Chart — Pharmacology
Cardiac Drug Class Chart
Side-by-side comparison of major cardiac drug classes — with common medications, primary uses, and major side effects — for rapid clinical reference and NCLEX preparation.
Educational use only. Cardiac medication administration requires assessment of BP and HR before each dose. Hold parameters are individualized and provider-ordered. Always follow your facility protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Cardiac Drug Classes
| Drug Class | Common Medications | Uses | Major Side Effects |
|---|---|---|---|
| ACE Inhibitors (-pril) | Lisinopril, enalapril, captopril, ramipril | Hypertension, HFrEF, post-MI, diabetic nephropathy | Dry cough (bradykinin), hyperkalemia, first-dose hypotension, angioedema (rare — life-threatening) |
| ARBs (-sartan) | Losartan, valsartan, candesartan, olmesartan | Hypertension, HF (ACE intolerant), diabetic nephropathy | Hyperkalemia, hypotension, dizziness. No cough. Angioedema rare. Contraindicated in pregnancy. |
| ARNIs | Sacubitril/valsartan (Entresto) | Chronic HFrEF (EF ≤40%) — reduces HF mortality and hospitalization | Hypotension, hyperkalemia, angioedema. Must stop ACE inhibitor 36 hours before starting ARNI. |
| Beta-Blockers (-olol) | Metoprolol, carvedilol, atenolol, bisoprolol | Hypertension, HFrEF, angina, post-MI, AF rate control | Bradycardia, hypotension, fatigue, bronchospasm. Never stop abruptly — rebound hypertension and angina. Hold if HR <60. |
| CCBs — Dihydropyridines (-dipine) | Amlodipine, nifedipine, felodipine | Hypertension, stable and vasospastic angina | Peripheral edema, flushing, headache, reflex tachycardia |
| CCBs — Non-Dihydropyridines | Diltiazem, verapamil | AF/flutter rate control, SVT, angina, hypertension | Bradycardia, AV block, constipation (verapamil). Avoid in decompensated HF. Avoid with beta-blockers. |
| Nitrates | Nitroglycerin (SL, IV, patch), isosorbide mononitrate, isosorbide dinitrate | Acute angina (SL), angina prevention, acute pulmonary edema (IV), hypertensive urgency | Headache, hypotension. NEVER with PDE-5 inhibitors (sildenafil) — fatal hypotension. Tolerance with continuous use. |
| Loop Diuretics | Furosemide (Lasix), bumetanide, torsemide | Heart failure (fluid overload), pulmonary edema, hypertension | Hypokalemia, hypomagnesemia, hyponatremia, dehydration, ototoxicity (high IV doses). Monitor K⁺. |
| Thiazide Diuretics | Hydrochlorothiazide (HCTZ), chlorthalidone, metolazone | Hypertension (first-line), mild edema; ineffective with CrCl <30 | Hypokalemia, hyperuricemia (gout risk), hyperglycemia, hyperlipidemia, hyponatremia |
| Potassium-Sparing Diuretics | Spironolactone, eplerenone | HFrEF (mortality benefit), hyperaldosteronism, K⁺ preservation | Hyperkalemia (dangerous with ACE inhibitors/ARBs), gynecomastia (spironolactone) |
Common Hold Parameters
| Medication Class | Common Hold Threshold | Notes |
|---|---|---|
| Beta-blockers | HR < 60 bpm or SBP < 90 mmHg | Never stop abruptly; taper if discontinuing |
| ACE inhibitors / ARBs | SBP < 90 mmHg; significant hyperkalemia; rising creatinine | Check K⁺ and renal function periodically |
| Loop diuretics | SBP < 90 mmHg; low urine output; rising creatinine | Monitor weight, I&O, K⁺, BUN/Cr daily in HF |
| Non-DHP CCBs | HR < 60 bpm; signs of AV block; SBP < 90 mmHg | Continuous cardiac monitoring for IV diltiazem/verapamil |
Hold parameters are facility-specific and provider-ordered. Always document reason for holding and notify provider.
NCLEX Quick Tips
- ACE inhibitor dry cough = bradykinin accumulation. Switch to ARB if intolerable.
- Beta-blockers: hold for HR <60. Never stop abruptly — rebound effects.
- Nitrates + PDE-5 inhibitors (Viagra) = absolute contraindication. Fatal hypotension.
- Furosemide (loop diuretic) → hypokalemia. Monitor K⁺ and supplement as ordered.
- Spironolactone → hyperkalemia. Avoid with ACE inhibitors without careful monitoring.
- ARNI (Entresto): wait 36 hours after ACE inhibitor before starting.
- Verapamil/diltiazem + beta-blockers: additive bradycardia — avoid combination in HF.
- Priority pre-administration assessment for cardiac meds: BP and HR.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with ACC/AHA Guidelines / NCLEX-RN Test Plan. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →