Cardiovascular System Drugs Flashcards
Cardiovascular System Drugs
● Antihypertensives
○ ACE inhibitors
○ Angiotensin II Receptor Blockers
○ Calcium Channel Blockers
○ Vasodilators
○ Diuretics
● Antiarrhythmics – affect the rhythm of the heart
○ Electrolyte blockers
○ Beta blockers
○ Digoxin
○ Atropine
Angiotensin-converting enzyme inhibitors (ACE inhibitors)
Suffix - pril
Indication: Hypertension, CHF
Action: Blocks conversion of angiotensin I to angiotensin II, increases renin levels and decreases aldosterone leading to vasodilation
Nursing Considerations:
● Can cause a non-productive dry cough - should be discontinued if it does
* Nothing makes it go away – can progress into angioedema
● Monitor BP
● Contraindicated during pregnancy – they cause birth defects (the amount of amniotic fluid around the fetus can be decreased)!
Angiotensin II Receptor Blockers (ARBs)
Suffix - sartan
Indication: hypertension, DM neuropathy, CHF
Action: inhibits vasoconstrictive properties of angiotensin II
Nursing Considerations:
● Monitor BP
● Monitor fluid levels
● Monitor renal and liver status
● Contraindicated during pregnancy
● Does not cause a dry cough
What is calcium responsible for?
Our blood vessels and heart need calcium to contract
Calcium Channel Blockers in the Heart and Blood Vessels
Suffix - mil
Names: Verapamil and Diltiazem
Indication: Hypertension, angina, dysrhythmias (a-fib/flutter)
Action: Blocks calcium channels in the heart and blood vessels. In the blood vessels - causes vasodilation so more blood can go to the heart (decreasing BP), and increased coronary perfusion. In the heart - can slow the heart rate, slow AV node conduction, and decrease the force of contraction
Nursing Considerations:
● Side effects:
○ Constipation → Increase dietary fiber/fluid intake (slowing down peristalsis in the gut)
○ Dizziness, facial flushing, HA, edema in ankles and feet
● Interactions:
○ Enhances cardiac suppression with digoxin and β-blockers (can slow down the heart too much with these meds). If given together, monitor closely!
○ Caution in HF (contractility goes down with calcium channel blockers) - that pump would fail to push blood forward, don’t want this
○ DO NOT GIVE in AV block > 2nd degree (heart is already having slowing of impulses – will slow it down further)
○ Can give calcium channel blockers that ONLY act on the blood vessels with HF and AV block!
Calcium Channel Blockers ONLY in the blood vessels
Suffix - dipine
Indication: Hypertension, angina
Action: Blocks calcium channels in the blood vessels. Causes vasodilation (decreasing BP), and increased coronary perfusion
Nursing Considerations:
● Side effects:
○ Dizziness, facial flushing, HA, edema in ankles and feet
○ Gingival hyperplasia → use a soft bristle toothbrush and have good dental care
○ * Reflex tachycardia - Can combine with a β-blocker to prevent this side effect (compensate to get CO up)
● *No constipation
● *Preferable for clients with HF or AV block
● Interacts with grapefruit juice
Arterial Venodilators
- Only used in emergencies
Names: Hydralazine, Minoxidil
Indication: Hypertension, hypertensive crisis, HF
Dilates arterial smooth muscles, decreases BP (afterload), which increases CO
Nursing Considerations:
● Reflex tachycardia can occur → can combine with a BB to reduce!
● Hypotension can trigger volume expansion → can combine with a diuretic to reduce!
● Long term use can cause SLE–like symptoms (lupus like) - should be d/c’d.
● Increased fall risk (because we’re dropping the BP quickly)
Arterial and Venous Venodilators
- Only used in emergencies
Names: Nitrates- nitroglycerin
Indication: Hypertension, hypertensive crisis, angina
Action: Venous dilation reduces venous return to heart (preload - slower flow/pressure), causing a decrease in ventricular contraction (decreases the workload/demand of the heart!) Arterial dilation decreases BP (afterload), which increases CO
Nursing Considerations:
● Headache is an expected side effect (lots of blood rushing to the head)
● Other common side effects: dizziness, flushing, orthostatic hypotension, falls risk
What are the 6 classes of anti-arrhythmics?
Class 1 = Sodium channel blockers:
● Procainamide
● Lidocaine
Class 2 = Beta blockers:
● Propranolol
● Esmolol
Class 3 = Potassium Channel blockers:
● Amiodarone
● Sotalol
● Ibutilide
Class 4 = Calcium Channel Blockers:
● Diltiazem
● Verapamil
Anticholinergic and antiarrhythmic:
● Atropine → used for bradycardia
Misc:
● Adenosine
● Digoxin
Atropine
Therapeutic class: Antiarrhythmic; anticholinergic
Indication: excessive secretions (rest & digest), sinus bradycardia, heart block
Action: Inhibition of acetylcholine, increasing the HR, causing bronchodilation, and decreasing secretions
Nursing Considerations:
● Monitor for urinary retention and constipation
● Avoid in clients with glaucoma (increased pressure in eyeball)
Sodium Channel Blockers
Names: Procainamide, Lidocaine
Indication: Used for many dysrhythmias
Action: Blocks sodium channels, which slows impulse conduction and delays repolarization
Nursing Considerations
Adverse effects:
● Diarrhea
● SLE-like syndrome (lupus S&S)
● Negative inotropic (how hard the heart is pumping) effects → hypotension, cardiosupression (not good for HF)
Stimulation of Beta-1 receptors can result in chronotropy and inotropy - what is that?
Chronotropy - increased HR
Inotropy - increased contractility
What are Beta-1 and Beta-2 receptors responsible for?
● Beta 1 receptors in the heart - job is to increase HR
● Beta 2 receptors in the lungs - job is bronchodilation, gluconeogenesis
● Beta 2 in the uterus - uterine relaxation (prevents contractions) in case of an emergency
Beta-blockers
Suffix - lol
Names: Propranolol, metoprolol, atenolol, esmolol
Indication: hypertension, angina, arrhythmias, MI, cardiomyopathy, alcohol withdrawal, anxiety
Action: blocks Beta 1 and 2 adrenergic receptors slowing the heart rate
Nursing Considerations:
● Do not discontinue abruptly, discontinue them slowly
● Can mask (hides) the signs of hypoglycemia (will decrease HR); important to monitor blood sugars
● Caution with asthma and COPD - can potentially cause bronchospasm – since we have beta receptors in the lungs (activate beta 2 receptors)
Potassium Channel Blockers
Names: Amiodarone, Ibutilide
Indication: Dysrhythmias
Action: Blocks potassium currents to prevent repolarization, decreases myocardial excitability and interferes with other excitatory pathways (beta receptors, Na, Ca) – slowing HR, slowing impulses (won’t be given to acutely convert somebody out of a rhythm, it’s going to be given to help keep them in a normal sinus rhythm)
Nursing Considerations:
● SE of amiodarone: dizziness, tremors, ataxia, pulmonary fibrosis, bradycardia, heart block, blue-gray skin discoloration (has iodine in it)
● Has iodine and can disturb thyroid
● Not given in pregnancy!
