Cath-Lab Drug Reference Chart

The medications you'll see in the cardiac cath lab — grouped by class, with mechanism and the one thing you must remember for each. Printable and exam-ready.

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Anticoagulants

Drug	Class / mechanism	Key point
Unfractionated heparin	Antithrombin activator (inhibits IIa & Xa)	Monitor with ACT/aPTT; reverse with protamine
Enoxaparin (LMWH)	Mainly factor Xa inhibition	Monitored (when needed) by anti-Xa; only partially reversed by protamine
Bivalirudin	Direct thrombin inhibitor	Preferred anticoagulant in HIT; renally cleared
Fondaparinux	Selective factor Xa inhibitor	Not used alone for PCI (catheter thrombosis risk)
Warfarin	Vitamin K antagonist	Reverse with vitamin K + PCC/FFP; monitored by INR

Antiplatelets

Drug	Mechanism	Key point
Aspirin	Irreversible COX-1 → ↓ thromboxane A₂	Foundation of antiplatelet therapy
Clopidogrel / Prasugrel / Ticagrelor	P2Y12 (ADP) receptor inhibitors	Prasugrel avoided with prior stroke/TIA; ticagrelor can cause dyspnea
Cangrelor	IV P2Y12 inhibitor	Rapid onset/offset when oral agents can't be used
Eptifibatide / Tirofiban / Abciximab	Glycoprotein IIb/IIIa inhibitors	Potent; stop infusion if bleeding (abciximab effect is longer)

Vasoactive & emergency drugs

Drug	Action	Use
Epinephrine	α + β agonist	Anaphylaxis, cardiac arrest
Norepinephrine	Potent α agonist	First-line vasopressor in cardiogenic/septic shock
Dobutamine	β₁ agonist (inotrope)	Low-output states
Milrinone	PDE-3 inhibitor (inodilator)	Inotropy + vasodilation; watch hypotension
Nitroglycerin	Venodilator	Angina; avoid with PDE-5 inhibitors & severe AS
Nitroprusside	Arterial + venous dilator	Hypertensive emergencies; cyanide risk
Atropine	Antimuscarinic	Symptomatic bradycardia / vasovagal
Adenosine	Transient AV-nodal block	Terminates SVT; give rapid IV push
Amiodarone	Class III antiarrhythmic	VT/VF, stable wide-complex tachycardia
Magnesium sulfate	Membrane stabilizer	First-line for torsades de pointes

Reversal agents (know these cold)

Reverses	Agent
Heparin	Protamine sulfate
Warfarin	Vitamin K (+ PCC or FFP for speed)
Benzodiazepines (e.g., midazolam)	Flumazenil
Opioids (e.g., fentanyl)	Naloxone
Dabigatran	Idarucizumab
Factor Xa inhibitors (apixaban/rivaroxaban)	Andexanet alfa

Contrast & sedation

Agent	Notes
Iodinated contrast	Premedicate (steroids + antihistamine) for prior reactions; hold metformin in renal impairment; hydrate high-risk patients
Midazolam	Procedural sedation; reversed by flumazenil
Fentanyl	Analgesia; reversed by naloxone

Test yourself on all of these with the free pharmacology question bank, and read the full cath-lab medications guide.

Frequently asked questions

What reverses heparin?

Protamine sulfate neutralizes heparin. Warfarin is reversed by vitamin K (plus PCC or FFP for urgent reversal) — a common exam distinction.

Which anticoagulant is used in patients with HIT?

Bivalirudin, a direct thrombin inhibitor, is preferred because it does not cross-react with heparin-induced thrombocytopenia antibodies.

What is the first-line vasopressor in cardiogenic shock?

Norepinephrine is generally preferred over dopamine because it causes fewer arrhythmias.

Can I print this drug reference chart?

Yes — use the 'Print / Save as PDF' button at the top for a clean printable copy.