Cardiac Meds
Hypertension
1. ACE inhibitors – blocks production of angiotensin II  vasodilation, sodium and urine excretion, potassium retention
a. “pril” – captopril, enalapril, lisinopril
b. Adverse reactions  hypotension, rash, dry
cough
c. Nursing interventions  monitor for
hyperkalemia d/t potassium retention, poss stop
diuretics temporarily, monitor for angioedema
d. Administration  oral 2-3 times daily, given
before meal to increase absorption
e. Contraindications  not for use on patients w/
decreased renal function
f. Interactions  potassium sparing
diuretics/potassium supplements, nitroglycerin
d/t extreme vasodilation (hypotension)
2. Angiotensin II receptor blockers (ARBs) – blocks receptors for angiotensin II  vasodilation, sodium and urine
excretion, potassium retention
a. Similar to ACE inhibitors, but less effective for
preventing acute cardiovascular events (MI).
b. “artan” – losartan, valsartan, candesartan
c. Adverse reactions  angioedema, dizziness,
hypotension, insomnia
d. Nursing interventions  monitor BP before
administration, monitor for angioedema (treat
w/ epinephrine)
e. Administration  oral only, take with or without
food
f. Contraindications  caution w/ diuretic use,
hyperkalemia, and renal issues
g. Interactions  if given w/ other
antihypertensives monitor for hypotension
Cardiac Meds
3. Calcium channel blockers – also used for dysrhythmias and angina – blocks calcium channels in vascular smooth muscle
 vasodilation and lowered blood pressure
a. Nifedipine, verapamil
b. Adverse reactions  reflex tachy and angina, headache, lightheadedness and dizziness d/t vasodilatory effect
c. Nursing interventions  monitor heart rate, monitor for lightheaded and dizziness, monitor BP and hold if
systolic below 90, have regular dental checkups and good oral hygiene
d. Administration  nifedipine oral, some others can be IV use, do not crush or chew sustained-release forms,
may also be administered with a beta blocker to prevent reflex tachycardia
e. Contraindications/precautions  no grapefruit juice, st johns wort, or use in people who have renal
impairment
f. Interactions  st johns wort decreases affects, grapefruit juice may increase blood levels and
antihypertensive effects
4. Alpha 1 blockers – also used for BPH – blocks alpha 1 receptors  dilation of target organ
a. Doxazosin, prazosin
b. Adverse reactions  orthostatic hypotension,
reflex tachycardia (natural response to sudden
drop in BP)
c. Nursing interventions  monitor headaches
and for reflex tachycardia
d. Administration  take at bedtime and rise
slowly from lying
e. Contraindications/precautions  caution w/
hepatic disease and geriatric clients
f. Interactions  use w/ Viagra increases
hypotension
5. Beta blockers – also used for angina, dysrhythmias, MI, and heart failure – blocks beta receptors in heart and kidneys
 decreased release of renin from kidneys and decreased HR and contractility
a. “olol” – atenolol, metoprolol, propranolol
b. Adverse reactions  bradycardia, SOB, coughing especially when laying flat
c. Nursing interventions  monitor HR (less than 60 report), monitor for SOB, do not stop med suddenly
d. Administration  oral and IV use, may be enhanced with food, take at same time everyday (before meals or
bedtime)
e. Contraindications/precautions  do not use for bradycardia, or greater than 1st degree heart block, heart
failure. Caution with Reynaud’s disease, liver disorders, renal disorders.
f. Interactions  use with other antihypertensive drugs may increase effects, use with digoxin may increase
bradycardia, anticholinergic drugs may decreased beta blocker effects
Cardiac Meds
6. Alpha 2 agonists – also used epidural injection and ADHD management – selectively activates alpha 2 receptors in brain
 reduces BP by reducing sympathetic stimulation
a. Clonidine
b. Adverse reactions  CNS effects like drowsiness and dizziness, as well as dry mouth, rebound hypertension
may occur if stopped abruptly
c. Nursing interventions  monitor for CNS effects, dry mouth will resolve after few weeks, taper slowly
d. Administration  oral, transdermal patch, give oral at bedtime to reduce drowsiness, apply patch to dry upper
outer arm or anterior chest once every 7 days (rotate locations).
e. Contraindications/precautions  do not use w/ anticoag therapy
f. Interactions  increased sedation effects of CNS depressants (alcohol, opioids), decreased effects when used
with MAO inhibitors, tricyclic antidepressants, and amphetamines
7. Alpha/Beta blockers – also used for heart failure in conjunction with digoxin/ace inhibitors/diuretics – blocks alpha and
beta receptors  dilation of arterioles, decreased heart rate and contractility, and decreased release of renin 
decreased resistance of blood vessels, decreased cardiac output, and increased excretion of water and sodium
a. “lol – carvedilol, labetalol
b. Adverse reactions  dizziness, hypotension, bradycardia, postural hypotension
c. Interventions  monitor BP and report hypotension, report HR below 60 and hold drug
d. Administration  oral, give with food to minimize hypotension
e. Contraindications/precautions  do not use with severe unstable HF, asthma, severe bradycardia, or
cardiogenic shock
f. Interactions  use with insulin will alter effectiveness of hypoglycemic meds
8. Vasodilators – also used for HF, angina – dilates arterioles which decreases resistance and blood pressure
a. Hydralazine
b. Adverse reactions  reflex tachycardia, dizziness, weakness, fluid retention and edema, taper when stopping,
facial rash, joint pain
c. Nursing interventions  monitor for tachycardia, monitor for systemic lupus effects, monitor for crackles in
lungs (fluid retention)
d. Administration  oral, IM, IV, oral with food to enhance absorption,, IV undiluted (only use to stop
hypertensive crisis so need to monitor BP)
e. Interactions  severe hypotension with MAOI antidepressants and other hypertensives, NSAIDS may decrease
effectiveness