6th March 2024

Common cardiac drugs

The table below explains the mechanism of action as well as the common side effects of the commonly used medications for coronary heart disease.


Drug name	Mechanism of action	Side effects
Aspirin	Nonselective COX-1 and COX 2 inhibitors. This inhibits platelet generation of thromboxane A2.	GI upset, GI ulcers, nausea, bleeding, rash
Clopidogrel	Selectively inhibits the binding of ADP to its platelet P2Y12 receptor which prevents activation of glycoprotein GPIIb/IIIa complex and inhibits platelet aggregation. Irreversible effect.	Stomach pain, headache, nausea, diarrhoea
Prasugrel	Selectively inhibits the binding of ADP to its platelet P2Y12 receptor which prevents activation of glycoprotein GPIIb/IIIa complex and inhibits platelet aggregation. Irreversible effect.	Bleeding, dizziness, shortness of breath, headache
Ticagrelor	Reversible P2Y12 receptor antagonist.	Bleeding, dizziness, shortness of breath (related to increased adenosine plasma levels), headache
Fondaparinux	Selectively binds antithrombin III which potentiates factor Xa inhibition.	Bleeding, black stools
Bisoprolol	Cardio selective B1 adrenergic receptor antagonist	Bradycardia, tiredness, insomnia
Ivabradine	Acts on If funny ion current in the sinoatrial node, reducing pacemaker activity	Visual luminous phenomena, headache, bradycardia and heart block
Isosorbide mononitrate	Prodrug for nitric oxide which is a potent vasodilator.	Low blood pressure, headache, flushing, tiredness
Ranolazine	Inhibits sodium and potassium ion channel currents	Dry mouth, dizziness, ringing in ears
Atorvastatin	HMG CoA reductase inhibitor and decreased cholesterol production in the liver.	Muscle aches, constipation, rhabdomyolysis, indigestion
Nicorandil	Nitrate and ATP sensitive potassium channel agonist which has vasodilatory effects.	Headache, flushing, skin ulceration
Verapamil, diltiazem	Non-dihydropyridine calcium channel blocker	Bradycardia, constipation
Nifedipine	Dihydropyridine calcium channel blocker	Bradycardia, constipation, headache, flushing

References

Drug bank online. Available at: https://go.drugbank.com/drugs
The British national formulary. Available at: https://bnf.nice.org.uk/

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