Cardio-inhibitory drugs depress cardiac

FATHER SATURNINO URIOS UNIVERSITY

San Francisco St. Butuan City 8600, Region XIII Caraga, Philippines ●
Tel. Number 085-34130001 local 4853
Nursing Program
function by decreasing heart rate
(chronotropy), myocardial contractility
PHARMACOLOGY N21 (inotropy), or both, which decreases
cardiac output and arterial pressure.
Cardiovascular Agents
● These cardiac changes reduce the work
Prepared by: Jovenice JC V. Alquizar, SN BSN2
of the heart and myocardial oxygen
consumption.

CARDIOVASCULAR AGENTS
coronary arteries

PDF by: Mrs. Daisy Carin CORONARY VASODILATORS DRUGS

● Coronary vasodilators are mainly
ANTIARRHYTHMIC DRUGS represented by nitroglycerin-derived
● Antiarrhythmics are drugs that are used
nitrates, which are potent vasodilators
to treat abnormal heart rhythms
and may also decrease blood pressure
resulting from irregular electrical activity
(nitroprusside).
of the heart.
● Drugs that dilate large coronary arteries,
● Antiarrhythmic medications prevent and
such as nitroglycerin and the calcium
treat abnormal heartbeats
channel-blocking agents, can dilate
(arrhythmias). Problems with your heart's
these stenotic segments. This dilation
rhythm are caused by a disruption in the stenotic -
constricted
may contribute to the relief of
heart's electrical system. A drug called
myocardial ischemia by increasing
atropine may be prescribed if your
coronary blood flow.
heart beats too slowly (bradycardia).
● Vasodilators are medications that open
● Cardiac illnesses
(dilate) blood vessels. They affect the
- Cardiac stimulants increase
muscles in the walls of your arteries and
- Cardiac depressants decrease
veins, preventing the muscles from
tightening and the walls from narrowing.
Cardiac Stimulant
As a result, blood flows more easily
● A cardiac stimulant is a substance
through your vessels.
which acts as a stimulant of the heart
e.g., via positive chronotropic or inotropic
ANTIHYPERLIPIDEMIC DRUGS
action.
● Hyperlipidemia is an increase in the
● Examples of cardiac stimulant drugs are
lipids, which are a group of fats or
cocaine and methamphetamine.
fat-like substances in the blood.
● The heart really takes a beating when
● Cholesterol and triglycerides are the 2
stimulants are abused. A stimulant
lipids in the blood. Elevation of one or
forces the heart to work harder,
both of these lipids occurs in
creating a strain on the whole
hyperlipidemia.
cardiovascular system. The blood
● Serum cholesterol levels above 250
pressure goes up. One's heart rhythm
mg/dl and the triglyceride levels above
may become irregular and a person
150 mg/dl are associated with
may suffer chest pain.
Atherosclerosis which is considered to
be a major contributor to the
Cardiac Depressant
development of heart disease.
● A cardiac depressant is an agent that
● Low-density lipoprotein (LDL) transport
depresses the rate or force of
cholesterol to the peripheral cells.
contractions of the heart.
 ● High-density lipoprotein (HDL) take loss of bile acids, the liver uses
cholesterol from the peripheral cells and cholesterol to manufacture more bile.
transport it to the liver, where it is ● The uses of the bile acid resins are
metabolized and excreted hyperlipidemia and pruritus associated
with partial biliary obstruction.
a. HMG-CoA Reductase Inhibitors ● Adverse reactions are constipation,
● The anti hyper lipidemic drugs, abdominal cramps, flatulence, and
HMG-CoA reductase inhibitors nausea. and increase bleeding
(3-hydroxy-3-methyglutaryl coenzyme tendencies.
A), are typically referred to as STATINS. ● Examples of bile acid resins drugs are
● These drugs appear to have one of two the following:
activities, namely, inhibiting the ○ Cholestyramine
manufacturer of cholesterol or ○ Colestipol
promoting the breakdown of ○ Colesevelam
cholesteron.
● STATINS drugs along with diet restricted c. Fibric Acid Derivatives
in saturated fat and cholesterol are the ● Fibric acid derivatives, also known as
treatment of hyperlipidemia. fibrates, are the third group of
● Adverse reactions: the statins are usually antihyperlipidemic drugs and work in a
well tolerated when adverse reactions variety of ways.
occur. Often mild and transient and do ● Clofibrate acts to stimulate the liver to
not require discontinuing the therapy. increase the breakdown of very
These includes: headache, dizziness, low-density lipoproteins (VLDLs) to LDLs,
insomnia, flatulence, abdominal pain, decreasing the liver synthesis of VLDLs
cramping, constipation, and nausea. and inhibiting cholesterol formation,
● HMG-CoA Reductase Inhibitors (STATINS) and lowering triglycerides.
drugs: ● Fenofibrate acts by reducing VLDL and
- Atorvastatin stimulating the catabolism of
- Fluvastatin triglyceride-rich lipoproteins, resulting in
- Lovastatin a decrease in plasma triglycerides and
- Pravastatin cholesterol.
- Rosuvastatin ● Gemfibrozil increases the excretion of
- Simvastatin cholesterol in the feces and reduces the
production of triglycerides by the liver,
b. Bile Acid Resins thus lowering serum lipids levels and
● Bile, which is manufactured and triglycerides
secreted by the liver and stored in the ● The adverse reactions associated with
gallbladder, emulsifies fat and lipids as fibric acid derivatives includes the
these products pass through the following: nausea, vomiting, GI upset,
intestines. diarrhea, cholelithiasis (stone in the
● Once emulsified, fats and lipids are gallbladder), and cholecystitis
readily absorbed in the intestine. (inflammation of the gallbladder).
● The bile acid resins bind to bile acids to ● The fibric acid derivatives are
form an insoluble substance that cannot contraindicated in patients with
be absorbed by the intestine, so it is hypersensitivity to the drugs and in those
secreted in the feces. With increased with significant hepatic or renal
dysfunction because these drugs may
 increase the already elevated
cholesterol. a. Angiotensin-converting enzyme (ACE)
● The drugs are used cautiously during inhibitors
pregnancy (category C) and not during ● Angiotensin-converting-enzyme
lactation or in patients with peptic ulcer inhibitors are a class of medication used
or diabetes. primarily for the treatment of high blood
pressure and heart failure.
d. Miscellaneous Antihyperlipidemic Drug ● They work by causing relaxation of
● Miscellaneous antihyperlipidemic drugs blood vessels as well as a decrease in
include niacin and ezetimibe. blood volume, which leads to lower
Antihyperlipidemic drugs for information blood pressure and decreased oxygen
on combinations of more than one class demand from the heart.
of antihyperlipidemic drugs in one ● Mechanism of action: ACE inhibitors
tablet. produce vasodilation by inhibiting the
● The mechanism of action by which formation of angiotensin II.
Niacin(nicotinic acid) lowers blood ● This vasoconstrictor is formed by the
lipids. Ezetimibe inhibits the absorption of proteolytic action of renin (released by
cholesterol in the small intestine, leading the kidneys) acting on circulating
to a decrease in cholesterol in the liver. angiotensinogen to form angiotensin I.
● Niacin is used as adjunctive therapy for ● Angiotensin I is then converted to
lowering very high serum triglyceride angiotensin II by angiotensin-converting
levels in patients who are at risk for enzyme.
pancreatitis and whose response to ● ACE inhibitors are contraindicated in
dietary control is inadequate. I also used patients with a history of angioedema or
in combinations with other hypersensitivity related to treatment with
antihyperlipidemic in lipid-lowering an ACE inhibitor and those with
treatments hereditary or idiopathic angioedema.
Should not be given to patients that are
ANTIHYPERTENSIVE DRUGS already taking a direct renin inhibitor
● Antihypertensives are a class of drugs such as aliskiren.
that are used to treat hypertension (high ● Block box warning: Captopril, this
blood pressure). Antihypertensive medication may cause fetal/neonatal
therapy seeks to prevent the morbidity/mortality if used in pregnancy.
complications of high blood pressure, ● Give potassium supplements and
such as stroke and myocardial potassium-sparing diuretics cautiously
infarction. because ACE inhibitors can cause
● The classes of blood pressure potassium retention and hyperkalemia.
medications include: ● Warn the patient to avoid
- Angiotensin-converting enzyme potassium-containing salt substitutes.
(ACE)inhibitors Give captopril and moexipril 1 hour
- Angiotensin receptor blockers before meals.
- Beta-blockers ● Withhold the dose and notify the
- Calcium channel blockers prescriber if the patient develops a
- Diuretics fever, sore throat, leukopenia,
hypotension, or tachycardia.
● Captopril may cause protein in the
urine, reduced neutrophils, and
 granulocytes, rash, loss of taste, ● Children: safety and efficacy of ARBs
hypotension, or a severe allergic have not been established in this age
reaction. group.
● Adults: ARBs are not allowed during
Examples of ACE inhibitors include: pregnancy.
- Benazepril ● Older adults: are more susceptible to
- Captopril drug toxicity because of underlying
- Enalapril conditions that would interfere with
- Fosinopril metabolism and excretion of drugs.
- Lisinopril Renal and hepatic function should
- Moexipril always be monitored.
- Perindopril
- Quinapril Examples of Angiotensin II Receptor Blocking
Agents drugs include:
b. Angiotensin II Receptor Blocking Agent - azilsartan
● Angiotensin II receptor blockers help - candesartan
relax your veins and arteries to lower - eprosartan
your blood pressure and make it easier - irbesartan
for your heart to pump blood. - telmisartan
● Angiotensin is a chemical in your body - valsartan
that narrows your blood vessels.This - losartan
narrowing can increase your blood - Olmesartan
pressure and force your heart to work
harder. c. Beta-Blockers
● Indications: Like ACE inhibitors, they can ● Beta blockers, also known as
also be used alone for treatment of beta-adrenergic blocking agents, are
hypertension or in combination with medications that reduce your blood
other anti-hypertensive agents. pressure.
● Utilized in treatment of heart failure for ● Beta blockers work by blocking the
patients who do not respond to ACE effects of the hormone epinephrine,
inhibitors also known as adrenaline.
● Assess for the mentioned ● Beta blockers cause your heart to beat
contraindications to this drug (e.g. drug more slowly and with less force, which
allergy, hypovolemia, renal impairment, lowers blood pressure.
etc.) to prevent potential adverse ● Nursing considerations: Safety measures
effects. to prevent orthostatic hypotension such
● Obtain baseline status for weight, vital as changing positions slowly, hold onto
signs, overall skin condition, and railings when using stairs
laboratory tests like renal and hepatic ● To check pulse rate and when to call
function tests, and serum electrolyte to HCP
assess patient’s response to therapy. ● Common side effects as well as
● By blocking the effects of angiotensin potential long-term effects such as
receptors in vascular endothelium, sexual dysfunction and depression. If
these drugs are able to slow down the any issues arise, discuss with HCP.
progress of renal disease in patients with ● DO NOT STOP TAKING DRUG SUDDENLY.
type 2 diabetes and hypertension. Doing so may cause tachycardia,
 dysrythmias, elevated BP, angina and ● Diabetics are not usually given
MI. beta-blockers because they can effect
● ALWAYS inform HCP before surgery or the blood glucose level and because
dental work they are on a beta-blocker the drugs will mask the cardiovascular
● Any chest pain experienced during effects of hypoglycemia such as
activity should be discussed with the tachycardia, mild tremors and
HCP so that safe activity levels can be diaphoresis. If your pt is a diabetic and
discussed. (If they exercise regularly, on a beta-blocker, monitor closely for
their target heart rate may need to be signs of hypoglycemia unique to the pt
lowered) and monitor blood glucose frequently
● Extended release forms of the drug ● Patients with COPD (including asthma)
should never be crushed and taken. should be monitored closely for
● Nursing considerations: Obtain current respiratory issues such as wheezing and
BP and apical pulse rate; if below 90 difficulty breathing (remember what
systolic or 60 beats per minute (BPM) beta blockers BLOCK–bronchodilation)
hold the drug and notify the health care They should not be given nonselective
provider (HCP). Check your institution’s beta-blockers.
policy, some say hold below 50 BPM
● Safety measures to prevent orthostatic Drug Names of Beta-blockers include:
hypotension such as changing positions - Acebutolol
slowly, hold onto railings when using - Atenolol
stairs - Betaxolol
● To check pulse rate and when to call - Bisoprolol
HCP - Carteolol
● Common side effects as well as - Carvedilol
potential long term effects such as - Labetalol
sexual dysfunction and depression. If - Metoprolol
any issues arise, discuss with HCP. - Nadolol
● DO NOT STOP TAKING DRUG SUDDENLY. - Nebivolol
Doing so may cause tachycardia, - Penbutolol
dysrythmias, elevated BP, angina and - Pindolol
MI. - Propanolol
● ALWAYS inform HCP before surgery or - Sotalol
dental work they are onabeta-blocker - Timolol
● Any chest pain experienced during
activity should be discussed with the d. Calcium Channel Blockers
HCP so that safe activity levels can be ● Calcium-channel blockers as anti
discussed. (If they exercise regularly, hypertensive agents decrease blood
their target heart rate may need to be pressure, cardiac workload, and
lowered) myocardial consumption of oxygen.
● Extended release forms of the drug ● Since these drugs can significantly
should never be crushed and taken decrease cardiac workload, they are
● Monitor for side effects, especially effective in treatment of angina.
orthostatic hypotension ● These drugs inhibit the movement of
● Monitor older pts for mental confusion or calciumions across myocardial and
changes in LOC which may indicate an arterial muscle cell membranes. As a
overdose result, action potential of these cells are
 altered and cell contractions are Examples of calcium channel blockers
blocked. include:
● Resultant effects include: depressed - Amlodipine
myocardial contractility, slow cardiac - Felodipine.
impulse in conductive tissues, and - Isradipine.
arterial dilation and relaxation. - Nicardipine.
● Like ACE inhibitors and ARBs, they can - Nifedipine
also be used alone for the treatment of - Nisoldipine
hypertension or in combination with
other antihypertensive agents. e. Diuretics Drugs
● Extended-release preparations are ● A diuretic is any substance that
usually indicated for hypertension in promotes diuresis, the increased
adults. production of urine.
● Children: calcium-channel blockers is ● This includes forced diuresis. There are
the drug group that is first considered in several categories of diuretics. All
cases of hypertension in this age group diuretics increase the excretion of water
that needs drug therapy. from bodies, although each class does
● Adults: these drugs are not allowed so in a distinct way.
during pregnancy. ● Diuretics, sometimes called water pills,
● Older adults: are more susceptible to help rid your body of salt (sodium) and
drug toxicity because of underlying water. Most of them help your kidneys
conditions that would interfere with release more sodium into your urine. The
metabolism and excretion of drug. sodium takes with it water from your
Renal and hepatic function should blood, decreasing the amount of fluid
always be monitored. flowing through your veins and arteries.
● Nursing considerations: Assess for the This reduces blood pressure.
mentioned contraindications to this
drug (e.g. headache, rash, There are three types of Diuretics:
bradycardia, etc.) to prevent potential - Thiazide
adverse effects. - Loop
● Monitor cardiopulmonary status closely - Potassium sparing
as the drug can cause severe effects on
these two body systems. ● Each type affects a different part of
● Monitor the ECG when therapy starts your kidneys. Some pills combine more
and when the dosage is adjusted. than one type of diuretic or combine a
● If the patient's systolic pressure is below diuretic with another blood pressure
90 mmhg or the heart rate drops below medication.
60 beats/minute, withhold the dose and ● Which diuretic is best for you depends
notify the prescriber or follow the on your health and the condition being
ordered parameters for withholding the treated.
medication. ● Increased Intraocular Pressure: Monitor
● Advise the patient that fluid and sodium for persistent or increased eye pain or
intake may need to be restricted to decreased visual acuity.
minimize edema. ● Lab Test Considerations: Monitor
electrolytes (especially potassium),
blood glucose, BUN, and serum uric
 acid levels before and periodically
throughout the course of therapy.
● When administering Furosemide: Assess
fluidstatus. Monitor daily weight, intake
and output ratios, amount and location
of edema, lung sounds, skin turgor, and
mucous membranes. Notify health care
professional if thirst, dry mouth, lethargy,
weakness, hypotension, or oliguria
occurs. Monitor BP and pulse before
and during administration.
Examples of oral thiazide diuretics include:
- Chlorothiazide (Diuril)
- Chlorthalidone
- Hydrochlorothiazide (Microzide)
- Indapamide
- Metolazone
Examples of loop diuretics include:
- Bumetanide (Bumex)
- Ethacrynic acid (Edecrin)
- Furosemide (Lasix)
- Torsemide (Demadex)
Examples of potassium-sparing diuretics
include:
- Amiloride
- Eplerenone (Inspra)
- Spironolactone (Aldactone, Carospir)
- Triamterene (Dyrenium)
ANTIPLATELET DRUGS
● Thiazide diuretics are recommended as
oneof the first drug treatments for high
blood pressure.
● If diuretics aren't enough to lower your
blood pressure, your doctor might add
other blood pressure medications to
your treatment plan.
● Diuretics are also used to prevent, treat
or improve symptoms in people who
have:
○ Heart failure
○ Liver failure
○ Tissue swelling (edema)
○ Certain kidney disorders, such as
kidney stones
ANTICOAGULANT DRUGS
● Anticoagulants are medicines that
prevent the blood from clotting as
quickly or as effectively as normal. Some
people call anticoagulants blood
thinners.
● Anticoagulants are used to treat and
prevent blood clots that may occur in
your blood vessels. Blood clots can
block blood vessels (an artery or a vein).
● Anticoagulants are medicines that help
prevent blood clots. They're given to
people at a high risk of getting clots, to
reduce their chances of developing
serious conditions such as strokes and
heart attacks. A blood clot is a seal
created by the blood to stop bleeding
from wounds.
● Patients on anticoagulant therapy must
be educated about their increased risk
for bleeding, monitoring for bleeding,
managing bleeding if it occurs, and
drug-specific information.
● Sometimes it clots too much, putting the
patient at risk of complications such as
strokes or heart attacks. Anticoagulant
drugs are used to reduce the ability of
the blood to clot.
● Examples of anticoagulants include:
aspirin, heparin and warfarin.
● An antiplatelet drug, also known as a
platelet agglutination inhibitor or
platelet aggregation inhibitor, is a
member of a class of pharmaceuticals
that decrease platelet aggregation and
inhibit thrombus formation. They are
effective in the arterial circulation,
where anticoagulants have little effect.
● Antiplatelets are medicines that stop
cells in the blood (platelets) from
sticking together and forming a clot. A
blood clot can lead to a heart attack or
stroke. Aspirin is the most common
antiplatelet. At a low dose, aspirin
reduces inflammation in the arteries.
These are vital nursing interventions done in ANTILIPIDEMICS: STATINS
patients who are taking antiplatelet agents: By: https://www.youtube.com/watch?v=GGujNNt_q9Q&t=211s

● Obtain baseline status for complete

blood count and clotting studies to Statins are medications that reduce cholesterol
determine any potential adverse levels that was discovered by Akira Endo (a
effects. Administer drug with meals to Japanese biochemist) in 1971.
relieve GI upset. Statins:
● Provide comfort measures for - Rosuvastatin
headache because pain due to - Simvastatin
headache may decrease patient - Atorvastatin
compliance to treatment regimen. Cholesterol is produced by the Liver and is
● Educate patient on ways to promote transported by Lipoproteins:
safety like using electric razor,
soft-bristled toothbrush, and cautious LOW-DENSITY LIPOPROTEIN - which is known as
movement because any injury at this bad cholesterol, the main function is to
point can precipitate bleeding. transport cholesterol throughout the body
● Educate patient on drug therapy
including drug name, its indication, and HIGH-DENSITY LIPOPROTEIN - wich is known as
adverse effects to watch out for to good cholesterol. This type removes the excess
enhance patient understanding on drug cholesterol and carries it back to the level for
therapy and thereby promote degradation.
adherence to drug regimen.
● It is also important that adults are HOW DOES STATINS WORK?
educated on what to do should STATINS work by competitively inhibiting HMG
bleeding occurs (e.g.applying firm coenzyme, a reductase. This enzyme catalyzes
pressure) as well as what signs of the reduction of HMG coenzyme, which is the
bleeding should be watched out for. rate-limiting step in hepatic cholesterol
● Other drugs taken should be biosynthesis. INHIBITION of this enzyme decreses
documented because there are a lot of the cholesterol synthesis. Leading to an
drug interactions with these drug class. It upregulation in LDL receptors in the liver. This
should also be emphasized that INCREASES LDL UPTAKE by hepatocytes
periodic blood tests is expected to decreasing the amount of LDL cholesterol in
monitor the effect of therapy. the blood.

Antiplatelets drugs include: WHO SHOULD WE GIVE STATINS TO?

● ASA, also called acetylsalicylic acid Statins are given as a PREVENTION of
(Aspirin, Asaphen, Entrophen, Novasen) Cardiovascular Diseases in patient with LDL
● Clopidogrel Cholesterol more than 190mg/dl.
● Prasugrel
● Ticagrelor CONTRAINDICATIONS:
- Chronic liver disease or elevated liver
enzymes/elevated serum transaminases
- CATEGORY X in pregnant mothers
- Important to monitor creatine kinase in
patients on statins as myopathy is one of
the most serious side effects of statins.