DRUGS AFFECTING THE

CARDIOVASCULAR
SYSTEM
• ANTIHYPERTENSIVES
– ACE inhibitors - vasodilators
– Angiotensin II receptor blocker
– Calcium Channel Blocker
– Symphatolytics
• DIURETICS
– Thiazide - osmotic
– Loop - Potassium- Sparing
• ANTI- ANGINAL
– Nitrates - non- nitrates
• ANTI- ARRYTHMIC
• CARDIAC GLYCOSIDES
• DRUGS AFFECTING THE BLOOD
– Anticoagulants - hemostatics
– Throbolytics
 Brief Review Ana/ Physio
• Determinants of BP
– Cardiac output
– Peripheral vascular
resistance
• Baroreceptors (pressure receptors)
specialized cells in the arch of the aorta
• Renin- Angiotensin Aldosterone system
– Compensatory mechanism when blood pressure
within the kidneys fall
 Baroreceptors
BLOOD ( VENTRICLES)

AORTA & CAROTID ARTERIES

SUFFICIENT INSUFFICIENT
PRESSURE PRESSURE

BARORECEPTORES

SEND INFO TO BRAIN

 Renin- Angiotensin System
Dec BP/Oxygen

Juxtaglomerular cell (kidney)

Renin

Angiotensinogen (liver)

Angiotensin I
ACE

Angiotensin II

A B
 A

Intense vasoconstriction
> Increase peripheral resistance
> Increase BP, restore blood flow

Increase – kidney

Decrease renin
 B

Adrenal Cortex

aldosterone

nephrons

Na & water retention

increase BP Na rich blood

hypothalamus

osmoreceptors

anti diuretic hormone

further increase blood volume

hypertension
• “ silent killer” • Stepped Care
• When a person’s Approach
blood pressure is 1. Lifestyle
above the normal modification
limits for a 1. Wt reduction
sustained period 2. Dec sodium intake
• TYPES: 3. Moderate alcohol
– Primary intake
– secondary 4. Smoking cessation
5. Increase physical
exercise

2. + drug
Health Teachings
P- ressure (blood) monitor
R- ise slowly
E- ating must be considered
S- tay on medication
S- kipping or abrupt stopping is NO- NO
U- ndesirable responses
R- emind to exercise, decrease alcohol
E- liminate smoking
 Angiotensin- Converting
Enzyme Inhibitors (“pril’)
• MOA: blocks the conversion of angiotensin I to
angiotensin II
• Uses: hypertension, MI
• Eg:
– benazepril (Lotesin) moexipril (Univasc)
– captopril (capoten) perindopril (Aceon)
– enalapril maleate (Vasotec) lisinopril
– quinapril (Accupril) ramipril
– fosinopril (Prinivil) trandorapril
• SE: cough, hypotension, HA, dysgeusia (any
perversion of taste perception), insomia, N/V, diarrhea
• AE: reflex tachycardia, chest pain, angina, CHF,
cardiac arrythmias, ulcers, liver & renal problem
,photosensitivity, hyperkalemia, neutropenia,
angioedema
• DI: + probenecid = decrease elimination
+ potassium supplement & diuretics =
hyperkalemia
+ NSAIDS = decrease hypotensive effect
+ Antacids = decrease absorption
+ tetracycline = decrease absorption of tetra
• CI: renal disease, severe Na depletion, CHF,
pregnant and lactating women
Nursing Considerations
• Encourage implement lifestyle changes
• Administer on an empty stomach
• Alert if patient is for surgery/ dialysis /
situations which may drop the fluid volume
• Parenteral form only if oral form is not
available
• Adjust dose if with renal failure
• Do not give if BP is below 90/70, monitor BP
esp for 2 hours after the first dose
(hypotension)
• Avoid ambulation (dizziness)
• Report cough / angioedema
• Report dysgeusia if more than 1 month
 Angiotensin II Receptor
Antagonist (“sartan”)
• Selectively bind the angiotensin II receptors
in the blood vessels and adrenal cortex.
• Eg: telmisartan ( Micardis)
losartan ( Diovan)
irbesartan ( Aprovel)
candesartan ( Blopress)
valsartan ( Cozaar)
eprosartan ( Teveten)
• USES: when ACE inhibitors are not
tolerated
• SE: HA, diarrhea, dyspepsia, cramps
• AE: angioedema, hyperkalemia
• CI: nephro dysfunction, CHF,
pregnancy
• NURSING CONSIERATIONS:
• +++ ensure female patient not pregnant
• Take without regard to food
 Calcium Channel Blockers
• MOA: prevents movement of calcium ions in the
myocardium and vascular smooth muscles.
• Normally: Ca inc muscle contractility, peripheral
resistance and BP
• EG: amlodipine ( Norvasc) nimodipine
(Nimotopp)
diltiazem (Cardizem) felondipine (Plendil)
nicardipine ( Cardene)
nifedipine (Procardia) potent
verapamil ( Calan)
USES: Angina, hypertension, atrial fibrillation
• SE/AD: HA, dizziness, hypotension, syncope,
reflex tachycardia, constipation, AV block,
bradycardia, peripheral edema

• NURSING CONSIDERATIONS
– Monitor ECG, CR, BP
– Have “E” cart available with IV administration
– Position to decrease peripheral edema
– Protect drug from light and moisture
– Increase OFI and fiber in the diet
– Avoid overexertion when anginal pain is
relieved
– May give paracetamol if with HA
– Take with meals or milk
– No not chew or crush sustained released
 Vasodilators
• MOA: relaxes smooth muscles of blood
vessels esp the arteries; promotes
increase blood flow to the brain & kidney
• EG: hydralazine ( Apresoline)
minoxidil (Loniten)
diazoxide ( Hyperstat) POTENT
nitroprusside ( Nitropress)

USES: severe hypertension, emergencies

• SE/ AE:
– hydralazine: tachycardia (beta blockers),
palpitations, edema (diuretics), HA, dizziness,
GI bleed, lupus like and neurologic symptoms
– minoxidil: similar effects, excess hair growth,
precipitates angina
– Nitroprusside & diazoxide (hyperglycemia) :
similar
• CI: allergy, pregnancy, lactation, cerebral
insufficiency
• DI: + other antihypertensive drugs =
additive effect
• NURSING CONSIDERATIONS:
D – irectly acts on vascular smooth muscle
I – ncrease renal and cerebral blood flow
L – upus like reaction ( fever, facial rash,
muscle and joint pain, spleenomegaly)
A - ssess peripheral edema
T – ake with food
O – ther side effects (headache, dizziness,
anorexia, Inc. Cardiac, Dec. Blood pressure)
R – eview BP (orthostatic hypotension), blood
glucose,