Drugs acting on the Cardiovascular System
increase total peripheral resistance
The Cardiac Cycle
Diastole: resting phase of the heart, blood is
returned to the heart during this phase/
Systole: contracting phase of the heart;
blood is pumped out of the heart during this
phase.
Cardiac Cycle: a period of cardiac muscle
relaxation followed by a period of
contraction in the heart.
Deoxygenated Blood- right atrium through
tricuspid valve to right ventricle through
pulmonary valve to the lungs.
Oxygenated Blood- through pulmonary
veins to the left atrium through the mitral
valve t the left ventricle, through the aortic
valve to the aorta.
Renin Angiostensin System
Drugs Affecting the Blood Pressure
Closed system of blood vessels delivers
oxygenated blood to tissues and removes
waste products. Blood flows from the areas
of high pressure to areas of low pressure.
Maintanance of pressure system is
controlled by specific areas of the brain and
various hormones.
Three Elements that determine pressure in
the CV system.
Heart rate
Stroke volume
Total peripiheral resistance
BP control involves:
Baroreceptor stimulation
If decrease pressure in aorta and
carotid arteries
Vasoconstriction, output and rate,
If pressure vasodilation, output and
rate
Weight reduction
Reduction of sodium intake
Moderation of alcohol intake
Smoking cessation
Physical activity increase
Step 2: Inadequate response
Continue lifestyle modification
Initial drug selection
Diuretic or B Blocker
ACE inhibitor, Ca Channel blocker,
alpha blocker, alpha and beta blocker
Stepped care management of
Hypertension
Step 3: Inadequate Response
Increase drug dose or substitute
another drug or add a second drug
from another class.
Add a second or third agent or
diuretic if not already prescribed.
Antihypertensive Agents
Classification
Diuretics
Adrenergic agents
Beta blockers
Alpha and beta blockers
Alpha adrenergic blockers

Alpha1 blockers
Spironolactone (Aldactone)

Alpha2 agonists

Angiotensin-converting enzyme Alpha1 Blockers (peripherally acting)

inhibitors Block the alpha1-adrenergic receptors

Angiotensin II receptor blockers

Aldosterone Receptor Antagonist The SNS is not stimulated

Calcium channel blockers Zosins:

Doxazosin ( Cardura)
Vasodilators

Prazosin (Minipress)

Decrease the plasma and extracellular

Terazosin (Hytrin)
fluid volumes

Results:
Result: DECREASED blood pressure
decreased preload
Stimulation of alpha1-adrenergic receptors

decreased cardiac output

decreased total peripheral
resistance
Overall effect: workload
of the heart causes decreased blood pressure.
decreased blood pressure
Common Drugs:
causes HYPERtension
Blocking alpha 1 adrenergic receptors
Beta Blockers
Blockade of the receptors in the
heart and juxtaglomerular of the
nephron decreases the HR,
contractility and excitability

Furosemide (Lasix)

With membrane stabilizing
properties thus decreasing
arrhythmias , workload and O2
consumption
Effects:
o Decreases heart rate
o Prolongs SA node recovery
Beta-Blockers
Beta Adrenergic Blocker
Propranolol (Inderal)
Penbutolol (Levator)
Pindolol (Visken)
Sotalol (Betapace)
Timolol (Timoptic)
Carteolol (Cartrol)
Nadolol (Corgard)
Beta 1 Adrenergic Blocker
Metoprolol (Lopressor)
Esmolol ( Brevibloc)
Betaxolol (Kerlone, Betoptic)
Acebutolol (Sectral)
Bisoprostol (Zebeta)
Atenolol Tenormin)
Central-Acting Adrenergics
Stimulate alpha2-adrenergic receptors
o Slows conduction rate
through the AV node
o Decreases myocardial
contractility, thus
o decreasing myocardial
oxygen demand
Sympathetic outflow from the CNS is
decreased
Used to treat essential hypertension as step 2
drug
Result: decreased blood pressure
Clonidine (Catapres)
Side Effects: Most common dry mouth,
drowsiness, constipation, sedation
Other: headaches, sleep disturbances,
nausea, rash, cardiac disturbances
(palpitations), High incidence of orthostatic
hypotension
Angiotensin-Converting Enzyme
Inhibitors (ACE)
Prevent angiotensin-converting
enzymes from converting
angiotensin I to angiotensin II,
a powerful vasoconstrictor and
stimulator of aldosterone
release,
Result:
 Decrease systemic vascular Contraindications
resistance, afterload, vasodilation
Decrease aldosterone secretion = Allergy
Impaired renal function
slight increase in serum potassium
Pregnancy and Lactation
and a loss of serum sodium and fluid
therefore, decrease blood pressure
Adverse effects:
Angiotensin-Converting Enzyme
Inhibitors (ACE) CV: Reflex and tachycardia, chest
pain, CHF and Cardiac arrhythmias
Indicated for the GI: irritations, ulcers, constipation,
treatment of
and hepatotoxicity
hypertension,
alone or in GU: renal insufficiency, failure and
combination with proteinuria, edema, hyperK
other drugs Derma: rash alopecia and dermatitis
Treatment of Respiratory: unrelenting cugh that is
CHF and Left
Ventricular fry and nonproductive reverse when
Dysfunction drug is stopped.
Fatal Pancytopenia and MI
Common Drugs:
NOTE: first-dose hypotensive effect
may occur!!
Benzepril (Lotensin)
Angiotensin II Receptor Blockers
Captopril (Capoten)
(ARB)
Enalapril (Vasotec)
Allow angiotensin I to be converted
Fosinopril (Monopril) to angiotensin II
But Selectively bind with
Lisinopril (Prinivil) angiotensin II receptor sites in
vascular smooth muscle and in the
Moexipril (Univasc) adrenal gland blocks
vasoconstriction
Perindopril (Aceon)
Blocks the release of aldosterone
Quinapril (Accupril) Indicated to be used alone or in
combination therapy for the
RAmipril (Altace) treatment of hypertension

Trandolapril (Mavik) Common Drugs:( -sartans)
Interactions:
Telmisartan (Micardis)
Allopurinol risk for Irbesartan (Avapro)
hypersensitivity Losartan (Cozaar)
 Eprosartan (Teveten) o Drugs that increase K levels
Candesartan (Atacand) o Grapefruit juice, St. Johns
Valsartan (Diovan) worth

Cautions:
Adverse Effects
Pregnancy and Lacation
Hepatic and renal impairment o Nausea, Fatigue, Headache,
diarrhea
hypovolemia
o Orthostatic hypotension
Bowel elimination problems o Nephrotoxicity
Interactions: o Dyslipedemia
o Hepatotoxicity
Phenobarbital = increase ARB serum o Gynecomastia, vaginal
levels
bleeding
Adverse Effects:
Calcium Channel Blockers
Headache, Dizziness, Syncope and
Weakness
GI: Diarrhea, abdominal pain, Inhibit the movement of
Nausea, dry mouth and tooth pain calcium ions across the

Renal: HyperK membranes of myocardial and
arterial muscle cells, altering
Derma: Dry skin and rashes the action potential and
blocking muscle cell
contraction; depressing
myocardial contractility
slowing cardiac impulse
formation in the conductive
tissues, relaxing and dilating
Aldosterone Receptor Antagonist arteries.
= fall in blood pressure and decrease
Eplerenone (Inspra)
venous return

Blocks Aldosterone secretion Indicated for treatment of

hypertension and angina
in the RAAS
Calcium Channel Blockers
Cautions/Contraindications

Common Drugs:
Hyperkalemia
Dm type 2 with Felodipine (Plendil)- not for angina
microalbuminuria
Isradipine (Dynacirc)
Renal Insufficiency
Nicardipine (Cardene)- available per
Interactions IV
 Nifedipine (Calcibloc, Adalat, Heartblock or Sick sinus syndrome
Procardia) P and L
Nisoldipine (Sular) Renal and Hepatic Dysfunction

Amlodipine (Norvasc)
Adverse Effects:
Diltiazem (Cardizem)
CNS: dizziness, light headedness,
Verapamil (Calan SR) headache and fatigue
Interactions:
GI: Nausea, Constipation, Hepatic
Cyclosporine = Diltiazem = injury
increased toxicity
Grapefruit juice: increased drug level
CV: Hypotension, Bradycardia,
peripheral edema and heart block
Cautions:
Derma: Skin flushing and Rash

Vasodilators Hydralazine (Apresoline)

Act directly on vascular smooth
muscle to cause muscle
relaxation, leading to vasodilation
and drop in blood pressure
Indicated for the
treatment of severe
hypertension that has not
responded to other
therapy and hypertensive
emergencies
Directly relaxes arteriolar smooth
muscle
Result:
Decrease systemic vascular response
Decrease afterload
Peripheral vasodilation
Vasdilators
Common Drugs:
Maintains or increases renal blood
flow
Nitroprusside (Nitropress) toxic
levels can cause cyanide toxicity
Diazoxide (Hyperstat) also blocks
insulin release
Minoxidil (Loniten) associated
with reflex , tachycardia and
increased rennin release
Cautions:
(Conditions that can be exacerbated
by sudden drop in BP)
Cerebral insufficiency, PVD, CAD,
CHF or Tachycardia
Adverse Effects:
Dizziness, Anxiety and Headache
Reflex, Tachycardia, CHF, chest
pain, edema
Skin rash and lesions
 GI: Upset, N/V (Nitroprusside)
cyanide toxicity
Dyspnea, H/A, vomitting, Dizziness,
ataxia, loss of consciousness,
imperceptible pulse, absent reflexes,
dilated pupils, shalow breathing
Hypothyroidism
Minoxidil
o Abnormal Hair Growth
Ganglionic Blocking Agent
Occupies cholinergic receptor sites
of the autonomic nervous system
Blocks the effect of Ach on both
SNS and PNS
Vasodilation BP and blocking of
reflex tachycardia
For management of Severe or
Malignant HPN
Mecamylamide inversine
Adverse Effects
Severe hypotension, CHF, Dizziness,
syncope, weakness and vision
changes
PNS blockade: dry mouth, glossitis,
N/V, constipation and urinary
retention
Important Nursing Care for Clients
taking Antihypertensives
Obtain a thorough health histry
and head-to-toe physicial
examination.
Implement lifestyle changes
Weight loss, exercise, smoking
cessation, diet, avoiding alcohol
and low Na diet
Monitor the client closely
- BP < 140/90 mmHg
Instruct patients to keep a journal
of regular BP checks. Blood
glucose and serum electrolytes
Fluid volume = Avoid excessive
sweating, dehydration, vomiting
and diarrhea
Monitor for therapeutic effects
Nursing Care
Provide Comfort Measures:
o SFF, take with meals if with
GI upset
o Bathroom Facilities
o Environmental control and
Skin care
Safety measures
o change positions slowly to
avoid syncope from postural
hypotension.
o Bed rails up, Companion at
bed side
o Administer IV forms with
extreme caution and use an
IV pump.
o Encourage supervised
exercise.
Patient Teachings
report unusual shortness of
breath; difficulty breathing;
swelling of the feet, ankles,
face, or around the eyes;
weight gain or loss; chest pain;
palpitations; or excessive
fatigue.
If patients are experiencing serious
side effects, or believe that the dose
or medication needs to be changed,
they should contact their physician
immediately.

Men taking these agents may
not be aware that impotence
is an expected effect. This
may influence compliance
with drug therapy.
Hot tubs, showers, or baths; hot
weather; prolonged sitting or
standing; physical exercise; and
alcohol ingestion may aggravate
low blood pressure, leading to
fainting and injury. Patients
should sit or lie down until
symptoms subside.
Remind patients that medications is
only part of therapy.
Educate patients about the
importance of not missing a dose and
taking the medications exactly as
prescribed.
Patients should not take any
other medications, including
OTC drugs, without first getting
the approval of their physician.
Patients should never
double up on doses if a
dose is missed; check
with physician for
instructions on what to do
if a dose is missed.
Instruct patients that these drugs
should not be stopped abruptly,
as this may cause a rebound
hypertensive crisis, and perhaps
lead to CVA.
CARDIOTONIC AGENTS
Congestive Heart Failure: a condition in
which the heart muscle fails to adequately
pump blood around the cardiovascular
system leading to a backup or congestion
of blood in the system
Can be brought about by the following
Conditions:
Coronary Artery Disease (CAD)
Cardiomyopathy
Hypertension
Valvular Heart Disease
Pulmonary Edema: severe left-sided
congestive heart failure with backup of
blood into the lungs, leading to loss of fluid
into the lung tissue
Drugs to Treat CHF
Cardiotonic or Inotropics
Affect the intracellular calcium
levels in the heart muscles leading to
increased contactility
contraction
strength = CO = renal
perfusion = urine
output and
reninurine
output = Cardiac
workload
Drug Classes
Cardiac Glycosides
Phospodieterase
inhibitors
Other Agents
Vasodilators
Angiotensin Converting Enzyme
Inhibitors
Diuretics
Some Beta blockers
Cardiac Glycosides
Increase intracellular calcium and allow
more calcium to enter myocardial cells
during depolarization, causing the
following effects:
Positive (+) inotropic -Increased
force of myocardial contraction
Negative (-) chronotropic -Slowed
heart rate by slowing the rate of
cellular repolarization
Negative (-) dromotropic -
Decreased conduction velocity
through the AV node
Increased cardiac output and renal
perfusion
Have very different bioavailabilities
Very narrow margins of safety
Watch out for digitalis toxicity
contraindications and cautions
 Cardiovascular Conditions Arrange for taking the clients weight
everyday
V tach or V Fib, Heartblock or Sick
sinus syndrome, IHSS, AMI
Same time everyday
enal insufficiencies and Electrolyte
abnormalities
Same amount of clothing

Pediatric and Geriatric clients

Pregnancy and Lactation Nursing Care

Verapamil, Amiodarone,
quinidine, quinine, Maintain Emergency equipments
erythromycin, tetracycline or
cyclosporine = Digoxin
Toxicity
K salts, lidocaine, phenytoin,

Atropine SO4
K losing diuretics, IV Calcium Cardiac
Keep digoxin Immune Fab
arrhythmias (Digibind, Digifab) Monitor
therapeutic digoxin level 0.5-2
Cholestyramine, ng/mL
colestipol, charcoal,
bleomycin, Provide Comfort Measures
cyclophosphamide or
methotrexate = oral
Small frequent feedings
digoxin absorption

Bathroom facilities
Adverse Effects:

Environmental control

CNS:Headaches, weakness,
drowsiness and vision changes Position of comfort
( Yellow halo around objects)

Adequate rest periods
GI: Upset, N/V, anorexia
Adequate lighting
CV: arrhythmias
Nursing health care teachings

Nursing Care

Encourage food rich in K but low in

Consult with the
prescriber about the Na

need for a loading Avoiding inter-changing of lanoxin
and lanoxicaps
dose when -
mg of lanoxicaps =
beginning therapy 0.125 mg of Lanoxin
in therapeutic effect
Monitor Apical
mg of lanoxicaps = 0.23 mg of
pulse for 1 full lanoxin in therapeutic effect

minute Observe for Signs and symptoms of
Digitalis Toxicity
Hold if less than 60
Predisposing factors

bpm adult; infant Overdose or accumulation of
90 bpm digitalis

K, Ca, Mg
Administer IV very
Used together with highly protein
slowly for a period bound drugs
of 5 minutes
Avoid IM injections Management

Discontinue drug
Monitor electrolyte balance K level
Avoid highly CHON bound drugs
Antiarryhthmic drugs and FAB
fragments
ANTIDOTE : Digoxin Immune Fab
(Digibind)
Phosphodiesterase Inhibitors
Amrinone lactate
(Inocor)/Inamrinone
Milrinone lactate (Primacor)
Phosphodiesterase Inhibitors
Cautions:
Severe aortic and pulmonic valvular
disease
Fluid volume deficit
Ventricular arrhythmias
Elderly, pregnant and lactating clients

Block the enzyme phosphodiesterase

leading to an increase in myocardial
cell cyclic adenosine
monophosphate (cAMP), which
increases calcium levels in the cell
causing a stronger contraction and
prolonged effects of sympathetic
stimulation, leading to vasodilation,
increased oxygen consumption, and
arrhythmias
Indicated for the short-term
treatment of CHF in patients who
are not responding to digoxin or
diuretics alone or who have poor
response to digoxin, diuretics, and
vasodilators Phosphodiesterase
Inhibitors
Interactions:
Furosemide = forms precipitates
CV: Ventricular arrhythmias,
hypotension, chest pain
GI: N/V, anorexia,a bdominal pain
Others: Vasculitis, pericarditis, pleuritis
and ascites, burning at the injection sites
Inamrinone Thrombocytopenia may be
common
pulse and BP
Accurate I and O
Platelet counts prior and during
Treatment
Injection sites

Effects:
Safe bathroom access, safety precautions and health teachings

Increase myocardial contractility =

positive notropic effects

Peripheral vasodilation

Examples: