🚧 Under construction — VoTechWorks is being built. A free tech program — complimentary, as our commitment to get America working.
voTechWorksGrade 13 · a vocational technology learning center, by urbanicity
newSchoolWorks.com › VoTechWorks › Health & Personal Services › Pharmacy Technician › Pharmacology and the Top 200 Drugs › Lesson 4
HLT-PHAR41-02 · Lesson 4 · 15 clock hours · theory

Cardiovascular drugs

Objective. Name the major cardiovascular classes — ACE inhibitors, ARBs, beta blockers, calcium-channel blockers, diuretics, statins, antiplatelets and anticoagulants — with their indications and key cautions.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed pharmacist or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

VoTechWorks program approval and accreditation are still in progress. Credentials are issued only by the certifying bodies named in each program, after their own exams.

Cardiovascular Drugs

Cardiovascular disease is the leading cause of death in the United States, and cardiovascular medications make up a large share of the Top 200 drugs dispensed every year. Pharmacy technicians must be able to recognize the major drug classes, understand why they are prescribed, and know the cautions that protect patient safety.

ACE Inhibitors

Angiotensin-converting enzyme (ACE) inhibitors block the enzyme that converts angiotensin I to angiotensin II, a potent vasoconstrictor. The result is lower blood pressure and reduced workload on the heart. Common agents include lisinopril, enalapril, and ramipril. They are indicated for hypertension, heart failure, and protection of the kidneys in diabetic patients. The signature adverse effect is a dry, persistent cough caused by accumulation of bradykinin. ACE inhibitors are contraindicated in pregnancy because they can cause fetal kidney damage. Monitoring for elevated potassium (hyperkalemia) and rising creatinine is routine.

Angiotensin II Receptor Blockers (ARBs)

ARBs block angiotensin II at its receptor rather than preventing its formation. Examples include losartan, valsartan, and olmesartan. Indications mirror those of ACE inhibitors. Because ARBs do not raise bradykinin, they rarely cause cough and are often used when a patient cannot tolerate an ACE inhibitor. They carry the same pregnancy contraindication and the same risk of hyperkalemia.

Beta Blockers

Beta blockers competitively block beta-adrenergic receptors, slowing the heart rate and reducing the force of contraction. Common agents include metoprolol, atenolol, carvedilol, and bisoprolol. Indications include hypertension, heart failure, angina, and rate control in atrial fibrillation. Key cautions: beta blockers can mask the symptoms of hypoglycemia in diabetic patients; they should never be stopped abruptly because rebound tachycardia or angina can occur; and they must be used carefully in patients with asthma or chronic obstructive pulmonary disease because non-selective agents can cause bronchospasm.

Calcium-Channel Blockers (CCBs)

CCBs prevent calcium from entering heart and blood-vessel muscle cells, causing vasodilation and, with certain agents, a slower heart rate. The class divides into two subgroups. Dihydropyridines (amlodipine, nifedipine) act mainly on blood vessels and are used for hypertension and angina. Non-dihydropyridines (diltiazem, verapamil) also slow conduction through the AV node and are used for rate control in atrial fibrillation. Non-dihydropyridines are generally avoided in heart failure with reduced ejection fraction because they can worsen cardiac function.

Diuretics

Diuretics increase urine output to reduce fluid volume and blood pressure. Thiazide diuretics (hydrochlorothiazide, chlorthalidone) are first-line for hypertension. Loop diuretics (furosemide, bumetanide) are more powerful and are used in heart failure and edema. Potassium-sparing diuretics (spironolactone, triamterene) are weaker alone but are combined with other diuretics to offset potassium loss. Key cautions include electrolyte imbalances — particularly low potassium with thiazides and loops — dehydration, and orthostatic hypotension.

Statins

Statins inhibit HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis, lowering low-density lipoprotein (LDL) cholesterol and reducing the risk of heart attack and stroke. Common agents include atorvastatin, rosuvastatin, simvastatin, and pravastatin. The most important adverse effect is myopathy, which ranges from muscle aches to the rare but serious rhabdomyolysis (breakdown of muscle tissue that can damage the kidneys). Patients should report unexplained muscle pain or weakness. Liver enzyme elevations can occur; baseline and periodic liver function monitoring may be ordered.

Antiplatelet Drugs

Antiplatelets reduce the ability of platelets to clump together and form clots. Aspirin irreversibly inhibits cyclooxygenase, reducing thromboxane A2 production. Clopidogrel (Plavix) and ticagrelor (Brilinta) block the P2Y12 receptor on platelets. These drugs are used after myocardial infarction, stroke, and placement of coronary stents. The major risk is bleeding. Patients should be advised to notify all healthcare providers and to avoid nonsteroidal anti-inflammatory drugs (NSAIDs) unless directed by their prescriber.

Anticoagulants

Anticoagulants prevent clot formation or extension and are used in atrial fibrillation, deep vein thrombosis, pulmonary embolism, and mechanical heart valves. Warfarin (Coumadin) inhibits vitamin K-dependent clotting factors. Because its effect is measured by the INR (international normalized ratio), frequent blood monitoring is required. Warfarin has extensive drug and food interactions; foods high in vitamin K (such as leafy green vegetables) can reduce its effect. Direct oral anticoagulants (DOACs) — rivaroxaban (Xarelto), apixaban (Eliquis), dabigatran (Pradaxa), and edoxaban (Savaysa) — have more predictable pharmacokinetics and do not require routine INR monitoring, but they still carry significant bleeding risk. No universal reversal agent exists for all DOACs, though specific antidotes are available for some agents.

Putting It Together

A patient with hypertension, heart failure, high cholesterol, and atrial fibrillation might reasonably be prescribed a beta blocker, an ACE inhibitor, a diuretic, a statin, and an anticoagulant simultaneously. Recognizing each drug's class, indication, and key caution allows pharmacy technicians to catch potential errors, flag missing information, and support the pharmacist in counseling patients effectively.

Key terms12

ACE inhibitorA drug that blocks angiotensin-converting enzyme, lowering blood pressure; may cause a dry cough and is contraindicated in pregnancy.
ARB (angiotensin II receptor blocker)A drug that blocks the angiotensin II receptor to lower blood pressure; used when ACE inhibitor cough is not tolerated; also contraindicated in pregnancy.
Beta blockerA drug that blocks beta-adrenergic receptors, slowing heart rate and reducing blood pressure; must not be stopped abruptly.
Calcium-channel blocker (CCB)A drug that prevents calcium entry into cardiac and vascular smooth muscle; dihydropyridines act mainly on vessels, non-dihydropyridines also slow heart rate.
Thiazide diureticA diuretic drug used first-line for hypertension that can cause low potassium; examples include hydrochlorothiazide and chlorthalidone.
Loop diureticA potent diuretic acting on the loop of Henle, used in heart failure and edema; examples include furosemide and bumetanide.
StatinAn HMG-CoA reductase inhibitor that lowers LDL cholesterol; key risk is myopathy, including rare rhabdomyolysis.
AntiplateletA drug that reduces platelet aggregation to prevent arterial clots; examples include aspirin and clopidogrel; major risk is bleeding.
AnticoagulantA drug that interferes with the clotting cascade to prevent or treat blood clots; examples include warfarin and the DOACs (rivaroxaban, apixaban, dabigatran, edoxaban).
INR (international normalized ratio)A standardized blood test used to monitor the anticoagulant effect of warfarin.
RhabdomyolysisSevere breakdown of muscle tissue that can lead to kidney failure; a rare but serious risk of statin therapy.
HyperkalemiaElevated potassium in the blood; a risk with ACE inhibitors, ARBs, and potassium-sparing diuretics.

Worked examples3

1.
    Answer:
    2.
      Answer:
      3.
        Answer:
        In class: Class tables from the top-200 list · Warfarin and DOAC counselling points for the pharmacist · Case: a patient on four heart drugs
        Materials: Drug references, class tables
        Check: Class quiz ≥ 80%

        Practice check8

        Answer each question, then check it. Nothing is recorded; this is your own practice.

        PTCE domain: Patient Safety and Quality Assurance
        1. A patient taking lisinopril calls to report a persistent dry cough. Which action is MOST appropriate for the pharmacy technician?
        PTCE domain: Medications
        2. Which laboratory value must be monitored regularly for a patient taking warfarin?
        PTCE domain: Medications
        3. Which class of diuretics is considered first-line pharmacotherapy for uncomplicated hypertension?
        PTCE domain: Patient Safety and Quality Assurance
        4. A patient is prescribed clopidogrel after placement of a coronary stent. Which of the following is the MOST important caution to communicate to the pharmacist for patient counseling?
        PTCE domain: Medications
        5. Atorvastatin belongs to which pharmacological class?
        PTCE domain: Patient Safety and Quality Assurance
        6. A patient stabilized on warfarin suddenly starts eating large daily servings of spinach and kale. What effect is MOST likely to occur?
        PTCE domain: Patient Safety and Quality Assurance
        7. Which adverse effect is MOST associated with statin therapy and requires the patient to notify the pharmacist or prescriber promptly?
        PTCE domain: Medications
        8. A prescriber switches a patient from lisinopril to losartan because the patient cannot tolerate the cough. Losartan belongs to which drug class?
        Record this lesson on my transcript. Sign in with your key and enrollment email to record lessons (enroll free if you have no key). This page stays open to read and practise.
        ← Previous lessonTop-200 drugsNext lesson →