Edgewood College

School of Nursing
N312
CARDIAC DRUGS I
Hypertension - a sustained elevation in blood pressure > 140/90. A normal blood
pressure is defined as < 120/80. Pre--hypertension is defined as 120-139/80-89. Patients
with diabetes or chronic kidney disease are treated to keep BP < 130/80. A common and
chronic disorder. Leads to heart disease, kidney disease, and stroke. Primary
hypertension (essential) affects 90% of all those with hypertension. Lifestyle changes
may be sufficient to control blood pressure. If not sufficiently controlled drug
therapy is needed. Usual drug classes used are: diuretics, beta-blockers, ACE
inhibitors, and Ca+ channel blockers.
Congestive Heart Failure a condition when the left or right or both ventricles lose
the ability to pump enough blood to meet the bodys circulatory needs. The end result
is inadequate perfusion and volume overload. Some causes of CHF are: myocardial
infarct, hypertension, congenital defects, and cardiomyopathies. Drugs used to control
CHF are: diuretics, Ca+ channel blockers, cardiac glycosides, and ACE inhibitors.
Angina angina pectoris is pain that is felt beneath the sternum that may radiate to
the left shoulder and arm or chin. There is an insufficient supply of oxygen to the
heart muscle that is causing the pain. Angina is caused by myocardial insufficiency when
the coronary arteries are unable to supply the heart with enough blood because they
are narrowed or in spasm. Angina is treated with three types of drugs: nitrates,
beta- blockers and Ca+ channel blockers.
Arrhythmia an abnormality in the conduction rhythm of the heart beat. Usually a
tachycardia (too fast) or bradycardia (too slow) develops and is treated with
antidysrhythmic drugs. Rhythm disorders can be atrial, supraventricular and
ventricular.
Terms Defined
Preload- the pressure or stretch exerted on the walls of the ventricle by the volume of
blood filling the heart at the end diastole. (Volume of blood entering the heart.)
Diuretics will preload. Vasodilators also decrease the preload. Effect is greater on
veins than arterial system.
After load the pressure the ventricle has to overcome to eject the stroke volume.
Vasodilators (NTG) will after load. ACE inhibitors will after load.
Inotropic drugs these drugs increase the myocardial contractility. Increase the
force in which the heart contracts. Digoxin is an example. There are also negative
inotropics.

Chronotropic drugs these will increase the heart rate. Negative chronotropics
will decrease the heart rate. Digoxin is an example of a neg. chronotropic.
PVR peripheral vascular resistance. The pressure exerted against the wall of
the vascular space. Peripheral constriction will PVR. The elasticity and viscosity
of the blood will also affect the PVR.
DIURETICS loop, thiazide, potassium sparing, and osmotic. Potassium needed
to maintain electrical excitability of muscle and nerve conduction. > intracellular
K+ < extracellular. Most diuretics act by disrupting reabsorption of sodium and
chloride.
*furosemide (lasix) loop diuretic. Most effective type of diuretic and most prescribed.
Acts in Henles loop to provide profound diuresis. Available po, IV, and IM. PO onset
is 60 minutes; with IV it is 5 minutes. Diuresis will occur even when the renal blood
flow is low. Used for pulmonary edema from cardiac (CHF) and renal disease,
hypertension.
Adverse effects: hyponatremia, hypochloremia, hypokalemia, hypotension, ototoxicity,
hyperglycemia, hyperuricemia. Drug interactions: digoxin, lithium, ototoxic drugs,
antihypertensives. Typical adult dose 20 40 mg. qd, bid.
Potassium K+ supplement PO or IV piggyback. *Protocol for IV use.
Potassium sliding scale
*hydrochlorothiazide (HCTZ) thiazide diuretic, similar action as loop diuretics but
works in the segment of distal convoluted tubule. Does NOT work well with renal
damage. Available only as PO. Adverse effects similar to loop diuretics.
*spironolactone (aldactone) potassium-sparing diuretic, modest diuretic response
but will decrease potassium excretion. Blocks aldosterone in distal nephron which
retention of K+ and excretion of Na+. Used most often in combination with loop
or thiazide diuretics. Caution when used with ACE inhibitors as they may increase K+.
*mannitol (osmitrol) osmotic diuretic, works in lumen of nephron. Used to ICP
and intraocular pressure. Available IV route only, onset 30-60- minutes.
ACE INHIBITORS pril drugs. Blocks angiotensin-converting enzyme, which will
inhibit production of angiotensin II. End result is vasodilation (esp. arterioles),
blood
volume. Used for TX. of hypertension, CHF, myocardial infarct, diabetic nephropathy.
*captopril (capoten) decreased absorption if taken with food, half-life only 2 hours.
Adverse effects: hypotension esp. first dose, cough, hyperkalemia, and renal failure with
renal stenosis and rash.

ANGIOTENSIN - RECEPTOR BLOCKERS ARBs block the action of angiotensin

II. Similar to ACE inhibitors except they do not cause cough or hyperkalemia. ARBs are
often prescribed when ACEs arent effective or the side effects are intolerable.
Losartan ( cozaar) used for hypertension, CHF and diabetic nephropathy.Helps to
prevent kidney disease in diabetics.
The generic names for ARBs end in-sartan

BETA-BLOCKERS- olol drugs, beta-adrenergic antagonists. May block beta1 (cardiac)

and/or beta2 (bronchial) receptors. Reduces heart rate, cardiac output at rest and during
exercise. Lowers blood pressure. Contraindicated in cardiogenic shock, heart block,
bronchial asthma if beta 2 properties present.
*metoprolol (lopressor)- beta 1 selective drug. Used as monotherapy or in combination
with a diuretic or vasodilator for hypertension. Also used for TX. for angina pectoris.
*propranolol hydrochloride (inderal)- nonselective beta1 beta2 blocker.
CALCIUM CHANNEL BLOCKERS block the entry of calcium across the cell
membrane blocking repolarization and preventing contraction of smooth muscle. End
result is vasodilation, bradycardia, AV conduction, force of contraction. Reduces
oxygen demands of heart. TX. for angina, hypertension, cardiac arrhythmia. Use with
caution in CHF patients esp. if they are on a beta-blocker.
*diltiazem (cardizem) act on smooth muscle and heart, causing increase coronary
perfusion, vasodilation decreasing blood pressure, and decreases the velocity of
conduction through the heart. Uses: angina, hypertension, and cardiac arrhythmias.
Adverse effects: bradycardia, heart block, if toxicity should occur can give calcium
gluconate IV to counter the vasodilation, epinephrine for severe hypotension.
*nifedipine (adalat)- most potent, different in that it has little effect on heart, so
is not used for arrhythmias. Target vascular smooth muscle Used for angina,
hypertension. Can develop reflex tachycardia (if baroreceptors stimulated), which can be
controlled by beta-blockers. Available as a sustained-release capsule.
VASODILATORS dilate arterioles (afterload) and veins (preload). Used for
control of angina, peripheral vascular disease, and hypertension.

*hydralazine (apresoline) direct effect on arterioles, little effect on veins. Used

to control B/P with a beta-blocker and diuretic.
*sodium nitroprusside (nipride) very potent, drug of choice for emergencies. Given
IV. Cyanide poisoning is a side effect since cyanide is a metabolite.
*nitroglycerine organic nitrate. Effective, fast and inexpensive. Used primarily for
angina. Given SL or transdermal ointment. Bottles need to be protected from the light
and replaced every 6 months. Patient education inform patients that NTG can be
repeated 3X, 5 minutes part, if no relief of chest pain need to be seen by physician. Can
cause headache, dizziness
CARDIAC GLYCOSIDE derived from the foxglove plant. Slows the heart rate
and makes the contraction more forceful. Decreases the movement of sodium out of the
myocardial cells after contraction. Calcium enters the cell in exchange which enhances
contractility. This increases cardiac output, alleviating the symptoms of CHF.
*digitalis glycoside (digoxin) narrow range of therapy, dig. toxicity is increased
when potassium level is low. S/S nausea, vomiting, slow heart rate, dizziness. Check
pulse before giving, hold of < 60/min. Therapeutic dig. level 0.5-0.8ng/ml. Half-life is
1.5 days.