NR118 Care of the Adult
Cardiac Drugs
Information from Harding, et al (2020) or from Deonne Johnson, RN, MSN
Class/Examples
Indication
Patient Teaching/Nursing Implications
Short Acting Nitrates
First line therapy for
1. Teach patient to keep from direct
the treatment of
sunlight.
 Nitrostat (Sublingual
angina.
Act
to
dilate
2.
Place tablet or direct spray under
NTG)
peripheral blood
tongue. May cause a tingling
 Nitrolingual
vessels to decrease SVR
sensation. If no tingling sensation
(Translingual spray)
which reduces cardiac
occurs the drug may be ineffective.
workload.
3. Call EMS if pain persists after 5
minutes. May take an additional 2
tablets while waiting on EMS to
arrive.
4. NTG may cause increased HR,
headache and dizziness. Patient can
take acetaminophen for headache.
5. Caution patient not to stand up too
quickly because hypotension may
occur after NTG administration.
6. NTG may be taken prophylactically
before activity known to precipitate
chest pain.
7. Patient should report any changes in
normal pattern or response of pain.
8. Replace the NTG tablets every 6
months because they lose potency
once opened.
Long-Acting Nitrates
Used to reduce the
1. Predominant side effect is headache.
incidence of chest pain.
Headaches may diminish over time
 Isordil (Isosorbide
even though the anti-angina effect
dinitrate)
remains.
 Imdur (isosorbide
2. Orthostatic hypotension is a
mononitrate)
problem with all nitrates.
 Nitroglycerin
3. Tolerance to NTG-induced
Ointment
vasodilation can develop, so patients
 Transdermal
should schedule an 8 hour nitrateControlled-Release
free period every day (preferably at
Nitrates (patch)
night).
4. Nurse should avoid getting the
ointment or the medication from the
patch on skin.
5. See implications for short acting
nitrates.
β-Adrenergic Blockers
 Inderal (propranolol)
 Lopressor
(metoprolol)
 Corgard (nadolol)
 Tenormin (atenolol)
 Coreg (carvedilol)
 Bystolic (nebivolol)
Calcium Channel Blockers
 Procardia (nifedipine)
 Calan (verapamil)
 Cardizem (diltiazem)
 Cardene (nicardipine)
Preferred drugs for the
management of
chronic stable angina.
Decrease myocardial
contractility, HR, SVR
and BP to reduce the
myocardial oxygen
demand. Also, have
been shown to
decrease morbidity and
mortality in patients
with CAD, especially
following MI.
May be used if βblockers are poorly
tolerated,
contraindicated or
ineffective against
angina pain.
Also used to manage
Prinzmetal’s angina
pain.
ACE Inhibitors
 Capoten (captopril)
 Vasotec (enalapril)
 Lotensin (benazepril)
 Prinvil, Zestril
(lisinopril)
ARBs (Angiotensin II Receptor
Blockers)
 Cozaar (losartan)
 Diovan (valsartan)
 Benicar (olmesartan)
PDE5 Inhibitors
Cause systemic
vasodilation (decreased
SVR), decreased
myocardial
contractility, and
coronary vasodilation.
May be added to the
drug regimen for
certain high-risk
patients with chronic
stable angina.
Used to treat high
blood pressure (HTN)
and Chronic Kidney
Disease. Blocks the
angiotensin 2 receptor
sites so that sodium
retention and
vasoconstriction do not
occur.
Originally discovered
during the search for
1. Sometimes are poorly tolerated d/t
the side effects of bradycardia,
hypotension, wheezing and GI
complaints.
2. Should be avoided in patients with
asthma, cautious use in patients
with diabetes (mask signs of
hypoglycemia. Should NOT BE
DISCONTINUED ABRUPTLY without
medical supervision.
1. Potentiate the action of digoxin.
Digoxin levels should be closely
monitored after starting this
therapy.
2. Teach patient signs and symptoms
of digoxin toxicity. (Bradycardia &
dizziness or syncope, nausea &
vomiting, visual disturbance)
3. Should be used with caution in
patients with heart failure.
4. Avoid grapefruit while on nifedipine.
1. Can cause orthostatic hypotension.
2. Cough can be very bothersome and
cause people to stop the
medication.
3. Should not be used with potassiumsparing diuretics as hyperkalemia
may result.
1. May cause dizziness, hyperkalemia,
angioedema.
2. Problems such as severe diarrhea or
weight loss should be reported to
the PCP.
1. Because these medications are given
for erectile dysfunction and act by



Viagra (sildenafil)
Cialis (tadalafil)
Levitra (vardenafil)
new anti-anginal
medications.
2.
Diruetics
Loop Diuretic
 Lasix (furosemide)
Thiazide Diuretic
 HCTZ(hydrochlorothiazide)
Potassium-sparing
 Aldactone
(spironolactone)
Given to reduce or
prevent fluid overload
associated with cardiac
failure.
Anti-platelet
Aggregation/Anticoagulant
 Aspirin
 Plavix (clopidogrel)
 Heparin
 Coumadin
Given to prevent
thrombus formation in
at-risk clients.
1.
2.
3.
1.
2.
3.
Anti-dysrhythmics
 Digoxin (lanoxin)

Lidocaine

Atropine

Amiodarone
Digoxin is given to slow
and strengthen cardiac
contractions. Given to
control atrialfibrillation
Lidocaine is given to
control PVCs and
prevent conversion to
Ventricular Tachycardia
or Ventricular
Fibrillation. Acts to
decrease ventricular
irritability and
excitability.
Atropine is given to
correct bradycardia or
asystole.
Amiodarone is used to
1.
vasodilating the vessels of the penis,
patients taking these drugs should
not take nitrates.
These drugs are being studied for
the treatment of pulmonary
hypertension.
Watch for hypokalemia with the
loop diuretics and thiazide diuretics.
Patient may be on a potassium
supplement if on the above
medications.
Watch patients for digoxin toxicity if
on Lasix. Hypokalemia predisposes
the patient to digoxin toxicity.
Patients taking digoxin and Lasix
should be on a potassium
supplement.
Daily ASA 81 mg often prescribed for
post MI or in patients who are at
risk.
Heparin is administered following
fibrinolytic (thrombolytic) therapy to
prevent new clot formation.
Coumadin prescribed long-term for
uncontrolled atrial fibrillation to
prevent clots caused by increased
turbulence in blood flow.
Digoxin: A) Teach patients to check
pulse daily. Call provider if pulse
falls below 60 bpm. B) Teach patient
to recognize S/S of digoxin toxicity.
C)Hospitalized clients on digoxin will
have apical pulse daily prior to
administration.
2. Lidocaine is administered via IV. It
has been associated with malignant
hyperthermia.
3. Atropine is administered via IV. It is
a potent anticholinergic drug and a
belladonna alkaloid. Used after
epinephrine for asystole or pulseless
electrical activity to restore NSR.
(Anticholinergics cause increased
heart rate, dry mouth, urinary
retention, constipation and dilated
pupils with blurred vision)
treat life-threatening
dysrhythmias of the
ventricles (ventricular
tachycardia or
fibrillation).
4. The first dose of Amiodarone should
be given in the hospital, and only
used for people who have tried
other anti-dysrhythmia medication.