Pharmacology Drug Cards.

RN Pharmacology Cardiovascular system Drugs Chapter 40 Cardiac Glycosides, Antianginals, and Antidysrhythmics Chapter 41 Diuretics Chapter 42 Antihypertensives Chapter 43 Anticoagulants, Antiplatelets, and Thrombolytics •Chapter 44: Antihyperlipidemic

Adeline Samba, DNP, MSNed, RN

Pathophysiology for HTN

Force exerted on the walls of an artery. SBP of 120 to 129 and DBP of less than 80. Stage 1 hypertension falls between 130/80 and 139/89, and stage 2 hypertension is 140/90 or greater.

Factors Affecting Blood Pressure and Drugs • Increase blood volume: Diuretics-Hydrochlorothiazide • Increase sodium: ACE inhibitors-lisinopril, and ARB-losartan Vasoconstriction( BP)

• Renin Angiotensin I Angiotensin II Angiotensin converting Aldosterone(Na retention, BP) • enzyme

• Vasoconstriction: vasodilators-hydralazine, nitroprusside • Indirect vasodilators: CCB-amlodipine, Alpha 1 blockers-prazosin

• Increase stress(sympathetic stimulation): betablockers-metoprolol

Antihypertensive: Chapter 42

Drug class Drugs Action and use Adverse effects Nursing implications

Diuretics Hydrochlorothiazid e

First-line antihypertensives Decrease plasma and extracellular fluid volumes

Fluid and electrolyte imbalance Hypotension

Monitor K, Na, hydration status Teach patients to rise slowly to avoid orthostatic hypotension.

Beta receptor blockers (peripheral)

Propranolol, metoprolol, and atenolol

Cause reduced secretion of renin,  

Bradycardia Drowsiness, Impotence, Constipation, dry mouth, Edema hypoglycemia hypotension dizziness, insomnia, depression, fatigue, nightmares,

Rebound hypertension with abrupt discontinuation Advise patients to avoid over-the-counter (OTC) drugs without first checking with a health care provider

Alpha2 receptor agonists (central)

Clonidine and methyldopa

Decrease norepinephrine production, decrease blood pressure

orthostatic hypotension, fatigue, and dizziness drowsiness, dry mouth, dizziness, and bradycardia

High incidence of unwanted adverse effects: Also used for the management of opioid withdrawal  

Alpha1 receptor blockers (peripheral)

Doxazosin, prazosin, and terazosin

Reduces peripheral vascular resistance and BP by dilating both arterial and venous blood vessels

Tachycardia, dizziness, N/V/D, constipation, dry mouth, HA, chest pain, depression orthostatic hypotension headache, drowsiness, nasal congestion and weight gain

Also used for BPH

Combination alpha1 and beta receptor blockers

Labetalol and carvedilol        

Uses: hypertension and HF orthostatic hypotension, dizziness, paresthesia, nasal congestion, nausea, and fatigue.

 

Antihypertensive: Chapter 42 Cont.

Drug class Drug Action and use Adverse effect Nursing implications

Angiotensin- Converting Enzyme (ACE) Inhibitors

captopril (Capoten) enalapril (Vasotec) fosinopril (Monopril) lisinopril (Prinivil)

Inhibit ACE, decrease angiotensin II, and decrease BP irritated cough, nausea, vomiting, diarrhea, headache, dizziness, fatigue, hyperkalemia Angioedema: rare  

Renal Protective Effects

Angiotensin II Receptor Blockers(ARBs)

losartan (Cozaar) eprosartan (Teveten) valsartan (Diovan) irbesartan (Avapro)

ARBs block vasoconstriction and the secretion of aldosterone

Chest pain Orthostatic hypotension Dizziness, drowsiness, cough, palpitations, blurred vision, headache, edema, nausea, diarrhea, abdominal and back pain, arthralgia, fatigue, muscle cramps, pharyngitis, erectile dysfunction

Well tolerated  

Calcium Channel Blockers

amlodipine (Norvasc) Diltiazem Verapamil

Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction: promoting vasodilation

hypotension, constipation, nausea, dyspnea, flushing, headache, dizziness, ankle edema, bradycardia, and AV block.

 

Vasodilators hydralazine  

Directly relax arteriolar or venous smooth muscle (or both)

Hypotension reflex tachycardia, palpitations, edema, nasal congestion, headache, dizziness, lupus-like symptoms, and neurologic symptoms (tingling, numbness)

 

Vasodilators minoxidil See above T-wave electrocardiographic changes, pericardial effusion or tamponade, angina, breast tenderness, rash, and thrombocytopenia

 

Vasodilators nitroprusside (Nitropress)

See above Bradycardia, decreased platelet aggregation, rash, hypothyroidism, hypotension, methemoglobinemia, and (rarely) cyanide toxicity

Use in HTN crisis

Chapter 40 Cardiac Glycosides and drugs for heart failure

Drug class Drug Action Adverse effects Nursing implications

Cardiac Glycosides

+ve inotropic,

-ve chronotropic,

-ve dromotropic

Digoxin

Therapeutic index: 0.8-2.0ng/dl

Increase myocardial contractility.

Decrease rate of electrical conduction

 

Anorexia, nausea, vomiting, diarrhea, abdominal pain, headache, blurred or yellow vision, dizziness, weakness, confusion, visual impairment, anxiety.

Toxicity: Anorexia, diarrhea, nausea, vomiting, bradycardia, PVCs, cardiac dysrhythmias, headaches, malaise, blurred vision (white, green, or yellow halos around objects), confusion, and delirium.

Tx for toxicity__________________

Digoxin-immune Fab

Effects of K imbalance on toxicity_________________

Hypokalemia

Criteria to administer or hold the drug_________________

HR<60, or signs of toxicity Other agents used to treat heart failure

ACE inhibitors beta-blockers Loop diuretics Aldosterone inhibitors

See antihypertensives: chapter 42

   

Phosphodiesterase Inhibitors

Milrinone   Short-term management of HF for patients in the intensive care unit (ICU)

Work by inhibiting the enzyme phosphodiesterase. Positive inotropic response Vasodilation

cardiac dysrhythmias, headache, hypokalemia, tremor, thrombocytopenia, elevated liver enzyme levels

 

B-Type Natriuretic Peptides

nesiritide (Natrecor)  

Diuresis Natriuresis sodium loss Vasodilation

Hypotension, Insomnia Dysrhythmia, Headache Abdominal pain  

used as a final effort to treat severe, life-threatening HF

Antianginals

Drug class

Drug Action and use Adverse effect Nursing implications

Nitrates and Nitrites

 

 

 

 

-Nitroglycerin -Isosorbide dinitrate – Isosorbide mononitrate

Cause vasodilation because of relaxation of smooth muscles Potent dilating effect on coronary arteries

Headache, blurred vision, dizziness, syncope, weakness, diaphoresis, flushing, nausea, vomiting, dry mouth, paresthesia, peripheral edema, rash, pharyngitis, tolerance.

Orthostatic hypotension, chest pain, dyspnea, tachycardia, bradycardia

Hold for low BP

Administer maximum of 3 tablets 5 minutes apart for sublingual nitro

Administer SL nitroglycerin tablet if chest pain occurs. If pain has not subsided or has worsened in 5 minutes, call 911.

Other agents used to treat heart failure

Beta blockers: atenolol, metoprolol propranolol, nadolol Calcium Channel Blockers

Amlodipine, diltiazem Nicardipine, nifedipine verapamil

Reduce the workload of the heart

See chapter Inform patients not to discontinue beta blockers and calcium blockers without a health care provider’s approval. Withdrawal symptoms

Antidysrhythmic: Chapter 40

Drug class Drug Action, use Adverse effects Nursing implications

Class Ia procainamide, quinidine Uses atrial fibrillation, premature atrial contractions,

Fast sodium channel blockers Delay repolarization Increase APD

ventricular dysrhythmias, blood disorders, SLE–like syndrome, N, V,D, fever, leukopenia,

Monitor vital signs because hypotension can occur.    

Class Ib phenytoin, lidocaine Block sodium channels Lidocaine used for ventricular dysrhythmias Both are used for dysrhythmias caused by digoxin toxicity

twitching, convulsions, confusion, respiratory depression or arrest, hypotension, bradycardia, and dysrhythmias

 

Class Ic flecainide, propafenone Block sodium channels Used for severe ventricular dysrhythmias First-line for atrial fibrillation

dizziness, visual disturbances, and dyspnea

 

Class II beta blockers

Atenolol (Tenormin) block sympathetic nervous system stimulation, thus reducing the transmission of impulses in the heart’s conduction system

   

Class III amiodarone, dronedarone Increase APD Used for dysrhythmias that are difficult to treat

corneal microdeposits, which may cause visual halos, photophobia, and dry eyes; photosensitivity; pulmonary toxicity

 

Class IV Calcium channel blockers

Reduce AV node conduction Inhibit slow-channel (calcium-dependent) pathways

   

Diuretics: Chapter 41

Drug class Drug Action, use Adverse effects Nursing implications

Carbonic anhydrase inhibitors (CAIs)

Acetazolamide (Diamox)   Uses open-angle glaucoma Used with miotics to lower intraocular pressure

block the action of carbonic anhydrase, thus preventing the exchange of H+ ions with sodium and water. Resorption of water is decreased, and urine volume is increased.

Acidosis, Hypokalemia Drowsiness, Anorexia Paresthesias, Hematuria Urticaria, Melena Photosensitivity  

 

Loop diuretics bumetanide (Bumex) ethacrynic acid (Edecrin) furosemide (Lasix) Useful in treatment of edema in HF, nephrotic syndrome, ascites, To control hypertension

Act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption

Dizziness, headache, tinnitus, blurred vision, (GI)Nausea, vomiting, diarrhea Agranulocytosis, neutropenia, thrombocytopenia Hypokalemia, Hyponatremia, hyperglycemia, hyperuricemia  

Monitor serum electrolytes, tell pt to change position slowly.   Observe for signs and symptoms of hypokalemia (<3.5 mEq/L), such as muscle weakness, abdominal distension, leg cramps, and/or cardiac dysrhythmias.

Osmotic diuretics Mannitol (Osmitrol) Uses Cerebral edema Glaucoma Intravenous (IV) infusion only

Work mostly in the proximal tubule. Reduces intracranial pressure or cerebral edema associated with head trauma. Reduces excessive intraocular pressure

Convulsions Thrombophlebitis Pulmonary congestion

 

Diuretics Chapter 41

Potassium- sparing diuretics

spironolactone (Aldactone)

Work in collecting ducts and distal convoluted tubules Promote the excretion of sodium and water

Dizziness, headache Cramps, nausea, vomiting, diarrhea Urinary frequency, weakness, hyperkalemia Gynecomastia Amenorrhea Irregular menses Postmenopausal bleeding

 

Thiazide and thiazide-like diuretics

Hydrochlorothiazi de 1st line for HTN

Action primarily in the distal convoluted tubule Result: water, sodium, and chloride are excreted

Dizziness, headache, blurred vision Anorexia, nausea, vomiting, diarrhea Genitourinary Impotence Hematologic, Jaundice, leukopenia Urticaria, photosensitivity Hypokalemia, hyperglycemia, hyperuricemia, hypochloremic alkalosis

 

Coagulation Modifying drugs): Chapter 26

Disease processes

stroke, Myocardial infarction, DVT, PAD,

Atrial fibrillation, Mechanical heart valve,

Pulmonary embolism

What is common to these above disorders?

Clotting factors include:

Platelets

Vitamin K dependent clotting factors: II VII, IX,

and X,

Other Clotting factors: XI, XII

Coagulation Modifying drugs: Chapter 43

Drug class Drugs Action and use Adverse effects Nursing implications

Anticoagulants Heparin enoxaparin -LMWH dalteparin -LMWH Indication: _____________ ______________________  

Inhibit clotting factors II, IX, X, XI, and XII Prevent clot formation. Therapeutic value______________ ___________________

Bleeding Heparin-induced thrombocytopenia (HIT) Nausea, vomiting, abdominal cramps.

TX of HIT_____________ Antidote_____________ _ Lab to monitor_________ Contraindications___ ____ ______________________ ______________________

Anticoagulants  

Warfarin (Coumadin) Indication:_____________ ______________________ Therapeutic value______________

Inhibits production of vitamin K–dependent clotting factors II, VII, IX, and X, Prevent clot formation

Bleeding Antidote_____________ _ Lab to monitor_________ Diet restriction_________ ______________________

Anticoagulants Lepirudin, argatroban Antithrombin. Inhibits CF II bleeding Used to tx HIT

Anticoagulants fondaparinux (Arixtra) rivaroxaban (Xarelto) apixaban (Eliquis)

factor Xa inhibitors Dizziness, bleeding (See specifics)

 

Antiplatelet Aspirin(also antipyretic) cilostazol (Pletal) clopidogrel (Plavix Indication_______________ _______________________

Prevent platelet adhesion Aspirin: N, V, GI bleed, CNS symptoms, Blood dyscrasias Clopidogrel: Chest pain, flulike symptoms, N, D, bleeding

 

Antiplatelet Pentophylline Decrease blood viscosity bleeding  

Thrombolytic Indications_________ ___ _____________________

streptokinase alteplase (Activase, Cathflo Activase) reteplase (Retavase)

break down, or lyse preformed clots Indication______________  

Bleeding Nausea, vomiting, hypotension Cardiac dysrhythmias

Antidote_____________ _

Antilipemics: Chapter 44

Drug class Drugs Action and use Adverse effects Nursing implications

HMG–CoA reductase inhibitors First-line

atorvastatin (Lipitor) simvastatin (Zocor) lovastatin (Mevacor) pravastatin (Pravachol)

Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol Reduces LDL, and triglycerides Increases HDL

(GI) disturbances Rash, Headache Myopathy (muscle pain), rhabdomyolysis Elevations in liver enzymes or liver disease

 

Bile acid sequestrants cholestyramine (Questran) colestipol (Colestid)

Prevent resorption of bile acids from small intestine Prevent absorption of cholesterol

Constipation Heartburn, nausea, belching, bloating

Also used in the Treatment of loose bowel movements

B vitamin niacin Niacin Increases activity of lipase, which breaks down lipids

Flushing (caused by histamine release) Pruritus GI distress

 

Fibric acid derivatives (fibrates).

gemfibrozil (Lopid) fenofibrate (Tricor)

activating lipase, which breaks down cholesterol

Abdominal discomfort, diarrhea, nausea Blurred vision, headache risk of gallstones

 

cholesterol absorption inhibitor

ezetimibe (Zetia): Inhibits absorption of cholesterol and related sterols from the small intestine

   

Reference

• Yeager, L.M.K.D.M.B.W. J. (2023). Pharmacology (11th ed.). Elsevier Health Sciences (US).  https://pageburstls.elsevier.com/books/9780323793179