Nitroglycerin
💥 “Nitro-Glitter-In” → “The glitter bomb that opens veins!” • Prodrug → releases NO → ↑ cGMP → smooth muscle relaxation • Venodilation > arterial dilation → ↓ preload → ↓ O₂ demand • Used for acute angina (sublingual), prophylaxis (patch/oral) • ⚠️ Never mix with PDE5 inhibitors → fatal hypotension • Tolerance develops → need nitrate-free interval (8–12 h) • Side effects: headache, orthostatic hypotension, reflex tachycardia 🧠 Trigger: “Nitro glitter opens veins but crashes the party with Viagra.”
Isosorbide Dinitrate / Mononitrate
💊 “I-so-so survive!” • Same NO mechanism as nitroglycerin • Mononitrate = active metabolite, longer oral action • Dinitrate = shorter, first-pass metabolism • Used for chronic angina prophylaxis 🧠 Trigger: “I so so survive longer with MONO-nitrate.”
Nikorandil
⚡ “Nick-Open-Drill” • Nitrate donor (+NO) + K⁺ATP channel opener • ↓ preload & afterload → ↓ O₂ demand • Provides ischemic pre-conditioning protection • Used for chronic angina (alt or add-on) 🧠 Trigger: “Nick drills open K⁺ gates and releases NO sparks.”
Verapamil
🌊 “Very-Palm-Calm” • L-type Ca²⁺ channel blocker (heart + vessels) • ↓ HR, ↓ contractility, ↓ AV conduction • Used for angina, arrhythmia, migraine prophylaxis • ⚠️ Don’t combine with β-blockers → heart block • SE: constipation, bradycardia 🧠 Trigger: “Very calm palm slows your heart.”
Diltiazem
🌿 “Dil-Tea-Zen” → “Zen tea for the heart.” • Blocks Ca²⁺ channels (heart + vessels) • ↓ HR and afterload but gentler than verapamil • Used for angina and arrhythmias 🧠 Trigger: “Zen tea dilates and calms the heart.”
Nifedipine (and other DHPs)
🌸 “Nice-feet-dip-in” → “Dip feet to relax arteries.” • Vascular-selective Ca²⁺ blocker • ↓ afterload, ↓ BP → ↓ O₂ demand • Used for angina, HTN, Raynaud’s • ⚠️ Reflex tachycardia, flushing, ankle edema 🧠 Trigger: “Nifedipine spa relaxes arteries but makes heart race.”
Metoprolol / Atenolol
💙 “Met-a-heart” → “Meeting your calm heart.” • β₁-blocker → ↓ HR, ↓ BP, ↓ O₂ demand • ↑ diastolic time → ↑ coronary perfusion • Post-MI mortality ↓; first-line for stable angina • ⚠️ Avoid in asthma, bradycardia, AV block 🧠 Trigger: “Met your calm heart—beats slower, lives longer.”
Propranolol
💀 “Proper-no-air” • Non-selective β₁ + β₂ blocker • ↓ HR but → bronchospasm • ⚠️ Avoid in asthma / COPD 🧠 Trigger: “Proper-no-air blocks your lungs too.”
Pindolol
🎭 “Pin-do-low” → “Pinned heart too low.” • β-blocker with ISA (partial agonist) • ❌ Not used in angina (can worsen it) 🧠 Trigger: “Pinned too low—bad for angina.”
Ranolazine
🔷 “Run-low-zine” → “Run low on sodium.” • Blocks late Na⁺ current (INa) → ↓ Ca²⁺ overload → ↓ wall tension • No change in HR/BP • Used for chronic angina (2nd line) • ⚠️ Can prolong QT interval 🧠 Trigger: “Run low on sodium to relax heart.”
Ivabradine
🕰 “I-brake-the-heart” • Blocks If (funny) current in SA node → ↓ HR without ↓ contractility • Used for β-blocker intolerance, stable angina, HF • ⚠️ CYP3A4 substrate; may cause phosphenes (light flashes) 🧠 Trigger: “I brake the heart without dimming its power.”
Trimetazidine
🔥 “Trim-the-acid-engine” • Shifts metabolism from fat to glucose oxidation → less O₂ use per ATP • Metabolic modulator → ↑ efficiency in ischemia • Used 2nd-line for stable angina • ⚠️ May cause Parkinson-like symptoms in elderly 🧠 Trigger: “Trim the acid fuel—heart runs on sugar power.”
Papaverine
🌸 “Papa Very Relaxed” • Direct smooth muscle relaxant (no receptor) • PDE inhibition → ↑ cAMP → vasodilation • Used for Raynaud’s, spastic ischemia, GI spasm • ⚠️ Hypotension, arrhythmia 🧠 Trigger: “Papa relaxes everything he touches.”
Naftidrofuril
🦵 “Nifty Fuel for Legs” • 5-HT₂ antagonist + ↑ ATP availability • Improves oxygen use in muscle • Used for intermittent claudication → ↑ walking distance 🧠 Trigger: “Fuel for legs that can’t walk far.”
Nimodipine
🐠 “Nemo-dip-in Brain Waves” • DHP Ca²⁺ blocker, highly lipophilic → crosses BBB • Prevents cerebral vasospasm after subarachnoid hemorrhage • ⚠️ CYP3A4 substrate → avoid grapefruit juice 🧠 Trigger: “Nemo saves the brain from spasm.”
Flunarizine
🌪 “Flu-na relaxes dizzy neuron.” • Ca²⁺ channel blocker (piperazine type) • Used for migraine prophylaxis, vertigo, Meniere’s • Long half-life (~17 days) • ⚠️ Sedation, weight gain, depression 🧠 Trigger: “Flu-na flies in space—keeps your head from spinning.”
Prazosin
🖐 “Pray-zo-sin” → “Pray your hands warm again.” • α₁-blocker → vasodilation → warm extremities • Used for Raynaud’s, HTN • ⚠️ Orthostatic hypotension, tolerance with chronic use 🧠 Trigger: “Pray for warm fingers.”
Pentoxifylline
🚕 “Pen-taxi-fly-line” → “Taxi flying through sticky traffic.” • PDE inhibitor → ↑ cAMP • ↓ blood viscosity, ↑ RBC flexibility • Used for PAD, diabetic ulcers, claudication • ⚠️ Avoid in bleeding disorders, arrhythmia 🧠 Trigger: “Makes thick blood flow smooth like a flying taxi.”
Cilostazol (Silostazol)
🏃♀️ “See-low-stall” → “See low stalls, walk more!” • PDE3 inhibitor → ↑ cAMP → vasodilation + anti-platelet • Used for intermittent claudication → ↑ pain-free walking • ⚠️ Contraindicated in heart failure 🧠 Trigger: “See low stalls (legs stop) — Cilostazol keeps them running!”
Piribedil
🏴☠️ “Pirate bid on dopamine treasure.” • Dopamine agonist (D₁/D₂) → vasodilation in renal, mesenteric, cerebral beds • Used for cerebral and peripheral vascular insufficiency, Parkinson’s adjunct • ⚠️ Nausea, insomnia, dizziness 🧠 Trigger: “Pirate Piri opens blood flow with dopamine gold.”
Sildenafil (+ other PDE5 inhibitors)
🍆 “Silly-den-a-fil” → “Silly man fell for Love Potion #5.” • PDE5 inhibitor → ↑ cGMP → smooth muscle relaxation • Used for erectile dysfunction, pulmonary HTN • ⚠️ Never combine with nitrates → fatal hypotension • SE: flushing, headache, blue vision 🧠 Trigger: “#5 potion = love & vasodilation—but never mix with nitro!”
