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Cardiovascular Pharmacology
Presented by
Marcia Cornell RN, BSN, EMT-P
Teresa Peck BSN, RN
Cardiac Anatomy
Coronary arteries
Nitrates / Vasodilators
Examples
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Nitroglycerin (NTG)
Isosorbide (long-acting) (iso-Bid, Isordil, Sorbide, Srbitrate)
Nitrates / Vasodilators
Purpose / Causes
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Reduce peripheral resistance
Reduce workload on heart
Provide a better balance of oxygen supply and demand
Angina attacks
MI
Nitrates / Vasodilators
Adverse Effects
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Decrease in BP
 Dizziness
 Headache
 Syncope (fainting)
 Flushed face
Nitrates / Vasodilators
Nursing Interventions
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Sit quietly after taking
Assess B/P
If not effective after 3 doses, seek help
Beta-Blockers
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Examples
 Metoprolol (Toprolol) (Lopressor)
 Atenolol
 Propranolol (Inderal)
 Meliletine HCL (Mexitil)
 Propafenone HCL (Rythmol)
 Tocainide HCL (Tonocard)
 Sotalol HCL (Betapace)
 Acebutolol HCL (Sectral)
 Esmolol HCL (Brevibloc)
 Carvedilol (Coreg)
Beta-Blockers
Purpose / Causes
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Tx angina, HTN, arrhythmias (SVT, VT, ST)
Block beta-adrenergic receptors
Prevent SNS from increasing heart activity
Decreases excitability of cardiac muscle
Slows HR, decreases BP
Decreases myocardial O2 demand
Beta-Blockers
Adverse Effects
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Low HR
Low BP
Dizziness, fainting, headache
Beta-Blockers
Nursing Interventions
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Monitor HR, BP
Monitor for diarrhea, visual disturbances, respiratory distress.
Use with caution w/ pt w/ lung dx.
Monitor for dysrhythmias, dizziness, sleep disturbances
Calcium Channel Blockers
Examples
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Diltiazem (Cardizem)
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Verapamil (Calan, Isoptin)
Nifedipine (Adalat)
Calcium Channel Blockers
Purpose / Causes
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Block movement of calcium ions into cardiac and smooth muscle fiber.
Decrease cardiac contractility
Anti-arrhythmic – excessive atrial activity
Anti-hypertensive
Vasodilator – coronary arteries
Angina
Calcium Channel Blockers
Adverse Effects
 Dizziness
 Fainting
 Headache
 Fatigue
 Peripheral edema
 Nausea/ vomiting
 Tachycardia
 Use caution w/ CHF
 Increase toxicity of digoxin
Calcium Channel Blockers
Nursing Interventions
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Monitor apical pulse and BP
Watch for dizziness
Cardioglycoside
Examples
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Digoxin (Lanoxin)
Cardioglycoside
Purpose / Causes
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Tx heart failure
Anti-arrhythmic – atrial dysrhythmias
 A-fib w/ RVR, PSVT
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Slows conduction of impulses / HR
Increases contractility
Increases Cardiac Output (CO)
Cardioglycoside
Adverse Effects
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Toxic S/S
Nausea / vomiting
Fatigue
Headache
Weakness
Cardioglycoside
Nursing Interventions
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Observe for signs of toxicity
 N/V, anorexia, dysrhythmias, bradycardia, tachycardia, HA, fatigue,
visual disturbance.
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Blood levels checked
Monitor apical pulse and BP
Antihypertensives
Examples
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Adrenergic blocking agents
Sympathetic blocking agents
Calcium channel blockers
Diuretics
ACE inhibitors
Antihypertensive
Purpose / Causes
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Used to lower BP with minimal side effects
Inhibit SNS
Decrease sympathetic tone
Activate alpha receptors in medulla to decrease HR, BP, CO.
Antihypertensive
Adverse Effects
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Decreased HR
Low BP
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Nasal congestion
Reflex tachycardia
Dry mouth
Fluid retention
Depression
drowsiness
Antihypertensive
Nursing Interventions
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Monitor HR, BP
Monitor Diet, Wt.
Monitor Electrolytes.
Angiotension Converting Enzyme Inhibitor / ACE Inhibitors
Examples
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Enalapril (Vasotec)
Ramipril (Altace)
Captopril (Capoten)
Losartan (Cozaar)
ACE Inhibitors
Purpose / Causes
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Tx HTN, CHF
Block conversion of angiotension I to angiotensin II
Reduce peripheral resistance
Reduce aldosterone secretion
 Decreases preload and afterload
ACE Inhibitors
Adverse Effects
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Headache
Dizziness
Hypotension
Angioedema*
COUGH
ACE Inhibitors
Nursing Interventions
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Monitor HR,BP
Wt, diet
Monitor for swelling of the face
Diuretics (“Water pill”)
Examples
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Hydrochlorothiazide (HCTZ)
Furosemide (Lasix)
Spironolactone (Aldactone)
Diuretics
Purpose / Causes
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Remove excess sodium and water
Block reabsorption of sodium and water
Tx HTN, CHF
Diuretics
Adverse Effects
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May remove excessive potassium
Nausea / vomiting
Diarrhea
Dizziness
Diuretics
Nursing Interventions
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Monitor potassium levels
Monitor fluid intake
Monitor Wt.
Monitor urinary output
Cholesterol / Lipid lowering-STATINS
Examples
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Simvastatin (Zocor)
Lipitor
Lovastatin (Mevacor)
Crestor
All of these are statins
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Take on empty stomach
Cholesterol / Lipid lowering-Bile Acid Resins
Questran
Colestid
These are bile acid resins
Increased fluids and vitamins(D,E,K)
Cholesterol / Lipid lowering-Niacin
Niacin (Niacor, Niaspan, Slo-Niacin)
Flushing due to increased release histamine
Cholesterol / Lipid lowering-Fibric Acid Medications
Tx high triglycerides and high cholesterol
Ex-gemfibrozil (Lopid)
Cholesterol / Lipid lowering
Purpose / Causes
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Reduce low density lipoprotein (LDL) and cholesterol content.
Cholesterol / Lipid lowering
Adverse Effects
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Digestive discomfort
 Bloating, N/V, constipation
Muscle cramps
Impotence
Flushing-Niacin
Wt. loss
Insomnia
Water retention
Cholesterol / Lipid lowering
Nursing Interventions
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Restrict intake of fats, cholesterol, alcohol
STOP SMOKING
Exercise
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Anti-platelets / Anti-coagulants
Examples
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Warfarin (Coumadin) (PO)
Heparin (IV or SQ)
Plavix (PO)
Ticlid (PO)
Fragmin (SQ)
Lovenox (SQ)
Arixtra(SQ)
Anti-platelets / Anti-coagulants
Purpose / Causes
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Reduce risk of blood clot formation
Block coagulation process
Coumadin – interferes with vitamin K synthisis of clotting factors
ASA – prevents platelet adhesion
Anti-platelets / Anti-coagulants
Adverse Effects
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Aspirin (ASA)(PO)
Bleeding
 Avoid Trauma
Gastric irritation
Anti-platelets / Anti-coagulants
Nursing Interventions
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Monitor clotting ability
 PT / APTT
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Observe for bleeding
Monitor diet for foods high in vitamin K.
Rotate injection sites if SQ
Anti-dysrhythmics
Examples
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Procainamide (Pronestyl, Procan SR)
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Lidocaine
Disopyramide (Norpace CR)
Quinidine sulfate (Quinidex Extentabs)
Adenosine (Adonocard)
Antidysrythmics-Oral
Norpace
Procanbid
Quinidine
Tambocor
Cordarone
Anti-dysrhythmics
Purpose / Causes
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IV – for severe ventricular dysrhythmias
Suppress impulse triggering dysrhythmias.
Long term tx of V-tach, a-fib
Slows conduction thru AV
Anti-dysrhythmics
Adverse Effects
 Dry mouth
 Blurred vision
 Low BP
 Nausea/vomiting
 Dizziness
 Visual disturbances
 HA
 GI discomfort
 dysrythmias
Anti-dysrhythmics
Nursing Interventions
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Monitor HR (apical) and BP
No caffeine within 4-6 hrs of adenocard – inhibits effects
Inotropics
Examples
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Dobutamine (Dobutrex) (IV)
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Dopaminie (Intropin) (IV)
Inotropics
Purpose / Causes
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Increases myocardial contractility
Increases cardiac output
Increases BP
Improves renal blood flow
Used w/ severe CHF/ Pulmonary Edema
Inotropics
Adverse Effects
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Elevated BP, HR
Decreased peripheral circulation
Inotropics
Nursing Interventions
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Monitor BP, HR, Urinary output
Palpate peripheral pulses
 Notify physician if extremities are cold/mottled.
Vasopressors
Examples
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NTG (IV)
Nipride (IV)
Dopamine
Levophed
Vasopressors
Purpose / Causes
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Increase BP, CO
Vasopressors
Adverse Effects
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HA, elevated BP
N/ V
dizziness
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Vasopressors
Nursing Interventions
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Monitor Vital signs
Tranquilizers / Anti - anxiety
Examples
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Diazepam (valium)
Ativan
Tranquilizers
Purpose / Causes
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Decrease restlessness and anxiety
Tranquilizers
Adverse Effects
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Sedation
Dizziness
Tranquilizers
Nursing Interventions
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Use safety precautions
Thrombolytic Agents
Examples
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Streptokinase (Streptase)
Alteplase
Recombinant Activase
Tissue plasminogen activator (TPA)
Thrombolytic Agents
Purpose / Causes
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Dissolves blood clots when MI S/S less then 6 hr old.
 Prefer within 30 -60 min.
Restores blood flow
Limits size of infarction
Thrombolytic Agents
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Adverse Effects
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Bleeding
Stroke
Thrombolytic Agents
Nursing Interventions
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Monitor VS, telemetry
Monitor for signs of stroke
Stool Softeners
Examples
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Surfak
Colace
Stool Softeners
Purpose / Causes
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Reduce straining
Prevent constipation
Stool Softeners
Adverse Effects
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diarrhea
Stool Softeners
Nursing Interventions
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Monitor stools
Electrolytes
Examples
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Potassium
Magnesium
Calcium
Electrolytes
Purpose / Causes
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Restore electrolyte balance
Electrolytes
Adverse Effects
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Electrolytes
Nursing Interventions
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Analgesics
Examples
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Morphine
Analgesics
Purpose / Causes
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Control pain
Decrease myocardial oxygen demand
Analgesics
Adverse effects
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Monitor electrolyte levels
Low BP
N/V
Sedation
Analgesics
Nursing Interventions
Acute MI
M-Morphine
O- Oxygen
A-Aspirin
N-Nitroglycerin
Peripheral Vascular Medications
Trental-decreases blood viscosity, improves flow
Papaverine-relaxes and dilates muscle in vessels
Pletal-vasodilator, decrease platelet aggregation
Questions
Early signs of dig toxicity are:
A sustained pulse rate >60
N/V
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Diarrhea and rectal bleeding
Elevated respiration and BP
Early signs of dig toxicity are:
N/v
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A pt in ICU goes into Cardiogenic shock. The primary effect that the nurse
would look for after a Levophed drip is initiated is:
Decreased hyperventilation
Decreasing polyuria
Increasing BP
Increasing orientation
Increasing BP
A 62yo pt has an acute angina attack. The nurse knows that the treatment
of choice will be
Calcium channel blockers
Beta blockers
Nitrates
Narcotic analgesics
Nitrates