Anti-anginal drug:

Drug that are used to prevent

the attack of angina pectoris.

Nitrate –glyceryl trinitrate(nitroglycerine)

Isosobride dinitrate
Isosarbide mononitrate
• Mechanism of action : relaxes smooth muscle

Indication
 Angina pectoris
 Myocardial infraction
 Biliary colic

Dose
Nitrate-glycerl trinitrate( Nitroglycerine): 0.5mg sub-lingual at
first attack, repeat dose every 3min if required.
Isosorbide dinitrate: Acute angina: 5-10mg sublingually
Adult: 5-10mg QID
Isosorbide mononitrate: Adult: 20mg BD or TDS
• Contraindication
-Hypotension
-Glaucoma
-Malnutrition
-Hypothyroidism
-Cerebral haemorrhage

Side Effect
-Dizziness
-Tachycardia
-Headache
-Syncope
-confusion
 Nursing consideration
• Avoid alcohol
• Teach patient to take drug in empty stomach.
• Monitor BP and pulse.
• Advice patient to make position change slowly.
• Warn patient no to confuse sublingual with
oral form.
• Cardiac glycoside: are group of naturally
occuring compounds which help heart to beat
more efficiently which means blood gets more
oxygen and nutrients to body cells.

• Digoxin
• Digitoxin
• MOA: It increases the force of systolic
contraction and decrease the oxygen expenditure
for a given work output.

• Indication
-Congenital heart failure
-Atrial fibrillation

Dose
Digoxin : oral-2.5-1.5mg
Digitoxin : 0.75mg/kg
• Contraindication
-Hypokalaemia
-Hypertension
-Obstructive cardiomyopathy

Side Effect
-Anorexia
-Nausea and vomiting
-Dizziness
-Nervousness
-Diarrhoea
-Hepatotoxicity
 Nursing consideration
- Be sure to follow right dose because a slight
increase in dose is highly toxic.
- Maintain input and output chart
- Monitor pulse rate, rhythm and quality before
each dose.
- Maintain a sodium-restricted diet.
 Drug used in cv shock
• It is define as inability of the heart to pump
sufficient amount of blood to vital organ.
Blood pressure low and the circulation to the
organ of the body is inadequate.

-Dopamine
-Dobutamine
• Mechanism of Action: It stimulates dopaminergic receptors and beta
adrenergic receptors, which causes vasodilation and increase in rate
and force of contraction of heart.

Dose
-Dopamine: adult-2-5mcg/kg/min IV infusion, gradually increased to 20-
50mcg/kg/min according to response.
Children:2-20mcg/kg/min
-Dobutamine: Adult:2.5-10mcg IV

Indication
-Chronic cardiac failure
-Open heart surgery
-Trauma
- septicemia
• Contraindication
-Hypersensitivity
-Pheochromocytoma

Side Effect
-Nausea
-Hypertension
-Vomiting
-Tachycardia
-Headache
 Nursing consideration
 Explain patient about the side effect s of
disease.
 Monitor breathing, blood oxygen level, kidney
function during the therapy.
 Advice patient to avoid calcium antagonist as
it may make the cardiac failure worse.
• Anti-coagulant and antagonist: The drugs commonly
refers blood thinners, substances that prevent or
reduce coagulation of blood. The commonly used
anti-coagulants are heparin and warfarin.

• Heparin
• Warfarin
• Phytomennadione( vitamin K)
• Protamine sulphate
• Low molecular weight heparin( Delteparin sodium,
Enoxaparin sodium , Reviparin sodium, Tinazaparin
sodium)
Heparin- Heparin is a starch like substances produced by mast cells in
body. It is injectable rapidly acting anticoagulant.

MOA: It inhibit the effect of the activated clotting factor upon

prothrombin thus prevent the formation of thrombin.

Indication
-Thrombosis
-MI
-Deep vein thrombosis

Dose
Adult: 140mg daily for 2 days, than adjust according to prothrombin time.
child: 0.1mg/kg/day with a range of 0.05-0.34mg/kg/day.
Contraindication
-Peptic ulcer
-Hypertension
-Acute tuberculosis
-liver disease

Side Effect
-Bleeding
-Thrombocytopenia
-Alopecia
-skin necrosis
 Nursing consideration
• Make sure that blood clotting test are done in
accordance with doctor order.
• Heparin should not be given by IM
• Monitor prothrombin time during treatment.
Warfarin: Warfarin is an oral anti-coagulant.

MOA: It inhibits the synthesis of vit.k dependent

coagulation factor.
Dose: Adult- 10mg/day PO/IV initially for 2 days
followed by maintenance dose of 2-10mg/day
depending upon prothrombin time.
child-0.2mg/kg for 2-4 days
Indication
-Deep vein thrombosis
-Pulmonary embolism.
Contraindication
-pregnancy

Side effect
-Hypersensitivity
-Rash
-Alopecia
-Hepatitis
-Anaphylaxis
 Nursing consideration
• During warfarin,advice patient to report
immediately any abnormal bleeding .
• Explain about the side effect and observe
carefully.
• Advice patient to stop smoking.
Phytomenadione( vitamin-k): It is given routinely to newborn babies
Dose: oral-vit.k defeciency:10-40mg/day
as antidote: upto 5mg(IV)
Indication
-vitamin.k defeciency in newborn

Contraindication
-Pregnancy
-lactation
-Thrombosis

Side effect
-Pain
-Low BP
-Dizziness
-swelling
Low molecular weight heparin:
-Delteparin sodium
-Enoxaparin sodium
-Reviparin sodium
-Tinzaparin sodium

Indication
-deep vein thrombosis

Dose
100IU/Kg every 12-14hours.
 Nursing consideration
• Instruct patient to take medication as directed by
physician.
• Advice to take food rich in vitamin-k.
• Advice patient to report any symptoms of
unusual bleeding and pain, color, or temperature
change to any area of body to physician
immediately.
• Prothrombin time should be checked regulary as
clinical conditions.
• Difference between Heparin and warfarin

Heparin Warfarin
Route of administration Parental oral
Onset of action fast slow
Duration of action 4-6hrs 4-7days
Antagonist Protamine sulphate vit.k
• Lipid lowering drugs : These drugs are used to
prevent cardiovascular disease in all those at risk
of cholestreol, trigylceride
1) Nicotinic acid
2) Bizafibrate
3) Gemfibrozil
4) Simvastatin
5) Pravastatin
6) Atorvastatin
7) Cholestyramine
8) clofibrate
• MOA: lower cholesterol as well as triglycerides in the blood and reduce
hepatic production of triglycerides

• Indication
-Increase cholestreol and triglycerides
-lower high density lipids

Dose
Nicotinic acid: 1.5g/day
Bizafibrate: 200mg TDS
Gemifibrozil:1200mg PO in divided dose 30min before meal
Simvastatin:5-10mg OD in evening
Pravastatin: 40mg
Atrovastatin: 10mg/day PO
Cholestyramine: oral suspension
Clofibrtae: 500mg capsule
• Contraindication
-Pregnancy
-Hypersensitivity
-Peptic ulcer
-Nephrotic syndrome

Side Effect
-Jaundice
-Vomiting
-Diarrhoea
-Anaemia
-Myalgia
-Heartburn
 Nursing consideration
• Special care should be given to the patient
with hepatic dysfunction.
• Tell the patients to report immediately if
he/she notice change in heart rate.
• Monitor liver function test , glucose level
during therapy.
• Always advice to take medicine 30min before
meal in morning and evening.
• Anti-platelets drugs: These are drugs, which
interfere with platelet function and may be
useful in the prophylaxis of thrombo embolic
disorders.

• Aspirin
• Dipyridamole
• Abixicimab
• Eptifibatile
• Clopidogrel
• MOA: They inhibit the platelets aggregation by inhibiting
synthesis of thromboxane A2.
• Indication
-Myocardial infraction
-venous thrombo embolism

Dose
-Aspirin: MI and stroke prophylaxis: 50-325mg/day PO
-Dipyridamole: Adult: 300-600mg
child: 3-6mg/kg/day
-Abixicimab: 250mcg/kg over 1min
-Eptifibatile: IV-180mcg/kg
-Clopidogrel: 75mg
Contraindication
-Hypersensitivity
-Infant less than 3months
-Peptic ulcer
-Bleeding disorder
 Nursing consideration
i) Advice patient to take medicine only after
meal to minimize GI upset.
ii) Check for sign of GI bleeding especially in
gums and look for dark stool.
iii) Assess for vital sign, sign of bleeding , severe
headache.
iv) Encourage intake plenty of fluids.
• Anti-thrombic agent( thrombolytic/fibrinolytic
drugs): Thrombolytic is a drug used for
prevention or treatment of dangerous blood
clot.

• Streptokinase
• Ethamsylate
• MOA:

• Dose
• Streptokinase: 2.5-5IU IV over 30min
• Ethamsylate: 500mg QID for 5 days.

Indication
-MI
-Deep vein thrombosis
-Pulmonary embolism
• Contraindication
-Active bleeding
-Surgery
-Pregnancy
-GI bleeding

Side Effect
-Bleeding
-Anaphylaxis
-Allergy
-Hypotension
-Fever
 Nursing consideration
• Should be given in closed monitoring.
• Im injection is contraindicated
• Should have blood group and cross match
done for possibility of Hemorrhage
• If evidence of bleeding seen, stop drugs.