DRUGS AFFECTING THE

CARDIOVASCULAR SYSTEM

DRUGS AFFECTING BLOOD

PRESSURE

ANTIHYPERTENSIVE AGENTS
Does not cure HPN but maintains the BP within
normal range to prevent the damage that HPN
can cause

DIURETICS
Drugs that increase the excretion of sodium and
water from the kidney
Often the first agents tried in mild hypertension> affecting the blood sodium levels and blood
volume
Decrease BP and edema
usually given at morning

DRUGS AFFECTING BLOOD

PRESSURE

CARBONIC ANHYDRASE INHIBITORS

- Acetazolimide (Diamox)

- increase Na+, K+, & HCO3 secretion,

along with it is H2O

- metabolic acidosis
OSMOTIC DIURETIC

- Mannitol

- Increase osmotic pressure of the

glomerular filtrate.

- hypotension
- decreasing intracranial and intraocular
pressures

DRUGS AFFECTING BLOOD

PRESSURE
THIAZIDE DIURETICS

- hydrochlorothiazide

- blocks Na and K reabsorption; reabsorb Ca (K-wasting)

- hypercalcemia, hypokalemia
Advise the client to rise slowly from a sitting to a standing
position to avoid dizziness.
Diet: rich in K
LOOP DIURETICS

- Furosemide (Lasix)

- blocks Na, K, and Ca reabsorption

- hypocalcemia
POTASSIUM SPARING DIURETICS

- Spironolactone (Aldactone)

- excrete Na and water but it reabsorb K

- hyperkalemia

DRUGS AFFECTING BLOOD

PRESSURE

SYMPATHETIC NERVOUS SYSTEM BLOCKERS

A. Beta-blockers
- block vasoconstriction, decrease HR, decrease
cardiac muscle contraction, and tend to increase
blood flow to the kidneys -> decrease in the
release of renin

B. Alpha- and beta-blockers

- useful in conjunction with other agents and tend to
be powerful -> blocking all sympathetic receptors
- complains of fatigue, loss of libido, inability to
sleep, GI, GU disturbances -> unwilling to
continue

DRUGS AFFECTING BLOOD

PRESSURE
SYMPATHETIC NERVOUS SYSTEM BLOCKERS
C. Alpha-adrenergic blockers
- inhibit alpha1-adrenergic receptors, decreasing
sympathetic tone in the vasculature and cause
vasodilation -> lowered BP

D. Alpha1-blockers
- used to treat HPN-> blocks alpha 1 receptors -> decreases
vascular tone -> vasodilation -> decrease BP

E. Alpha2-agonists
-stimulate alpha2-receptors in the CNS -> inhibit
cardiovascular centers -> decrease in sympathetic outflow
-> decrease BP
- associated with CNS, GI effects and dysrhythmias

DRUGS AFFECTING BLOOD

PRESSURE

ANGIOTENSIN-CONVERTING ENZYME (ACE)

INHIBITORS

Blocks the conversion of angiotensin I to

angiotensin II in the lungs-> stops the
renin-angiotensin system before
vasoconstriction can occur or aldosterone
can be release.
Can be used alone or with diuretics
benazepril (Lotensin), enalapril (vasotec),
lisinopril (Zestril), captopril (Capoten)

DRUGS AFFECTING BLOOD

PRESSURE
THERAPEUTIC ACTION
prevent ACE from converting angiotensin I to angiotensin
II (powerful vasoconstrictor and stimulator of aldosterone
release) -> decrease in BP and aldosterone secretion ->
increase in K and loss of Na and fluids
USES:
HPN, CHF (with digoxin, diuretics)
Related to decrease in workload associated with decrease
in peripheral resistance and blood volume

PHARMACOKINETICS:
A: well-absorbed; D: widely distributed; M: liver; E: urine
and feces
Should not be used during pregnancy

DRUGS AFFECTING BLOOD

PRESSURE
ADVERSE EFFECTS:
Related to effects of vasodilation and alterations in
blood flow (tachycardia, chest pain, angina, CHF,
arrhythmias; GI irritation, ulcers, constipation, liver
injury, proteinuria, cough -> r/t effects in the lungs

NURSING CONSIDERATIONS:
- not to discontinue medications because it can
cause rebound hypertension.
- avoid using K+ sparing diuretics.(overuse can lead
to hyperkalemia)
-should be taken with empty stomach (1 or 2 hours
after meals)

DRUGS AFFECTING BLOOD

PRESSURE

ANGIOTENSIN II RECEPTOR BLOCKERS

selectively bind the angiotensin II receptors
in blood vessels to prevent vasoconstriction
and in the adrenal cortex to prevent the
release of aldosterone that is caused by
reaction of these receptors with angiotensin
II
lead to decrease in blood pressure caused
by a decrease in total peripheral resistance
and blood volume
irbesartan (Avapro), losartan (Cozaar),
olmesartan (Benicar), telmisartan (MIcardis)

DRUGS AFFECTING BLOOD

PRESSURE

ACTIONS: block vasoconstriction and the

release of aldosterone -> blocks the
blood-pressure rising effects of the reninangiotensin system and lower BP
USES: HPN, CHF, slows down renal disease
associated with HPN and DM

PHARMACOKINETICS:
A: well-absorbed; D: ; M: liver; E: urine and
feces

DRUGS AFFECTING BLOOD

PRESSURE

CONTRAINDICATIONS AND CAUTIONS:

Allergy, pregnancy, lactation, hepatic/renal
dysfunction

ADVERSE EFFECTS:
Headache, dizziness, syncope, weakness
associated with drop in BP/hypotension
Diarrhea, abdominal pain, nausea, dry
mouth, tooth pain
Cough, rashes, dry skin

DRUGS AFFECTING BLOOD

PRESSURE

Calcium Channel Blockers

Prevent the movement of Ca into the cardiac
and smooth muscle cells when cells are
stimulated -> interfere with the muscle cells
ability to contract -> loss of smooth muscle
tone -> vasodilation -> decrease in peripheral
resistance -> decrease in BP, cardiac
workload, myocardial oxygen consumption
Also effective in treatment of angina
amlodipine (Norvasc), diltiazem (Cardizem),
nicardipine (Cardene), nifedipine (Procardia),
verapamil

DRUGS AFFECTING BLOOD

PRESSURE
ACTIONS:
inhibit the movement of Ca ions across the myocardial and
arterial muscle cells -> altering the action potential ->
blocking contraction -> depresses myocardial contractility
-> relaxes and dilates arteries -> fall in BP

PHARMACOKINETICS:
A: well-absorbed; D: placenta/BM/pregnancy; M: liver; E: urine

CONTRAINDICATIONS AND CAUTIONS:

Allergy; renal/hepatic dysfunction; pregnancy and lactation

ADVERSE EFFECTS:
Dizziness, light-headedness, headache, fatigue; nausea,
hepatic injury; hypotension, bradycardia, peripheral edema

DRUGS AFFECTING BLOOD

PRESSURE

VASODILATORS
Relaxation of the vascular smooth muscles ->
decreasing peripheral resistance -> reducing
BP
Severe HPN, hypertensive crisis
diazoxide (Hyperstat), hydralazine (Apresoline),
minoxidil (Loniten), nitroprusside (Nitropress)

ACTIONS:
act directly on vascular smooth muscle to
cause muscle relaxation -> vasodilation ->
drop in BP

DRUGS AFFECTING BLOOD

PRESSURE
USES:
treatment of severe HPN that has not responded to
other therapy

PHARMACOKINETICS:
A: rapidly absorbed; D: widely distributed
(placenta/BM); M: liver; E: urine

CONTRAINDICATIONS/CAUTIONS:
same=)

ADVERSE EFFECTS:
dizziness, anxiety, headache, tachycardia, chest pain,
edema skin rash and lesion, nausea, vomiting

DRUGS AFFECTING BLOOD

PRESSURE

CARDIOTONIC DRUGS
Inotropic drugs -> affects intracellular Ca
levels in the heart muscle -> increased
contractility -> increase CO -> increase
renal blood flow and increase urine
production -> decrease renin release ->
breaking the RAS -> increases UO ->
decrease BV -> decrease workload of the
heart/relieve CHF

DRUGS AFFECTING BLOOD

PRESSURE
I. Cardiac Glycosides
- from foxglove plant or digitalis plants

*digoxin (Lanoxin)
- most often used to treat CHF
- very rapid onset

PHARMACOKINETICS:
- A: oral/parenteral; D: wide; M: liver; E: urine (safe to
hepatic dysfunction/caution to renal dysfunction)
- very narrow margin of safety (Th dose is very close
to To dose) -> digoxin toxicity -> extra care->
digibind (antidote)

DRUGS AFFECTING BLOOD

PRESSURE

ACTIONS:
Decrease in the myocardial workload and relief
CHF

USES:
CHF, atrial flutter, atrial fibrillation, paroxysmal
atrial tachycardia

ADVERSE EFFECTS:
Headache, weakness, drowsiness and vision
changes (halo-> toxicity), GI upset and
anorexia, arrhythmia

DRUGS AFFECTING BLOOD

PRESSURE

NURSING CONSIDERATIONS:
Monitor for toxicity as evidence by :
-nausea, vomiting, anorexia, halo vision,
confusion, bradycardia and heart blocks .
Do not administer if pulse is less than 60 bpm.
Should be caution in patient with
hypothyroidism and hypokalemia.
Antidote : Digi-bind
Phenytoin is the drug of choice to manage
digitalis-induced arrhythmia.
once daily
furosemide + digitalis = increase action of
digoxin

ANTIANGINAL AGENTS
Used to help restore the supply-demand
ratio in O2 delivery to the myocardium
when rest is not enough
Working by: (1) dilating blood vessels
->increasing O2; and (2) decreasing
workload of the heart-> decreasing O2
demand
Nitrates, beta-adrenergic blockers, Ca
channel blockers

ANTIANGINAL AGENTS
Nitrates
Act directly on smooth muscle to cause relaxation and
to depress muscle tone -> do not have action on nerves
Fast action
Relax and dilate blood vessels -> increasing blood flow
and lowers systemic BP because of decrease peripheral
resistance
Vasodilation -> blood pool in veins and capillaries ->
decreasing the BV that the heart has to pump; while
relaxation of the vessels decreases the resistance the
heart has to pump against (afterload)
Combination of these effects greatly reduces the
cardiac workload and the demand for O2->O2 ratio
nitroglycerin (NItrostat), amyl nitrate, isosorbide
dinitrate (Isordil), isosorbide mononitrate (Imdur)

ANTIANGINAL AGENTS
nitroglycerin nitrate of choice in acute angina
attack
sublingual, IV, transdermally, topically,
transmucosal
rapidly absorbed and has an onset within minutes
can be used for prevention
isosorbide dinitrate (Isordil), isosorbide mononitrate
(Imdur)
oral drugs; slower onset; may last up to 4 hours
taken before chest pains begin in anticipated
stress or exertion
not drugs of choice during attacks

ANTIANGINAL AGENTS
ACTIONS:
causes direct relaxation of smooth muscle ->
decrease in venous return -> decrease in
arterial pressure -> reduce cardiac workload
and decrease oxygen consumption
USES:
prevention and treatment of angina pectoris

PHARMACOKINETICS:
A: varies, rapid; D: wide; M: liver; E: urine (not
recommended during pregnancy and breast
feeding)

ANTIANGINAL AGENTS
CONTRAINDICATIONS AND CAUTIONS:
allergy; severe anemia (decreased CO), head
trauma (relaxation of vessels can lead to
bleeding), pregnancy and lactation
caution on hepatic/renal diseases, hypotension
and hypovolemia -> limited CO

ADVERSE EFFECTS:
related to vasodilation and decrease in blood
flow
(common) headache, dizziness, weakness;
nausea, vomiting, incontinence; hypotension;
tachycardia, syncope, angina

ANTIANGINAL AGENTS
Nursing Considerations :
1. Transdermal patch
apply the patch to a hairless area using a new patch
and different site each day.
remove the patch after 12-24 hours, allowing 10-12
hours patch free each day to
2. Sublingual medications :
note the BP before giving the medication.
offer sips of water before giving because dryness may
inhibit absorption.
one tablet for pain and repeat every 5 mins. for a total
of three doses; if not relieved
after 15 mins., seek medical help.
stinging or burning sensation indicates that the tablet
is fresh.

BETA- BLOCKERS
blocks the stimulatory effects of the SNS
nonselective(vasodilation, bronchoconstriction)
block the beta-adrenergic receptors and
vasoconstriction (->BP)
prevent the increase in HR
prevent increase in myocardial contraction
combination with nitrates to increase exercise
tolerance
lower dose than in treating HPN
not recommended to diabetes, vascular
disease, COPD
metoprolol, propranolol, nadolol

BETA- BLOCKERS
ADVERSE EFFECTS:
Related to blockade of SNS
Dizziness, fatigue, emotional disturbances;
gastric pain, nausea, vomiting, diarrhea; CHF,
decreased CO, arrhythmias; bronchospasms,
dyspnea, cough

DRUG INTERACTIONS:
Clonidine withdrawal (combined with betablockers) -> hypertension -> avoid combination
NSAIDS -> decreased antihypertensive effects
Epinephrine -> initial HPN
OHA/insulin -> change in blood glucose

CALCIUM CHANNEL BLOCKERS

Prevent the movement of calcium into the
cardiac and smooth muscle cells
->interfering with contraction-> loss of
smooth muscle tone -> vasodilation ->
decreased peripheral resistance ->
decreases venous return -> decrease
afterload -> decrease cardiac workload
and oxygenation
amlodipine (Norvasc), diltiazepam
(Cardizem), nicardipine (Cardene),
nifedipine (Adalat, Calcibloc), verapamil
(Isoptin)

CALCIUM CHANNEL BLOCKERS

ACTIONS:
Inhibit movement of calcium ions across
myocardial and arterial muscle cells

USES:
Angina, hypertension, arrhythmias

PHARMACOKINETICS:
A: well-absorbed; M: liver; E: urine (fetal
toxicity)

CALCIUM CHANNEL BLOCKERS

CONTRAINDICATIONS AND CAUTIONS:
Allergy, pregnancy and lactation, renal/hepatic
dysfunction

ADVERSE EFFECTS:
Dizziness, light-headedness, headache, fatigue;
nausea and hepatic injury; hypotension,
bradycardia, edema

NURSING CONSIDERATIONS:
Administer between meals to enhance absorption.
Take clients pulse rate before each dose, withhold if
pulse is below 60 bpm.
Refer for signs of congestive heart failure.