CARDIOVASCULAR DRUGS

Cardiac glycosides

Prototype: Digoxin (Lanoxin)

Action: -increases force of myocardial contraction (positive
inotrophic effect)
- decreases rate of conduction (negative chronotrophic
effect)
- positive inotrphic effect improves blood supply to vital
organs and kidneys, providing a diuretic effect: digitoxin- safer
to use for patients with renal failure
Use: CHF atrial fibrillation, atrial flutter
Adverse effects: bradycardia, green/yellow halos, anorexia, nausea,
vomiting, diarrhea
- toxicity occurs more quickly in presence of a low serum K
Nursing Implications: - hold if apical rate is below 60 or greater
than 120 beats per minute in adults, below 90 beats/min in infants, or
below 70 beats/min in children up to adolescence
-monitor serum digoxin levels/therapeutic
range (0.5-2.0 mg/ml)
- Digoxin antidote: Digoxin Immune Fab
(Digebind)

Anti Arrythmic drugs

1. Quinidine
2. Procainamide
3. Lidocaine (Xylocaine)
4. Disopyramide (Norpace)
5. Calcium Channel Blockers:
a. Verapamil (Isoptin)
b. Nifedipine (Procardia)
c. Diltiazem (Cardizem)
6. Digitalis

Anti Anginal Drugs

Prototype: Nitrates and Nitroglycerin

Action: Dilates the peripheral vascular smooth muscles of smaller
vessels
- tolerance may develop with continued use
Use: treatment and prophylaxis of angina pectoris
Adverse effects:Headache, usually disappears with long-term therapy,
flushing , hypotension, dizziness, reflex tachycardia
 Dilute IV NTG in 5% dextrose or 0.9% NaCl, avoid using
polyvinyl chloride plasts as it can absorb NTG
 Store in original dark glass container in a cool place, date bottle
when opening and discard after 3 months, no to alcohol.
Related Drugs:
Isosorbide dinitrate (Isordil): used to prevent and treat anginal
attacks, SL or PO
Prototype for calcium Channel Blockers:
Verapamil (Isoptin)
Action: inhibits myocardial oxygen demand by
inhibiting the influx of calcium through muscle cell, which leads to
reduced after load and coronary vasodilation, decreases myocardial
contractility, causing peripheral vasodilation leading to decreased heart
work load
Use: angina, essential hypertension (PO form), cardiac
dysrythmias (IV use)
Adverse effects: constipation, nausea and vomiting,
hypotension, bradycardia, AV block dizziness

 take radial pulse before taking Verapamil

 change position slowly to decrease orthostatic hypotension

Peripheral Vasodilators

Prototype 1: Isoxsuprine HCl ( Vasodilan)

- for relaxation of the smooth muscle of blood vessels,
used to treat peripheral vascular disorders such as Raynaud’s and
Buerger’s disease, diabetic vascular disease and varicose ulcers

Prototype2: Dipyramidamole (Persantine)

- potent vasodilator that also decreases platelet aggregation
- used in the prevention of thromboembolism in cardiac valve
replacement surgery
- also used in other thromboembolic disorders to decrease platelet
aggregation
adverse effects: headache, dizziness, weakness, hypotension, GI
distress, flushing and skin rashes

Other Antiplatelets
1. Aspirin
2. Cilortazol (Pletal)
3. Clopidogrel (Plavix)

Anti Dysrhythmics

Prototype 1: Quinidine (Quinaglute)

Action: decreases myocardial excitability and slows conduction
velocity
Use: atrial and ventricular dysrhythmias
Nursing implications:
- monitors serum Quinidine levels normal range: 3-6 mcg/ml
- clients taking Digoxin and Quinidine are more prone to digitalis
toxicity
adverse effects
1. Cinchonism: GI distress, tinnitus, visual disturbances, dizziness,
headache
2. AV block
3. hypotension
4. thrombocytopenia
*take radial pulse before taking
Prototype 2: Lidocaine (Xylocaine)
Action: prolongs refractory period in myocardium and purkinje
fibers, has little effects on atria
Use: ventricular arrythmias
Dose: given parenterally only
Adverse effects: drowsiness, seizures, ventricular tachycardia, heart
block, hypertension, bradycardia
Nursing implication: used in fusion pump

Prototype 3: Bretylium (Bretylol)

Action: an antifibrillatory drug, initially releases nor epinephrine to
increase conduction velocity and strengthen the heart beat
Use: life threatening arrythmias
Adverse effects: hypotension, dizziness

Related drugs
1. Amiodarone (Cordarone)- given orally to treat chronic recurrent
ventricular tachycardia or ventricular fibrillation that is unresponsive to
other drugs

Drugs related to Lidocaine:

1. Tocainide (Tonocard)-oral analog of Lidocaine
Use: ventricular arrythmias
Adverse effects: drug induced SLE
2. Phenytoin (Dilantin- for ventricular arrythmias unresponsive to
Lidocaine or Procainamide
- also used to treat digitalis-induced arrythmias

Betablockers

Prototype: Propanolol (Inderal)

Action: beta-adrenergic blockers that decreases heart rate, force
of contraction, myocardial irritability, and conduction velocity and
depresses automaticity
Uses: cardiac arrhythmias caused by excessive cardiac
stimulation of sympathetic nerve impulse, digitalis-induced
arrhythmias, essential hypertension, angina pectoris, preoperative
management of pheochromocytoma, prevention of migraine headache

Cardiac Stimulants

Atropine – blocks vagal stimulation of the SA node in the heart, thus

increasing heart rate, acts systemically to block cholinergic activity
throughout the body
Cardiac uses: treatment of sinus bradycardia or asystole;
management of symptomatic sinus bradycardia
Isoprotenerol (Isoprel) – stimulates bate1 adrenergic receptors in
heart to increase cardiac output
- also a bronchodilator
Cardiac use: cardiac standstill, Stokes-Adams syndrome,
ventricular arrythmias

Anticoagulants
Prototype 1: Heparin
Action: blocks conversion of prothrombin to thrombin and
fibrinogen to fibrin, Immediate action
*do not dissolve exsisting blood clots but prevent further coagulation
Use:
a. prophylaxis and treatment of thrombosis and embolism
b. anticoagulation for vascular and cardiac surgery
c. prevention of clotting in heparin lock sets, blood samples and
during dialysis
d. treatment of disseminated vascular clotting syndrome (DIC)
e. adjunctive treatment of coronary occlusion with acute MI
Antidote: Protamine Sulfate
Laboratory tests used to monitor therapy: partial thromboplastin
time (PTT)
Nursing implications:
1. do mot give IM
2. SC injection: given in fatty layer of abdomen or just above iliac
crest, do not inject within 2inches of umbilicus, scars or bruises;
do not aspirate, do not massage apply pressure on injection site
for 5-10secs. after injection; rotate injection sites and keep a
record; use infusion pump for IV (injection) infusion
3. report signs of bleeding
4. aspirin, antihistamines, ginseng, gingko biloba and guaifenesin
shouldn’t be taken
5. generally followed with oral anti coagulant therapy

Prototype 2: Warfarin (Coumadin)

Action: Blocks prothrombin synthesis action 2-5 days to occur
Use:
a. prophylaxis and treatment of thrombosis and embolism
b. atrial fibrillation with embolization
c. adjunct intreatment of coronary occlusion
Adverse effects: overdosage may cause paralytic ileus; skin necrosis
of toes (purple toes syndrome), tip of nose, buttocks, thighs, abdomen
Antidote: Vitamine K
Laboratory tests used to monitor therapy: prothrombin time (PT)
Nursing implications:
1. tablet can be crushed and taken with any fluid
2. discharge teaching: report any sign of bleeding; use soft
toothbrush, floss teeth with waxed floss, shave with electric
razors; carry medic alert ID

Thrombolytic drugs

Prototype: Streptokinase (Streptase)

Action: transform plasminogen to plasmin which degrades
fibrinogen, fibrin clots and other plasma proteins
Use: pulmonary emboli; coronary artery thrombosis; deep venous
thrombosis; arteriovenous cannula occlusion
Adverse reaction: bleeding,allergic reaction, arrythmias
Nursing Implications:
a. start therapy ASAP after thrombi older than 7days react poorly
to streptokinase
 b. when used in treatment of an acute MI, start therapy with in 6
hrs of attack
c. heparin is discontinued before streptokinase is started
d. corticosteroids can be given to decrease allergic reaction
e. IM injections are contraindicated
Antidote: Aminocaproic acid

Antilipemic Agents

Prototype: Cholestyramine (Questran)

Action: prevents the metabolism of cholesterol in the body
Use: hyperlipoprotienemia; pruritus caused by partial biliary
obstruction
Adverse effects: constipation, nausea and vomiting, deficiencies in
fat-soluble vitamins, rash
Nursing implication: long-term use increases bleeding
tendencies; oral Vit.K may be given prophylactically
Discharge teaching:
a. Take with water or preferred liquid and dissolve
b. Take before meals
c. Do not take at the same time with other medications as there
will be interference with absorption

Related drugs:
1. Colestipol(Colestick) – similar in action, use, adverse effects and
nursing implications to Cholestyramine
2. Reductase Inhibitors: Atorvastatin (Lipitor), Fluvastatin
(Lescol), Simvastatin (Zocor) decrease cholesterol levels by stopping
the body from making its own cholesterol
- take with meals to increase absorption
3. Fibric Acid Derivatives: Gemfirozil (Lopid) – decrease triglycerides
and increase HDL cholesterol
- may cause diarrhea or GI upset
4. Niacin-Vit.B3 (Nicobid) - reduces cholesterol and total lipid levels
- for treatment of hyperlipidemia
Adverse effects: tingling, flushing, jaundice

Antihypertensives

Prototype 1: Central Acting Antihypertensives [ Clonidine (Catepres)]

Action: blocks sympathetic nerve impulses in brain, which causes
decreased sympathetic outflow leading to decreased BP
Related drugs: Methyldopa – may cause blood dyscrasia and
hepatotoxicity

Prototype 2: Alpha-adrenergic Receptor blocker [Prazocin

(MInipress)]
Action: blocks alpha receptors in atrial smooth muscle vasculature
Use: essential hypotension and hypertension caused by
pheochromocytoma
-take with food to reduce dizziness

Prototype 3: Peripheral acting adrenergic Neuron Blockers

[Reserpine (Serpalan)]
Action: lowers BP by blocking norepinephrine in CNS and
peripherally
Use: rarely used due to its adverse effects
Adverse effects: suicidal depression, increased incidence of breast
cancer, impotence, decreased cardiac output

Prototype 4: ACE inhibitor (Angiotensin-converting Enzyme

Inhibitors) [Captopril (Capoten)]
Action: lowers BP by inhibiting angiotensin-converting enzyme,
which inhibits angiotensin II (vasoconstrictor) and indirectly reduces
serum aldosterone levels
Use: initial therapy of essential hypotension in clients with normal
renal function, severe hypertension in clients with renal dysfunction,
CHF
Adverse effects: blood dyscrasia, hyperkalemia, loss of taste
perception
-administer 1 hour before meals

Related drugs: Enalapril (Vasotec)

Prototype 5: Direct Acting Vasodilators [Hydralazine(Apresoline)]

Action: direct relaxation of arterides, smooth muscle causing
vasodilation
Use: hypertension; parenteral Hydralazine is used in hypertensive
emergencies
Adverse effects: Lupus-like syndrome, anorexia, nausea and
vomiting, depression, dizziness, tachycardia, palpitation

Related drugs:
a. Minoxidil (Loniten) – has more adverse effects than hydralazine
– may cause cardiac muscle lesions and hirsutism
Topical preparation: Rogaine – for treatment of baldness
b. Nitroperusside – given IV to treat hypertensive crisis
- infusion pump should be used
- aluminum foil-used to wrap the IV tubing for protection
against light