension, heart failure, angina, arrhythmias and dyslipidaemia. It brings together the diuretics, renin-angiotensin blockers, calcium channel blockers, beta blockers, nitrates, cardiac glycosides, antiarrhythmics and lipid-lowering agents that dominate cardiovascular therapeutics.
High-yield: Cardiovascular Pharmacology
- ACE inhibitors such as enalapril reduce angiotensin II and are first-line in hypertension with diabetes or heart failure, but cause cough and hyperkalaemia.
- ACE inhibitors and angiotensin receptor blockers are contraindicated in pregnancy and bilateral renal artery stenosis.
- Thiazide diuretics lower blood pressure and can cause hypokalaemia, hyperglycaemia, hyperuricaemia and hypercalcaemia.
- Calcium channel blockers of the dihydropyridine type such as amlodipine cause ankle oedema and reflex tachycardia.
- Verapamil and diltiazem slow the heart and must not be combined with beta blockers because of the risk of heart block.
- Beta blockers reduce mortality in heart failure and post-myocardial infarction but are avoided in acute decompensated failure.
- Digoxin inhibits the sodium-potassium ATPase, increasing contractility; hypokalaemia predisposes to digoxin toxicity.
- Digoxin toxicity causes nausea, yellow vision and arrhythmias and is treated with digoxin-specific antibody fragments.
- Glyceryl trinitrate relieves angina by venodilatation that reduces preload; tolerance develops with continuous use.
- Statins lower LDL cholesterol by inhibiting HMG-CoA reductase and can cause myopathy and raised liver enzymes.
- Amiodarone is a broad-spectrum antiarrhythmic causing pulmonary fibrosis, thyroid dysfunction and corneal deposits.
- Loop diuretics such as furosemide are used in pulmonary oedema and cause hypokalaemia and ototoxicity.
- Spironolactone is a potassium-sparing aldosterone antagonist that improves survival in heart failure but causes gynaecomastia.
- Adenosine is the drug of choice to terminate supraventricular tachycardia and acts for only a few seconds.
Cardiovascular drug essentials
- **ACE inhibitors:** First-line in diabetic hypertension and heart failure; cough, hyperkalaemia; avoid in pregnancy.
- **Digoxin:** Inhibits sodium-potassium ATPase; toxicity worsened by hypokalaemia; antibody fragments reverse it.
- **Amiodarone:** Broad antiarrhythmic; pulmonary fibrosis, thyroid and corneal effects.
- **Statins:** HMG-CoA reductase inhibitors; myopathy and deranged liver enzymes.
NMC competencies in this chapter
- **PH1.26:** Antihypertensive drugs
- **PH1.27:** Drugs for angina and ischaemic heart disease
- **PH1.28:** Drugs for congestive heart failure
- **PH1.29:** Antiarrhythmic drugs
- **PH1.30:** Diuretics and their clinical uses
- **PH1.31:** Hypolipidaemic drugs
Frequently Asked Questions
Why do ACE inhibitors cause a dry cough?
By blocking the breakdown of bradykinin, ACE inhibitors allow it to accumulate in the airways, producing a persistent dry cough in some patients.
Why does hypokalaemia worsen digoxin toxicity?
Low potassium reduces competition at the sodium-potassium ATPase, allowing more digoxin to bind and enhancing its toxic effects on the heart.
Why are verapamil and beta blockers a dangerous combination?
Both slow conduction through the atrioventricular node, and together they can cause severe bradycardia, heart block and depressed contractility.
Which drug terminates a supraventricular tachycardia acutely?
Adenosine, given as a rapid intravenous bolus, briefly blocks the atrioventricular node to break the re-entry circuit and restore sinus rhythm.
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