CARDIOVASCULAR DRUGS

BETA BLOCKERS
- These agents are antagonist of the beta receptors of the sympathetic nervous system
- They reduce cardiac output by diminishing the sympathetic nervous system response and
sympathetic tone.
- Will lead to vasodilation and decrease cardiac output.
- Decreased HR, vascular resistance, BP
- Ends with “OLOL”
- Expect result within 30 min
- Effect lasts for 6-12 hrs
- Maintenance medication taken everyday

NON-SELECTIVE (B1 and B2) SELECTIVE AND SPECIFIC (B1)

- Causes bronchoconstriction - Acebutolol

- Monitor for HR, RR - Atenolol
- Propranolol - Betaxolol
- Carteolol - Bisoprolol
- Nadolol - Metoprolol
- Penbutolol
- Pindolol
- Timolol

Indications:
- Hypertension
- Angina pectoris
- Myocardial infarction, CHF
- One responsibility: CHECK FOR HR!! If less than 60, do not give (will lead to bradycardia)
CANNOT BE GIVEN IF PATIENTS HAS:
- heart block
- Bradycardic
- COPD (due to bronchoconstriction → DOB)
- Diabetic (liver fails to convert glycogen to glucose, HYPOGLYCEMIA)

PHARMACODYNAMICS: Side effects and adverse effect

-CVS: bradycardia, hypotension, rebound hypertension when abruptly stopped (should be taken everyday
until physician ordered to stop)
- Respi: Bronchoconstriction, bronchospasm
- Others: insomnia, depression, nightmares, constipation, hypoglycemia

NURSING INTERVENTIONS
1. Instruct the patient to take the drug as prescribed. Warn not to abrupt stop the medication (to
prevent rebound hypertension)
2. Suggest to avoid over the counter medications
3. Remind client NOT to change positions abruptly (can lead to orthostatic hypotension)
4. Inform that this can cause sexual dysfunction (can lead to impotence in male and vaginal dryness
in female)
5. Advise to eat high fiber foods to counteract constipation (adverse rxn)
6. MONITOR FOR HYPOGLYCEMIA
7. Control and monitor BP
8. Lifestyle changes (exercise) and Diet Modifications
CALCIUM CHANNEL BLOCKERS
- These agents prevent the movement of calcium into the cardiac and smooth muscle cells when the
cells are stimulated
- Decreased BP, cardiac workload, myocardial contractility, venous return
- Effective for patient with MI, angina, CHF
- Ends with “dipine”

PHARMACODYNAMICS: Mechanism of action

- This effect will depress myocardial contractility, slow cardiac impulse formation in the
conductive tissues, and relax and dilate arteries
Diltiazem (Cardizem, Tiamate)
Verapamil
Amlodipine (Norvasc)
Felodipine (Plendil)
Isradipine (DynaCirc)
Nicardipine (Cardene)
Nifedipine (CALCIBLOC, Procardia CL)-prototype!
- EMERGENCY med
- Sublingually
Nisoldipine (Sular)

CONTRAINDICATION AND PRECAUTION:

- These drugs are contraindicated in the presence of allergy to any of these drugs
- With renal and hepatic dysfunction (e.g. acute renal failure, liver cirrhosis: this prevents the
effectivity/ metabolism/ excretion of medication. Metabolism: possible med will not be effective.
This can lead to toxicity/ severe adverse reaction for pt with kidney failure)
- Pregnancy and lactation (can lead to adverse rxn to the neonate and fetus)

ADVERSE EFFECTS:
Associated with these drugs are related to their effects on cardiac output and on smooth muscle
- CNS effects include dizziness, lightheadedness, headache, and figue
- GI problems can include nausea, hepatic injury, elated to toxic effects hepatic cells

THREE MAIN FUNCTION

1. Angina
2. Hypertension
3. Reynold’s Disease: causes arterial spasm which can be prevented with calcium channel blocker.
Common to female: affects extremities, prominent on hand

NURSING INTERVENTION
1. Monitor blood pressure carefully while patient is on therapy because of increased hypotensive
episodes
2. Provide comfort measures to help patient tolerate drug effects (safety precaution should be done
(Monitor for ECG because this mainly affects the heart)
CARDIAC GLYCOSIDE
- Available in oral and parenteral preparations
- All atrial rhythm
- Digoxin (Lanoxin
- Digitoxin (Crystodigin)
- Ouabain

Increases the level of calcium in the cell, blocks the reaction of sodium (outside) and potassium (inside).
Prevents water retention, hyperkalemia, hypokalemia

3 MAIN FUNCTION:
1. Positive inotropic effect: the myocardium will contract forcefully. Increase of Cardiac Output
2. Negative chronotropic effect: the heart rate is slowed due to decreased rate of cellular
repolarization. Increased cardiac output and decreased heart rate. Forceful contraction but slower
beat
3. Decreases conduction velocity through the AV node

Atrial Flutter
Atrial fibrillation
Paroxysmal atrial tachycardia
Ventricular tachycardia

CONTRAINDICATION AND PRECAUTION

-Contraindicated in the presence of allergy to any cardiac glycoside
- They are NOT given to patients with ventricular dysrhythmias (VTAC), heart block or sick sinus
syndrome, aortic stenosis, acute MI
- NOT given to patients with hypokalemia, hypomagnesemia, hypercalcemia and acute renal failure
- Get HR before giving Digoxin (APICAL PULSE - 1 FULL MIN)
- Consider drug to drug interaction: Diuretics: check for potassium, give potassium sparing diuretic.
- Increase potassium diet
- IF taken with Verapamil, Amiodarone, quinidine, quinine, erythromycin, and tetracycline - can increase
the risk of increased effects of digitalis

ADVERSE EFFECTS:
1. CNS:headache, weakness, seizure and drowsiness
2. CVS: arrhythmias

DIG TOXICITY:
- Anorexia, nausea, vomiting
- Visual changes (yellow halo around objects), pt will see an aura
- Palpitation

IMPLEMENTATION
1. Administer the initial rapid digitalization and loading dose as ordered IV
2. Check spelling of the drugs (DIGOXIN is different from DIGITOXIN!)
3. Check the dosage preparation and the level of digitalis in blood (normal .5-2 nanogram/mL)
4. Administer IV drug very slowly IV over 5 minutes to avoid arrhythmias. Do not ADMINISTER
intramuscularly because it can cause severe pain
5. Recheck pulse, HR after an hour, then refer to the doctor (2x checking)
6. Administer the drug without food if possible to avoid delayed absorption
7. Maintain emergency equipment and drugs
8. Provide comfort measures-small frequent meals, adequate lighting, comfortable position, rest
period and safety precaution
9. Continuous monitoring for potassium

DOPAMINE
- This drug is an immediate precursor of norepinephrine, occurs naturally in the CNS basal
ganglia where it functions as a neurotransmitter
- Causes vasoconstriction
 - Beta adrenergic agonist: vasopressor
- INCREASES CARDIAC OUTPUT, SYSTEMIC VASCULAR RESISTANCE, BP, CARDIAC
CONTRACTILITY, and urine output due to renal vasodilation output

PHARMACODYNAMIC:
-can activate the alpha- and beta-adrenergic receptors depending upon the concentration. It stimulates
receptors to cause cardiac stimulation and renal vasodilation
- the dose range is 1-20mcg/kg/min

3 THERAPEUTIC DOSES
1. At low dose (1-2 mcg/kg/hr) dopamine DILATES the renal and mesenteric blood. Increase in
UO= dopaminergic effect
2. At moderate dose of 2-10mcg, dopamine enhances cardiac output (INC HR, BP)
3. HIGH dose - more than 10mcg (constant vasoconstriction → decreased tissue perfusion) that is
why it is titrated; start at low dose to moderate and in severe cases high dose

- The nurse typically prepares the dopamine drip dopamine (at a concentration of 400-800mg) is
mixed in 250 mL D5W
- SODIUM BICARBONATE will inactivate the dopamine
- WHY GIVE THIS? Hypotension
- Administered using infusion pump: to monitor

Pharmacodynamics: side effect: tachycardia, hypertension, ectopic beats, angina (vasoconstriction),

dysrhythmia, Myocardial ischemia, n/v

NURSING CONSIDERATIONS
1. Check the iv-site hourly fr signs of drug infiltration of dopamine, which can cause severe tissue
necrosis (common) because of decreased tissue perfusion. Should be administered in central line
vein
2. Phentolamine should be infiltrated in multiple areas to reduce tissue damage (drug of choice/
standby drug)
3. Drug is effective if urine output is increased and BP is increased
4. Monitor ECG. HR, BP, UO, IV site
COMPUTATION OF DOPAMINE (cardio drugs - infusion pump)
Desired dose x Quantity x Time in Minutes x Body Weight
Drug concentration

1. A 70 kg patient has dopamine ordered at 6mcg.kg/min. The IV has 400 mg of dopamine in 250
mL. What IV rate is correct?

Always determine the dose of medication per mL (drug concentration)

400mg dopamine = 1.6 mg/dopamine/ mL fluid
250 mL fluid

Do you need to convert your dose from mg to mcg? Mcg to mg? Grams to mcg?
6 mg x 1000= 1600 mcg dopamine/ mL fluid

Use a streamlined equation where you only need 4 items

a. Ordered amount of drug
b. Pt. weight (most of the time)
c. Number of minutes in an hour (always the same!)
d. Dose/mL (calculated in #1)

EXERCISE:

2. A patient is ordered to start an IV dopamine drip at 2mcg/kg/min. The patient weighs 90kg. You
have a bag of dopamine that reads 400mg/250ml. What will you set the IV pump drip rate (ml/hr)
at?

400mg = 1.6mg/ml x 1000mcg = 1600 mcg/mL

250ml

2mcg/kg/min x 90kg x 60 mins = 10,800 = 6.75 ml/hr

1600mcg/mL 1600ml/hr

3. A patient is ordered to start an IV dopamine drip at 10 mcg/kg/min. The patient weighs 120bs.
You have a bag of dopamine that reads 800 mg/ 500 mL

800mg = 1.6 mg
500mL

120lbs / 2.2 = 54.5 kgs

10mcg/kg/min x 54.5 kg x 60 mins/hr 32, 700

________________________________ = ______ = 20.44 mL/hr
1.6 mg x 1000 = 1,600 mcg 1,600

4.

400mg = 1.6 mg/ml x 1000 mcg = 1600 mcg/ml

250mL

5 mcg/kg/min x 57 kgs x 60 mins = 17100 = 10.69 ml/hr

1600mcg/ml 1600
LIDOCAINE
- Antiarrhythmic drugs available for treatment of ventricular ectopy, VT, and VF
- An alternative antiarrhythmic of long standing and widespread familiarity with fewer immediate
side effects than may be encountered with other antiarrhythmics.
- Substitute medication for amiodarone
- Fewer side effects compared to other
- Monomorphic V TACH with pulse! (amiodarone or lidocaine)
- Discontinue if signs of toxicity occurs: Dec LOC, confusion, drowsiness, disorientation, tinnitus
→ ototoxicity, seizure (GRAND MAL SEIZURE)
- Reduce dose in elderly and those with poor cardiac output, heart failure, and liver dysfunction

GENERAL NURSING PROCESS FOR ANTIARRHYTHMICS

ASSESSMENT
Assessment
1. Patient history - the nurse obtains heath and drug histories she should elicit symptoms of SOB,
heart palpitations, coughing, chest pain, previous angina or dysrhythmias, and current
medications
2. Physical Examination: get baseline data: VS and weight, status
3. Laboratory examination: ECG, cardiac marker: CKMB, lactic dehydrogenase,

NURSING DX
1. Alteration on perfusion: decreased CO
2. Alteration in thought processes and sensory perceptual alteration
3. Anxiety related to irregular heartbeat
4. Risk for activity intolerance
5.

LIDOCAINE COMPUTATION: to be continued