Drugs acting on different

systems of the body

UNIT 6
 Specific objectives
• By the end of this unit the student should
be able to explain the drugs commonly
used in diseases of the,
1. Cardio –vascular system
2. Gastro-intestinal tract
3. Respiratory tract
4. Urinary tract
Drugs acting on Cardio-
vascular system
 Physiology of heart
• Heart is a muscular pump which moves
blood through vascular system.
• Circulating blood provides body cells
with oxygen, nutrients and other
chemicals necessary for functions of life.
• Blood also carries away the waste
products of metabolism.
• So, heart is vital to life
• Left side of the heart pumps out
oxygenated blood to the body against
arterial resistance.
• Right side of the heart receives
deoxygenated blood from veins and RV
pumps deoxygenated blood to the lungs.
• So the musculature of LV is thicker than
RV.
• The cardiac muscle possesses certain
1. Exitability
2. Contractility
3. Conductivity
4. Rhythmicity
5. Automaticity
• Drugs can act directly on the cardiac
musculature, nodal and specialized
conducting tissue or indirectly through
the vagus and sympathetic nerves or CNS
• Clinically three problems are associated
with heart.

1. Congestive cardiac failure ( CCF)-failure of

pumping action of heart

2. Cardiac arrhythmias- due to disturbances

in either the generation of impulses or its
conduction in the heart.

3. Angina pectoris or Myocardial infarctions

which are due to deficiency in supply of
oxygen to heart
 The drugs commonly used in
diseases of the Cardio
–Vascular system
1. Heart stimulants • Haematinics
• Anticoagulants
2. Anti anginals • Anti platelets
• Thrombolytics
3. Anti arrhythmic
• Hypolipidimics
drugs
4. Vaso
constrictors
 Heart stimulants/Positive
inotropic drugs
• Inotropic effect is the strength of
contraction of cardiac muscle.
• Cardiotonic or positive inotropic agents
are the chemicals increasing the
strength of contraction.
• Negative inotropic drugs are those
reducing cardiac contractions.
1.Positive inotropic agents
I. Cardiac glycosides
II. Phosphodiesterase inhibitors
I.Cardiac glycosides
I. Increase the force of contraction and
reduce conductivity within the AV node.
V. Most useful in the treatment of
supraventricular tachycardia.
V. Digoxin is the commonest used cardiac
glycoside.
• Both Digoxin and Digitoxin are
preparations of Digitalis group.
Mechanism of Action
• Cardiac glycosides inhibit the enzyme Na-
K-ATPase present in cardiac muscle.
• This cause an increase intracellular Na
& Ca in
• heart muscle cells that leads to increase
in force of contraction
Contraindication/precautions
1. Contraindicated in uncontrolled
ventricular arrythmias, constrictive
pericarditis, complete heart block.
2. Risk of Digoxin toxicity is increases with
hypercalcemia.
3. Hypokalemia, Hypomagnesemia, renal
failure.
4.Elderly patients have more risk of
toxicity because they are more sensitive to
drug’s effects,
5.Anorexia may be an early warning sign
of toxicity.
Adverse Effects
1. Bradycardia.
2. Weakness.
3. Fatigue.
5. May cause digoxin toxicity such as
anorexia, nausea, vomiting, visual
disturbance, confusion, bradycardia, heart
block, premature ventricular contractions.
Drug interactions
1. With potassium wasting diuretics
because they may cause potassium loss
increase the risk of digoxin toxicity.
2. Antacids, aminoglycosides
3. Metoclopramide decrease GI absorption
of digoxin.
Uses of Digoxin
1. Congestive cardiac failure
2. Atrial flutter
3. Atrial fibrillation
4. Supraventricular tachycardia
Nursing care of patient on digitalis
1. Observe for the development of nausea
and vomiting
2. Check for pulse rate and irregularity of
rhythm. Discontinue if the rate is less
than 60beats/min or if there are coupled
beats
3. When treating for atrial flutter check
for pulses deficit and immediately
inform the medical officer if there is a
4. When treating for CCF its essential to
maintain a fluid balance chart.UOP
should be high if patient is responding
for the treatment.
5. A diet with low sodium but rich in
potassium should be offered.( Low K+
levels causes digitalis toxicity)
6. Drug should be administered after
meals at the same time each day.
7.Parenteral preparation should be given
as deep IM injection.
8. Observe for the signs of digitalis toxicity
such as prolongation of PR interval and
shortening of Q-T interval in ECG
II.Phosphodiesterase inhibitors
• Exert most of their effect on the
myocardium
• Ex. Enoximone,Milrinone
 Anti anginals (Drug used in
Angina)
• Angina pectoris is the chest pain due to
anoxia of heart muscles generally due to
obstruction or spasm in coronary artery.
• The drugs used in angina pectoris
prevent terminate attacks of angina
pectoris are called antianginal drugs.
• These drugs are mainly classified as:
1. Nitrates.
2. Beta – Blockers.
3. Calcium channel blockers.
Nitrates
• Nitrates are the drugs which are
vasodilator effects thus used in angina
pectoris. Eg:Isosrbide Mono Nitrate,
Isosorbide dinitrate,Nitroglycerine
Mechanism of action
• Nitrates release NO (Free radical nitric
oxide) which is powerful muscle
relaxant.
• So they produce vasodilation, decreased
preload and afterload, reduce
myocardial oxygen consumption.
Indications / Uses
1. Acute angina.
2. Prevention of expected and chronic
anginal attacks.
3. Long term prevention of angina.
4. Nitroglycerine is also administer I.V to
treat surgical hypertension.
Adverse effects
1. Headache is most common 5. Palpitations
2. Orthostatic hypertension 6. Tachycardia
3. Flushing 7. Dizziness
4. Nausea, vomiting
Contraindication / Precautions
1. Hypersensitivity to nitrates
2. Severe anemia
3. Orthostatic hypertension
4. Early MI.
5. Increased ICP.
6. Use cautiously in patients with
hypotension
Drug interactions
• Antihypertensives, and Sildenafil,
Tadalafil may increase hypotension
effects.
Nursing Responsibilities
1. Nurse should teach the patient about
proper use and storage of nitroglycerine
sublingual tablets.
2. Instruct the patient to sit down and take
the drug at the first sign of an acute
angina attack.
3. Teach the patient to repeat the dose if
no relief occurs in 5minutes and take
emergency medical help if no relief
4. Inform patient that headache is
common side effect of nitrates and
typically subsides with continued
therapy.
5. Advise patient to avoid beverages.
6. Advise the patient that sublingual
tablets may be taken at the onset of
activities known to cause angina such as
sexual activity.
 Anti arrhythmic drugs
• An arrhythmia is any condition in which
the rhythm of the heart is disturbed. It
may due to:
a. Increased rate of spontaneous discharge
in conducting tissue or
b. Impaired conduction in part of the
conducting system due to drug or
diseases.
Mechanism of action
• These drugs block Na⁺ (Sodium) channel
of cell
membranes and reduces excitability of
cardiac muscle
and slows the conduction in heart.
• Verapamil drug block Ca⁺ channels and
prevents
accumulation of Ca⁺⁺ ion in myocardial
• Beta blockers also blockage beta
adrenoreceptor at heart and reduced
excitability of the heart.
Indications / Uses
1. Ventricular arrhythmias
2. Ventricular tachycardia
3. Lidocaine used to treat life threatening
ventricular arrhythmias
4. To treat sinus tachycardia (Propranol)
Contraindication / Precautions
1. Persistent severe bradycardia.
2. Cardiac failure.
3. Hypersensitivity to these drugs.
4. Cardiogenic shock.
5. Complete atrioventricular block.
6. 2nd & 3rd degree heart block
Adverse effects
1. Hypotension 4. Heart failure
2. Dizziness 5. Fatigue.
3. Nausea / Vomiting.
Drug interactions
1. Simultaneously use with
antihypertensives causes additive
hypotension.
2. Propranolol may increases hypotensive
effects when used with NSAID’s
Indomethacin, Ca⁺ channel blockers.
3. Concurrent use with Digoxin may
increased Digoxin levels and worsen
 Signs and symptoms of arrhythmia
1. Abnormal rapid or slow pulse
2. Heart block
3. Fibrillation
Classification of antiarrhythmic agents
1. Membrane stabilizing drugs( sodium
channel blocker)
a.Quinidine like drugs-Quinidine,
Procainamide
b.Lignocaine,Phenytoin,Tocainide
2.Anti sympathetic agents(catecholamine
block)
Beta blockers,Bretylium(also class 3
action)
3.Agents widening action potential
duration
4.Calcium channel blocker
Verapamil,Nifidipine
Class 1-interference with depolarization of
cardiac cell membrane by blocking sodium
channel
Class 2-Decreases the arrhythmic effects of
catecholsmines .Bretylium blocks the
release of amine and has also action like
class three drugs.
• Class 3- Prolongs duration of action
potential of atrial and ventricular
muscle with associated prolongation of
effective refractory period
• Class 4- Inhibits slow inward calcium ion
mediated current
 Nursing considerations in administrating
antiarrhythmic agents
• Titrate the dose to the smallest amount
enough to manage arrhythmia to
decrease the risk of drug toxicity.
• Monitor cardiac rhythm closely to detect
potentially serious adverse effects and to
evaluate drug effectiveness.
• Provide comfort and safety measures (e.
g. raising side rails, adequate room
lighting, noise control) to help patient
tolerate drug effects
• Ensure maintenance of emergency drugs
and equipment at bedside to promote
prompt treatment in cases of severe
toxicity.
• Educate patient on drug therapy
including drug name, its indication, and
adverse effects to watch out for to
enhance patient understanding on drug
therapy and thereby promote adherence
to drug regimen.
 Vasoconstrictors
• Vasoconstriction is the narrowing of
the blood vessels resulting from
contraction of the muscular wall of the
vessels.
• Medications causing vasoconstriction
are known as vasoconstrictors.
• They are one type of medicine used to
raise blood pressure.
• It may also occur in specific tissues,
causing a localized reduction in blood
flow.
• Many vasoconstrictors also cause pupil
dilation.
• Medications that cause vasoconstriction
include: antihistamines, decongestants,
and stimulants.
• Severe vasoconstriction may result in
 Hypotensive drugs /
Antihypertensives
• Hypertension is a disease characterized
by abnormally high blood pressure.
Classification of Antihypertensive drugs
1. Beta blockers -Eg. Atenolol,
Timolol, Metoprolol,Propanol.
2. Calcium channel blockers - Eg.
Nifedipine,
Amlodipine, Verapamil, Diltiazem.
3. ACE inhibitors - Eg. Captopril,
Ramipril, Lisinopril,Enalpril.
4. Diuretics -Eg.
Furosemide, Amiloride, Spironolactone.
5. Vasodilators - Eg.
Hydralazine, Minoxidil, Diazoxide.
6. Angiotensin antagonist- Eg. Losartan.
7. Drugs acting on the brain- Eg.Clonidine,
Methyl Dopa
Mechanism of action (Beta – Adrenergic
Blockers).
• Beta adrenergic receptors causes
vasoconstriction in blood vessels.
• Thus these drugs prevents stimulation of
beta – adrenergic receptors of
sympathetic nervous system, thereby
decreasing cardiac output.
Indications / Uses
Contraindication / Precautions
1. In patients with asthma
2. Sinus bradycardia
3. Cardiogenic shock
4. Second or third degree heart block.
• Use these drugs with cautiously in
pregnant and breast feeding women and in
those with impaired hepatic function.
Adverse effects
1.Orthostatic hypertension 2. Fatigue
2.Bradycardia 4.Nausea,
vomiting
Drug interactions
• Additive hypotension when used
concurrently with alcohol and
antihypertensives or calcium channel
blockers.
Nursing Responsibilities
1. Do not discontinue drug abruptly.
2. Administer propranolol constituently with
food, food may increase absorption.
Mechanism of action (Calcium channel
blockers)
3. They block the entry of Ca⁺⁺ ions into the
smooth and cardiac muscle cells.
4. It leads to decreased intracellular Ca⁺⁺ ions
which causes smooth muscle relaxation
leads to vasodilation
Indications / Uses
1. To treat the mild hypertension.
2. Angina pectoris
Contraindication / Precautions
1. In patient with: asthma
2. sinus bradycardia
3. cardiogenic shock
4. second and third heart block
5.Use these drugs cautiously pregnant and
breast feeding women and in those with
impaired hepatic function
Adverse effects
1. Dizziness 4.Headache.
2. Flushing 5.AV blocks.
3. Edema 6.Nausea.
Drug interactions
•They may increase risk digoxin toxicity
when used with digoxin.
•May cause heart block when used with
other calcium channel blocker
Nursing Responsibilities
•Nurse should know that Nifedipine may
be given
sublingually.
 Mechanism of action (ACE inhibitors)
•It acts by inhibiting angiotensin
converting enzyme and prevents the
conservation of Angiotensin – I and
Angiotensin – II and preventing peripheral
vasoconstriction
Indications / Uses
1. To treat mild hypertension.
2. Ramipril also used to treat heart failure
after myocardial infarction.
3. To reduce the risk of MI and death from
cardiovascular causes
Adverse effects
1. Dizziness 5. Light headedness.
2. Fainting 6. Tachycardia.
3. Palpitations 7. Rash
4. Proteinuria
Contraindication / Precaution
1. In patient with: asthma
2. Sinus bradycardia
3. Cardiogenic shock
4. Second and third heart block.
5. Use these drugs cautiously pregnant and
lactating mother and in those with
impaired hepatic function
Drug interactions
1.Antihypertensives , diuretics may
increase hypertensive effects.
2. NSAID’S may decrease it effects.
3. They may increase hypoglycemic effects
if used
with insulin and oral antidiabetics.
4. ACE inhibiters may increase diuretic
effects and
increase the risk of hyperkalemia with
concurrent
use with potassium sparing diuretics.
Nursing Responsibilities
1. Antihypertensives Captopril on empty
stomach.
2. Teach patient to report light headedness
and avoid sudden position changes to
minimize orthostatic hypertension.
 Mechanism of action (Vasodilators/
Peripheral vasodilator)
They are potent direct relaxant of
vascular smooth muscle and reduce both
systolic and diastolic B.P. Indications / Uses
1. Used in moderate to severe
hypertension.
2. To treat severe and essential
hypertension.
Contraindication / Precautions
1. In patient with;asthma
2. Sinus bradycardia
3. Cardiac failure.
4. Use these drugs cautiously pregnant and
5. breast feeding women and in those with
6. impaired hepatic function.
Adverse effects
1. Fluid retention.
2. Orthostatic hypotension.
3. Tachycardia.
4. Severe hypotension.(with IV doses)
5. Minoxidil also can causes excessive hair
growth
Drug interactions
Sildenafil, hypertensive drugs may
Nursing Responsibilities
1. Nurse should closely monitor patient
for fluid volume excess.
2. Monitor patient’s blood pressure every
5 mins at start of infusion and at least
every 15mins during infusion.
3. Assess weight of patient daily and
record intake and output.
4. Advise the patient taking Minioxidil
that excessive hair growth is likely to
occur 3 to 6 months after therapy begins.
5. Reassure the patient that extra growth
should be disappear 1to 6 month after
therapy ends
 Haematinics
• Haematinics are the drugs which used to
stimulate the formation of RBC’s These
are used primarily in the treatment of
Anemia.
• Eg. Iron.
Mechanism of action
•They act as supplement and replace
depleted iron stores in the bone marrow to
Eg: Ferrous Fumarate,Ferrous Sulphate,
Ferrous Gluconate,Iron Dexran
Indications / Uses
1. To prevent and treat iron deficiency
anemia.
2. In children during rapid growth period.
3. In pregnant and lactating mother.
4. As dietary supplement of iron.
5. Patient with post gastrectomy.
Contraindication / Precautions
1. Patient with hemochromatosis
2. Hemolytic anemia
3. Patient with hemosiderosis
4. Hypersensitivity to the drug
Adverse effects
1. Nausea / vomiting 3. Dark stools
2. Constipation 4. GI distress
5. Local pain at I.V. site.
6. Parental iron may causes, headache,
Vomiting nausea and anaphylaxis.
7. Temporarily stain teeth with liquid iron.
8. Bronchospasm with parenteral iron.
Drug interactions
• Antacids, Tetracyclines, Cimetidine
decrease absorption of oral iron
preparations.
• Vit C (ascorbic acid) and
chloramphenicol increases absorption of
oral iron prepartions.
Nursing Responsibilities
1. Nurse should administer drugs
according to prescribed routes.
2. Should check for constipation.
3. Monitor patients CBC count, HB and
plasma iron levels.
 4.Nurse should teach the patient to:
✓ Continue regular dosing schedule after
missing dose.
✓ Drink at least 2 liters of liquid daily.
✓ Avoids antacids, caffeine products, dairy
products, egg, whole grain breads for
1hour after taking oral iron preparations.
✓ Be aware that oral iron preparations
may turn stool dark green or black.
 Anticoagulants
•These are the agents which inhibit the
process of clotting, thus they are used to
prevent unwanted
thrombosis.
Mechanism of action
•Prevent extension and formation of clots
by inhibiting factors in the clotting
cascade.
Indications / Uses
1. Thrombosis in deep veins.
2. Unstable angina in PTCA.
3. Open heart surgery.
4. To treat and prevent thromboembolic
disorders and ischemic complications.
Contraindication / Precautions
1. Bleeding including thrombocytopenia.
2. Peptic ulcer disease.
3. Recent surgery.
4. Coagulation disorders
Adverse effects
1. Hyperlipidemia 5.Insomnia
2. Hemorrhages 6.Nausea
3. Thrombocytopenia
7.Constipation
4. Pain at injection site
Drug interactions
1. Chloramphenicol, Metronidazole,
Androgens,
Quinidine, thrombolytics increase the risk of
bleeding and may increase effects the risk of
Warfarin.
2. Alcohol, Barbiturates, Estrogen containing
hormonal contraceptives and some food rich
in vit.
K increase the risk of clotting and may
3.Prolonged or regular use with other
drugs that effect platelet function such as
Aspirin, NSAID’s may increase the risk
bleeding
Nursing Responsibilities
1. Don’t give Heparin by IM route.
2. Asses the early signs of unusual
bleeding.
3. Nurse should minimize venipunctures
 4. Monitor haemoglobin and clotting
factor and platelet level.
5. Nurse should teach the patient to:
✓ Not to take drugs or vitamins, including
over the counter or herbal products,
without medical approval.
✓ Inform physician and dentist of therapy
regimens before undergoing any medical
treatment.
 Antiplatelets
• These are the drugs which interfere with
platelet
• function and are useful in the
prophylaxis of thrombosis disorder
Mechanism of action
• They interfere with platelets function
and inhibits platelets clumping.
Indications / Uses
1. Used as prophylaxis for
thromboembolic events.
2. Aspirin used in patients with previous
MI or unstable angina to reduce the risk
of death from these conditions and in
men to reduce the risk of transient
ischemic stroke.
3. Clopidogrel is use to reduce a
cardiovascular events.
Contraindication / Precautions
1. Active bleeding 4. Recent surgery
2. Coagulation disorder 5.
Thrombocytopenia
3. Ulcer disorder 6. Cancer
Adverse effects
1. Bleeding/Hemorrhage
2. Headache,Nausea
3. Rash
4. Pain in injection site
5. Pancytopenia
6. Neutropenia
7. Dizziness
8. Abnormal stool
Drug interactions
• Prolonged or regular use with other
drugs that effect platelet function such
as Aspirin, NSAID’s may increase the risk
of bleeding
Nursing Responsibilities
• Monitor patient for bruising or bleeding.
• Assess the early signs of unusual
bleeding.
• Nurse should minimize venipuncture
and injections, apply pressure to all
puncture sites.
• Monitor hemoglobin and clotting factor
and platelets level.
 Thrombolytics (Fibrinolytics)
• These drugs are used to lyse (Dissolve)
thrombus
or clot.
Mechanism of action
• These agents activate plasminogen to
form plasmin thus dissolve clot or
thrombosis.
(Plasminogen Plasma Clot
Indications / Uses
1. Myocardial infarction 3. Pulmonary
embolism
2. Deep vein thrombosis 4. Stroke.
Contraindication / Precautions
1. Recent streptococcal infection 5. Ulcer
disease
2. Recent stroke 6. Cancer
Adverse effects
1. Bleeding 4.
Urticaria
2. Hypersensitivity reactions
5.Arrhythmias
3. Hemorrhage
Drug interactions
4. Prolong or regular use with other drugs
that effect platelet function such as
Nursing Responsibilities
• Assess the early signs of unusual
bleeding.
• Nurses should minimize veni punctures
and
injections, apply pressure to all puncture
sites.
• Monitor hemoglobin and clotting factor
and platelets level.
 Hypolipidemics
• These drugs are used in the treatment of
atherosclerosis and hyperlipidemia

Mechanism of action

• They inhibit the synthesis of cholesterol in

liver.

• Also they inhibit the transfer of

triglycerides from liver to plasma and block
HMGCOA reductase in the liverpreventing
Indications / Uses
1. CAD( Coronary artery disease)
2. Hyperlipidemia.
3. Hypertriglyceridemia.
4. Secondary prevention of cardiovascular
events.
5. Atherosclerosis.
6. Hypercholesterolemia.
7. Increase in Sr. level of HDLs
Contraindication / Precautions
1. Hypersensitivity to these drugs.
2. Elevated liver function test results.
3. Hepatic and severe renal dysfunctions.
4. Cautiously in pregnancy and breast
feeding women
Adverse effects 7. Diarrhea.

1. Headache. 8. Constipation.

2. Photosensitivity. 9. Dyspepsia.

3. Progression of 10. Rhabdomyolysis.

cataracts. 11. Abdominal

4. Insomnia. cramps.

5. Blurred vision. 12. Flatulence.

6. Nausea / vomiting. 13. Myopathies

14. Hypersensitivity
Drug interactions
1. Use with Erythromycin, Cyclosporin,
Nicotinic acid may increase the risk of
Rhabdomyolysis and myopathy.
2. May increase Digoxin levels.
3. Concurrent use of Simvastatin,
Atorvastatin with Warfarin sodium may
increase the effects of Warfarin
Nursing Responsibilities
1. These drugs should start only after diet
therapy has proven ineffective.
2. Advise patient to avoid alcohol
consumption.
3. Give Lovastatin with evening meal
because absorption is enhanced and
cholesterol biosynthesis is greater in
the evening.
4. Monitor liver function test periodically.
5. Monitor blood level of fat soluble
vitamin, serum cholesterol, and
triglyceride levels and liver function
tests during therapy