Chapter 15
Cardiovascular and Renal Medications
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Chapter 15
Lesson 15.1
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Learning Objectives
• Identify the approved way to give
different forms of antianginal therapy
• Discuss the uses and general actions of
cardiac drugs used to treat
dysrhythmias
• Describe the common treatment for
various types of lipoprotein disorders
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Cardiovascular System:
Major Arteries
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Cardiovascular System:
Major Veins
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Urinary System
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Antianginals and Peripheral
Vasodilators
Antianginals
– Nitrates: “Universal Vasodilators”
• Directly cause vascular smooth muscle to relax in
arterial and venous circulation
• Decrease myocardial oxygen use
• Increase collateral-vessel circulation to the heart
– Calcium Channel Blockers
• Dilate coronary arteries and arterioles
• Reduce response of electrical conduction system
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Main Components of
Microcirculation
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Antianginals and Peripheral
Vasodilators (cont.)
Action and Uses
• Nitrates
– Acute and chronic anginal attacks
– Reduce the workload of the heart
• Peripheral Vasodilators
– Relax the smooth muscles of peripheral arterial
vessels to increase peripheral circulation
– Used to treat leg pain caused by vasoconstriction
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Site of Action of Peripheral
Vasodilators
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Antianginals and Peripheral
Vasodilators (cont.)
Adverse Reactions
• Nitrates: Flushing, postural hypotension,
tachycardia, confusion, dizziness, fainting,
headache, lightheadedness, vertigo, weakness,
drug rash, localized pruritus, skin lesions, eye
and mouth edema, local burning in mouth,
nausea and vomiting
• Peripheral Vasodilators: Headache, weakness,
tachycardia, flushing, postural hypotension,
dysrhythmias, confusion, severe rash,
nervousness, tingling, and sweating
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Antidysrhythmics
Four Classes
• Class I: disopyramide, procainamide, quinidine
– Lengthen the refractory period
– Decrease cardiac excitability
• Class II: acebutolol, esmolol, propranolol
– Reduce sympathetic excitation (reduce loading)
• Class III: amiodarone
– Lengthen the time it takes for one cell to fire and recover
• Class IV: verapamil
– Blocks calcium entry into the myocardium, prolongs resting
phase
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Conduction System of the
Heart
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Antidysrhythmics (cont.)
Action and Uses
• Quinidine and Procainamide
– Treat rapid and irregular dysrhythmias by
decreasing the excitability of myocardial cells
• Bretylium
– Slows conduction rate in the ventricles, slows
norepinephrine release in the myocardium
• Disopyramide
– Slows the depolarization of cardiac cells
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Antidysrhythmics (cont.)
• Lidocaine
– Increases the strength of electrical impulses
• Adenosine
– Stops the heart for several seconds to allow it to
convert to normal sinus rhythm
• Beta-adrenergic blockers (propranolol)
– Decrease the heart beta-receptor response to
epinephrine and norepinephrine
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Antihyperlipidemics
Types of Lipoproteins
• Chylomicrons (mostly triglycerides)
– Formed from absorption of dietary fat in intestine
• Very low-density lipoproteins (VLDLs)
– Made up of large amounts of triglycerides that were made in the
liver (pre-beta lipoproteins)
• Low-density lipoproteins (LDLs)
– Breakdown of VLDLs linked with cholesterol and protein
• High-density lipoproteins (HDLs)
– Clear out excess cholesterol from tissue
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Path of Lipid Metabolism
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Antihyperlipidemics (cont.)
• HMG-CoA Reductase Inhibitors
– Highly effective for lowering LDL levels
• Fibric Acid Derivatives
– Highly effective for lowering triglyceride and
increasing HDL levels
• Bile Acid Sequestrants
– Form an insoluble compound with bile salts to reduce
serum cholesterol levels
• Niacin
– Effective at lowering LDL levels and increasing HDLs
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Chapter 15
Lesson 15.2
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Learning Objectives
• List the general uses and actions of
cardiotonic drugs
• Explain the actions of different
categories of drugs used to treat
hypertension
• Identify indications for electrolyte
replacement
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Internal Anatomy of the Heart
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Coronary Arteries
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Coronary Arteries
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Cardiotonics
Actions
• Increase the contraction strength or force
(positive inotropic action)
• Slow the heart rate
Uses
• Treatment of CHF and rapid or irregular
heartbeats (atrial fibrillation, atrial flutter,
frequent PVCs or paroxysmal atrial
tachycardia)
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Cardiotonics (cont.)
Adverse Reactions
• Digitalis toxicity: serum digoxin levels verify
• The amount of medication that is helpful (therapeutic)
and the amount that is harmful (toxic) are not very
different.
• Don’t confuse the sound-alikes digoxin and digitoxin
Drug Interactions
Nursing Implications and Patient Teaching
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Antihypertensives, Diuretics, and Other
Drugs Affecting the Urinary Tract
Diuretics
• Indirectly reduce blood pressure by producing
sodium and water loss and lowering the tone
or rigidity of the arteries
• Types
– Thiazide and sulfonamide diuretics
– Loop diuretics
– Potassium-sparing diuretics
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Antihypertensives, Diuretics, and Other
Drugs Affecting the Urinary Tract (cont.)
Adrenergic Inhibitors
Beta-adrenergic blockers
Nonselective; block beta1 and beta2 sites
Selective; block beta1 sites
Central adrenergic inhibitors
Cause vascular relaxation and lower blood pressure
Peripheral adrenergic antagonists
Limit norepinephrine release, prevent vasoconstriction
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Antihypertensives, Diuretics, and Other
Drugs Affecting the Urinary Tract (cont.)
Alpha1-adrenergic inhibitors
Lower peripheral resistance and blood pressure
Combined alpha- and beta-adrenergic blockers
Angiotensin-Related Agents
Angiotensin-converting enzyme inhibitors
Angiotensin II receptor antagonists
Vasodilators
Calcium Channel Blocking Agents
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High Blood Pressure
• Stage I: Lifestyle Changes
• Stage II: Drug Therapy
• Adverse Reactions
– Drug specific
• Drug Interactions
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Drugs Useful in Treating
Urinary Problems
• Urinary incontinence
– Treatment: anticholinergics/antispasmodics, alphaadrenergic agonists, estrogens, cholinergic agonists,
and alpha-adrenergic antagonists
• Benign prostatic hyperplasia
– Treatment: alpha1-adrenergic receptor blockers
• Analgesia
– Treatment: phenazopyridine
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