Cardiovascular medications are an important part of patient care decisions in cardiothoracic anesthesia. A firm grasp of clinical pharmacology principles and the influence of cardiopulmonary bypass (CPB) on drug metabolisms, eliminations, concentrations, and actions is crucial. This entails recognizing the physiological changes induced by CPB, including variations in systemic vascular resistance (SVR), inflammatory responses, and hemodynamic differences when compared to before CPB and comprehending the critical role of cardiovascular medications in managing these changes. Additionally, the complexities of drug pharmacokinetics and pharmacodynamics during CPB are key considerations. Effective management involves addressing preexisting cardiovascular conditions and minimizing drug interactions and side effects during CPB. It is essential to not only understand the mechanisms of action and appropriate usage of these medications in certain circumstances but also when to avoid using these medications for proper patient management. This chapter will focus on the key cardiovascular medications used during CPB, as well as how anesthesia is delivered to any given patient during this period.