CARDIOVASCULAR AGENTS

CONTRA NOTES/CONSIDERATION
CLASS GENERIC NAME ACTION INDICATION/S SIDE EFFECT/S
INDICATION/S S
ANTIHYPERTENSIVES
Captopril Suppresses RAAS, Treatment of   Hypotension  Monitor serum
Enalapril blocks conversion hypertension  Constant, potassium
Lisinopril of Angiotensin I to and adjunct Hypersensitivit irritated cough  WOF renal
Fosinopril Angiotensin II, therapy for CHF y (ACE cough) insufficiency
Moexipril blocks the release and MI  History of  Taste alteration  Explain to patients that
Perindopril of aldosterone. angioedema  Nausea, dizziness may occur
Quinapril  Pregnancy vomiting, during 1st week –
Ramipril diarrhea REPORT IF BEYOND
Trandolapril  Headache, 1
ACE dizziness, fatigue WEEK/PERSISTENT!
Inhibitors  Insomnia  Should be taken 20
(Angiotensin hyperkalemia minutes to 1 hour
Converting  Tachycardia before meals for better
Enzyme  Angioedema d/t absorption
Inhibitors) hypersensitivity  AFRICAN AMERICAN
-PRILS clients may not
respond well to ACE
inhibitors unless taken
with diuretics
Interactions
 Probenecid (↓
elimination of ACE
inhibitors)
 NSAIDs (↓ hypotensive
effects)
ARBs Valsartan Suppresses RAAS, Treatment of   Angioedema  Monitor serum
(Angiotensin Losartan blocks binding of hypertension,  Dizziness potassium
Receptor Candesartan Angiotensin II at reduces Hypersensitivit  Palpitations  Consider renal
Blockers) Irbesartan the AT1 receptor potassium y  Blurred vision sufficiency
-SARTANS Olmesartan site, prevents the retention (used  Pregnancy  Headache,  Can be taken with or
Telmisartan release of with thiazides)  Renal and diarrhea without meals
Eprosartan aldosterone, hepatic  Hyperkalemia  AFRICAN AMERICAN
causes vasodilation insufficiency clients may not
 and decreases  History of  Renal respond well to ARBs
peripheral angioedema dysfunction unless taken with
resistance  Hypotension  Neutropenia diuretics
 Heart failure Interactions
 Antihypertensives,
MAOIs, diuretics,
alcohol (↑
hypotensive effect)
 ACE Inhibitors,
aspirin (↑ renal
dysfunction)
 Lithium (↑ lithium
toxicity)

Selective: Blocks alpha-1 SELECTIVE:  Orthostatic  Explain that abrupt

Doxazosin adrenergic Hypertension (in hypotension discontinuation may
Prazosin receptors resulting patients with lipid  Nausea lead to rebound HPN
Terazosin to relaxation of problems and  Headache  Inform patients not to
 more potent smooth muscles DM), may be  Drowsiness take OTC cold, cough,
Alpha-
(vasodilation) used for BPH  Nasal congestion or allergy meds without
adrenergic
Nonselective: (selective)  Edema consulting MD
Blockers
Phentolamine Interactions
-SINS  Weight gain
Phenoxybenzamin NONSELECTIVE:  NSAIDs (↑ peripheral
e Hypertensive edema)
crisis due to  Nitroglycerin (↑
pheochromocyto syncope, hypotension)
mas
Beta Metoprolol Binds to beta- Hypertension  COPD  Decreased PR  Abrupt
Blockers Acebutolol receptors to reduce (alone or in  Asthma  markedly discontinuation
-OLOLs Atenolol heart rate, combination with  CHF Decreased BP causes rebound HPN,
Bisoprolol contractility, renin a diuretic),  Sinus  Bronchospasm angina, dysrhythmias,
Nadolol release and angina, bradycardia (nonselective) and MI
Nebivolol relaxation of dysrhythmia, MI,  Caution must be done
Propranolol smooth muscles migraine for patients with
 Selective – headache, diabetes mellitus
beta 1 (heart) tachycardia  Inform patients not to
 Nonselective – take OTC cold, cough,
beta1&2 (heart or allergy meds without
and lungs) consulting MD
 AFRICAN AMERICAN
 clients may not
respond well to beta
blockers unless taken
with diuretics

Clonidine Decreases Hypertension  Betablockers  Edema  Clonidine is available

Guanfacine sympathetic  Patients with  Drowsiness transdermally (7 day
Methyldopa response by impaired liver  Dry mouth duration of action)
stimulating alpha function  Dizziness  Patient may keep patch
receptors which (methyldopa)  Bradycardia on while showering
Central decreases  Skin irritation  Guanfacine has longer
Alpha-2 sympathetic (transdermal) half-life vs clonidine
Agonists activity, decreases  Methyldopa is for PIH
vagus activity → ↓ but can cross placental
cardiac output → ↓ barrier
epi, norepi, renin =  Explain that abrupt
↓ resistance, ↑ discontinuation may
vasodilation lead to rebound HPN
Dihydropyridines: Dihydropyridines Hypertension,  Dizziness  Can lower BP in
Amlodipine Blocks calcium angina pectoris  Headache African-Americans vs
Felodipine access to the cells and cardiac  Flushing other classes
Nifedipine resulting to dysrhythmia  Peripheral  Amlodipine is used
Nicardipine vasodilation edema with other anti-HPNs
 Gingival to reduce peripheral
Calcium Non- hyperplasia edema, has longer half
Channel Dihydropyridines: life than others so is
Blockers Diltiazem usually taken OD
-DIPINES Verapamil  Nifedipine is highly
*will be discussed potent
on anti-anginals IMMEDIATE release:
PRN/acute cases
EXTENDED release:
chronic
Thiazides Hydrochlorothiazid Inhibits sodium, Hypertension and  CKD  Hyponatremia  NOT effective for
(Diuretic) e (HCTZ) chloride and water peripheral  Oliguria  Hypokalemia immediate diuresis
Chlorothiazide reabsorption in the edema, used as  Hypercalcemia  Used only for patients
distal portion of the combination drug  Hyperuricemia with NORMAL RENAL
ascending loop of for other anti-  Hyperglycemia FUNCTION
Henle hypertensive  Monitor electrolytes
 meds  Photosensitivity  Monitor intake and
output, weight daily
 Instruct patient to
rise/change positions
slowly to avoid
orthostatic hypotension
 Advise use of sunblock
Interactions
 Potentiates other
anti-HPN meds
and Digoxin
 Report s/sx of
Digoxin toxicity
*Bradycardia
*N/V
*Vision
changes

Loop Furosemide (Lasix) Inhibits sodium, Edema, renal  Anuria.  Electrolyte  Should not be used if
Diuretics Bumetanide chloride and water dysfunction,  History of imbalance Thiazides can alleviate
(aka high Ethacrynic acid reabsorption in the hypertension hypersensitivity (decreased Na, Fluid volume excess
ceiling Torsemide proximal portion of to furosemide, K, Mg, Ca,  IF Furosemide alone is
diuretics, the ascending loop bumetanide, or Chloride) not effective = pair with
potassium of Henle torsemide (or  Hypotension Thiazide
wasting sulfonamides)  Blurred vision  Usually administered
diuretics)  Hepatic coma  Dehydration PO in AM or IV in
 Severe states  Dizziness cases needing
of electrolyte  Headache immediate action
depletion  Muscle cramps (pulmonary edema,
 Constipation acute HF)
 Ototoxicity  Can increase renal
blood flow by 40%,
used for pxs with
creatinine clearance of
<30mL/min and ESRD
 Causes calcium loss
 Observe for signs of
hypokalemia
 Monitor I&O, weight
daily
 Spironolactone Promotes sodium Diuretic-induced  CKD  Hyperkalemia  Mild diuretic, used in
Amiloride and water excretion hypokalemia,  Oliguria  Anorexia combination with other
Triamterene and potassium used with loop or  Nausea, diuretic
Eplerenone retention. The thiazide diuretic in vomiting,  Prescribed for pxs with
drugs interfere with treating CHF and diarrhea cardiac d/o →
the sodium- hypertension  Numbness and potassium retaining
potassium pump tingling of the effect
controlled by hands and feet  Maintains more regular
aldosterone HR, decreased r/f
myocardial fibrosis
 Effects may take 48 hrs
 Amiloride - effective
Potassium antihypertensive agent
sparing  Triamterene - useful in
diuretics tx of edema in HF or
liver cirrhosis
 Eplerenone - effective
antihypertensive agent,
low doses effective with
HF (same as
Spironolactone)
Interactions
 ACE Inhibitors and
ARBs (can increase
Serum K)
 Usually combined with
other K-wasting
ANTIHYPERLIPIDEMICS
Bile Acid Cholestyramine Binds to bile acids Hyperlipidemia  Gallbladder  Constipation  Preparation is in
Sequestrants Colestipol in the intestine and type II disorders  Flatulence powder form, mixed
Colesevelam prevent them from  Pregnancy  Cramping with water or juice
being reabsorbed   Peptic ulcer  Must be taken with
into the blood. food
Phenylketonuri  Ensure patient has
a initiated a 3-6-month
diet and exercise
program
 Monitor results of liver
 function tests,
cholesterol levels
 Take at bedtime
Gemfibrozil Increases activity Hyperlipidemia  Anticoagulants  GI upset  If px is ongoing
Fenofibrate of lipase promoting type IV (maintain  Nausea and anticoagulant tx →
VLDL, Hyperlipidemia caution) vomiting MONITOR INR!!
triacylglycerol type II  Ensure patient has
catabolism, initiated a 3-6-month
Fibrates promotes transfer diet and exercise
of cholesterol to program
HDL  Monitor results of liver
function tests,
cholesterol levels
 Take at bedtime
Niacin Inhibits free fatty Hyperlipidemia  Hepatic  Itching and  Only 20% of pxs can
acid release from types II, III, IV and disease flushing tolerate niacin
adipose tissue; V  Pregnancy  GI upset  If with drug counseling,
lowers blood  Heart failure  Cardiac titration, and use with
levels of LDL and  MI dysrhythmia aspirin → 60-70% of
increase levels of  Jaundice patients can tolerate
Nicotinic HDL  Ensure patient has
Acid initiated a 3-6-month
diet and exercise
program
 Monitor results of liver
function tests,
cholesterol levels
 Take at bedtime
Cholesterol Ezetimibe Inhibits cholesterol Reduces total  Hepatic  Diarrhea  Usually combined in
Absorption absorption in small cholesterol LDL, disease  GI upset therapy with a STATIN
Inhibitors intestine by binding and triglycerides  Pregnancy  URTI (HMG-CoA Reductase
to a critical  Lactating Inhibitor)
mediator of mothers  Ensure patient has
cholesterol initiated a 3-6-month
absorption → diet and exercise
reduces S. program
cholesterol, LDL &  Monitor results of liver
TGL function tests,
cholesterol levels
  Take at bedtime
Atorvastatin Inhibits HMG-CoA Hyperlipidemia  Liver disease  GI upset  Lifetime maintenance
Rosuvastatin reductase, the  Pregnancy  Headaches drug, abruptly stopping
Simvastatin enzyme necessary  Muscle cramps, could cause rebound
Fluvastatin for hepatic fatigue effect
Lovastatin production of  Eye cataract  Highly protein bound,
Pravastatin cholesterol,  Rhabdomyolysis usually OD
decreases the (muscle  Action can be seen
concentration of disintegration) within 2 weeks
cholesterol,  Increased liver  Can decrease CAD
decreases LDL, enzymes and reduce mortality
Hepatic 3- and slightly  Monitor liver enzymes
hydroxy-3 increases HDL  Annual eye exam
methylglutar
yl coenzyme  Ask patient to report
A (HMG- muscle aches or
CoA) weakness
Reductase  CAUTION IN
Inhibitor ADMINISTERING
-STATINS WITH OTHER HIGHLY
PROTEIN BOUND
DRUGS
 Ensure patient has
initiated a 3-6-month
diet and exercise
program
 Monitor results of liver
function tests,
cholesterol levels
 Take at bedtime
ANTIANGINALS
Nitrates Nitroglycerin (NTG) Relaxes the Angina relief  Known history  Headaches (less ● Common preparations:
Isosorbide Dinitrate vascular smooth of increased with frequent SL and IV, transdermal
(ISDN) muscle, decreases intracranial use; can be ● SL → rapid onset (1-3
Isosorbide myocardial demand pressure treated with minutes)
Mononitrate (ISMN) for oxygen,  Severe anemia acetaminophen), ● Transdermal (40-60
decreasing left  Right-sided  Hypotension minutes)
ventricular preload myocardial  Dizziness ● NTG Patch - usually
by dilating veins infarction  Weakness or applied OD
thus decreasing faintness ○ Should be
 afterload removed at
Hypersensitivit bedtime to
y allow 8-12 hr
nitrate free
interval
○ AVOID
TOLERANCE
● NTG patch removal →
tapered slowly to
prevent rebound effects
● Avoid hairy areas for
patch placement
● If chest pain has not
subsided 5 mins after
SL administration,
CALL 911 or
REPORT!!!
● Instruct patient on how
to self-administer
sublingual tablets
● Place patient in supine
position to avoid
hypotension
● Check pulse rate
Interactions
 Betablockers, Ca
channel blockers
(increased hypotensive
effect)
 Heparin (antagonistic
effect)
Calcium Verapamil Blocks calcium Angina (stable  Severe  Excessive  VERAPAMIL is highly
Channel Diltiazem access to the cells and vasospastic), hypotension or bradycardia potent, caution needed
Blockers resulting to hypertension, cardiogenic  Cardiac
(Non decrease in arrhythmias shock conduction
dihydropyridi contractility, heart  AV Blocks problems
nes) rate, conduction  Sick sinus  Constipation
and peripheral syndrome (with verapamil)
vasodilation but  CHF  chest pain
does not affect  shortness of
 cardiac output; breath
 swelling,
 rapid weight gain
 fever
 upper stomach
pain
Beta Please refer to Stable angina
Blockers antihypertensives! only
-OLOLS
BLOOD THINNERS
Heparin Combines with Prevent venous  Large  Bleeding  ANTIDOTE:
Warfarin antithrombin III thrombosis (leads esophageal  Petechiae PROTAMINE
Low-molecular which accelerates to stroke), DVT, varices  Ecchymosis SULFATE (Heparin)
weight heparin: the anticoagulant pulmonary  Patients who  Hematemesis  ANTIDOTE: VITAMIN
enoxaparin and cascade of embolism, stroke, have  Epistaxis K (Warfarin)
dalteparin reactions that open heart undergone  Other signs of  Poorly absorbed in GI
Selective Factor Xa prevents surgery as major surgery active bleeding  Given IM or SQ
inhibitor: thrombosis prophylaxis, DIC (EXCEPT IF  Heparin prolongs
fondaparinux formation. USED FOR clotting time, check
Conversion of PROPHYLAXI PTT
fibrinogen to S)  Ensure PT is 1.25 to
fibrin does not  2.5 times the control
Anticoagulan occur and the level or INR 2-3
ts formation of fibrin Thrombocytope  Provide safety
clot is prevented. nia
DOES NOT measures
  Encourage client to use
DISSOLVE
CLOTS!! dental swabs
Hypersensitivit (Toothettes), electric
y razor
 Bleeding/blood  Avoid any potential
conditions source of injury
 Pregnancy  Pad hard surfaces
 Provide adequate
lighting
Interactions
 NSAIDs, sulfonamides,
cimetidine, allopurinol,
other highly protein
bound drugs
 Aspirin Prevents Prophylactic use  GI discomfort  ANTIDOTE: Not
Clopidogrel thrombosis in the in:  Headaches specific, not universal
Cilostazol arteries by ✔ Prevention of  Bleeding (focus on hemorrhage
suppressing myocardial  Petechiae control!); MAY
platelet infarction (MI)  Ecchymosis CONSIDER
aggregation or stroke for  Hematemesis ACTIVATED
patients with  Epistaxis CHARCOAL IF
familial PATIENT CAN TAKE
 Increased
history ORAL LIQUIDS, within
bleeding
✔ Prevention of 1-2hrs post ingestion
tendencies
repeat MI or  Decrease intake of
Antiplatelets stroke Vitamin K rich foods
✔ Prevention of (green leafy
stroke for vegetables, etc)
DOES NOT patients  Provide safety
DISSOLVE having measures
CLOTS!! transient  Encourage client to use
ischemic dental swabs
attacks (TIAs) (Toothettes) for oral
care, electric razor
 Avoid any potential
source of injury
 Pad hard surfaces
 Provide adequate
lighting
 Administer with meals
= prevents GI upset
 Monitor aPTT
Streptokinase Binds with  Previous  Increased risk for  Provide safety
Urokinase plasminogen history of bleeding measures
Thrombolytic Alteplase causing conversion trauma/stroke  GI or cerebral  Encourage client to use
s of plasmin to hemorrhage dental swabs
dissolve clots  Re-thrombosis (Toothettes) for oral
CAN (usually resolved care, electric razor
DISSOLVE with Heparin)  Avoid any potential
EXISTING source of injury
CLOTS  Pad hard surfaces
 Provide adequate
lighting
ANTIARRHYTHMICS: Restores the cardiac rhythm to normal
Quinidine Stabilize cell Atrial and ● Diarrhea  Slows conduction and
Procainamide membrane by ventricular ● Nausea/ prolong repolarization
Disopyramide depressing action dysrhythmias, vomiting  Monitor vital signs,
potential by binding paroxysmal atrial ● Heartburn especially PR and BP
to sodium channels tachycardia ● Fever  Administer drug AS
and change the (PAT), ● Dizziness ORDERED
Sodium
duration of action supraventricular ● Lightheadedness  Advise patients to
Channel
potentials of the arrhythmias ● Headache avoid alcohol, tobacco,
Blockers
cells ● Hearing and caffeine
Class IA
loss/tinnitus →
sign of toxicity
● Liver damage
● Hypotension
● Blood dyscrasias

Lidocaine Acute ventricular ● Hypotension  Slows conduction and

Mexiletine HCl arrhythmias ● GI upset shortens repolarization
● Headache,  Lidocaine is given IV,
confusion, also used as anesthetic
dizziness  Monitor vital signs,
Sodium ● Arrest or especially PR and BP
Channel dysrhythmias
Blockers  Administer drug AS
● Seizures ORDERED
Class IB ● Anaphylactic  Advise patients to
reactions avoid alcohol, tobacco,
and caffeine

Flecainide Life threatening  Monitor vital signs,

Propafenone ventricular especially PR and BP
Sodium arrhythmias  Administer drug AS
Channel ORDERED
Blockers  Advise patients to
Class IC avoid alcohol, tobacco,
and caffeine

Class II: Acebutolol Binds to beta- Atrial flutter and Refer to Refer to  More commonly
Beta Esmolol receptors to reduce fibrillation, tachy- antihypertensives antihypertensives prescribed for
Blockers - HR, contractility dysrhythmias, arrhythmias compared
-OLOLS Please refer to and relaxation of ventricular and to Na channel blockers
antihypertensives!! smooth muscles supraventricular  SHOULD BE
through inhibiting dysrhythmias TAPERED DOWN
stimulation of beta- PRIOR TO D/C
receptors  Refer to
antihypertensives

Adenosine Prolongs and slows Life-threatening ● Cough  Act directly on the heart
Amiodarone down the outward atrial and ● Dizziness, muscles to prolong
movement of ventricular lightheadedness, repolarization and
potassium during dysrhythmias or fainting refractory period
action potential resistant to other ● Fever (slight)  Can be given IV, IO,
drugs ● Numbness or oral
tingling in the  Avoid grapefruit juice
fingers or toes  Absorption unaffected
● Painful breathing by food (OK to give
Class III:
● Sensitivity of the with or without food)
Drugs that
skin to sunlight  Monitor vital signs,
prolong
● Trembling or especially PR and BP
repolarizatio
shaking of the  Administer drug AS
n
hands ORDERED
● Trouble with
 Advise patients to
walking
avoid alcohol, tobacco,
● Unusual and
and caffeine
uncontrolled
movements of
the body
● Weakness of the
arms or legs
Class IV: Diltiazem Blocks the Supraventricular Refer to Refer to antianginals  Slows conduction
Calcium Verapamil movement of tachydysrhythmia antianginals velocity, decreases
Channel calcium towards s and prevention myocardial contractility
Blockers the cell membrane of PSVT and increases
slowing down both refraction in AV node
conduction and  Refer to antianginals
automaticity  Monitor vital signs,
especially PR and BP
 Administer drug AS
ORDERED
  Advise patients to
avoid alcohol, tobacco,
and caffeine
CARDIOTONIC DRUGS
Digoxin Inhibit the sodium- Cardiac Digoxin Toxicity  ANTIDOTE: DIGOXIN
potassium pump, arrhythmia, atrial  Anorexia IMMUNE
resulting in fibrillation, atrial  Diarrhea, nausea FAB/DIGIBIND
increase in flutter, and vomiting  Therapeutic Serum
intracellular paroxysmal  Bradycardia Level: 0.8-2.0 ng/ML
sodium. This supraventricular  Cardiac  Half-life: 30-40 hours
increase leads to tachycardia dysrhythmias (high risk for toxicity)
an influx of  Headaches  Do not administer with
calcium, causing  Malaise food and antacids
Cardiac the cardiac muscle  Count apical pulse rate
 Blurred vision,
Glycosides fibers to contract (APR) before
visual illusions
more efficiently administration
(white, green,
yellow halos  If APR <60 in adults
around objects) and <90 in children,
 Confusion and HOLD
delirium  Monitor serum digoxin
level
 Ensure availability of
antidote
 Provide rest periods
Phosphodies Amrinone Inhibits the enzyme Short-term  Limited to severe
terase Milrinone phosphodiesterase, treatment of situations because it is
Inhibitors promoting a patients not associated with fatal
positive inotropic responding to ventricular arrhythmias
response and cardiac  Administered for NO
vasodilation glycosides, LONGER than 48-72
vasodilators and hours, IV
diuretics  Increases stroke
volume, cardiac output
and promotes
vasodilation
 Protect drug from light
 Ensure patent IV
access
 Note for petechiae and
signs of bleeding