Drugs Affecting Cardiovascular and Blood

Hypertension
- Hypertension (HTN or HT), also known as high blood pressure (HBP), is a
long-term medical condition in which the blood pressure in the arteries is
persistently elevated
- It is a sustained elevation of Blood Pressure. Systolic Blood pressure of > 140 mmHg
and Diastolic Blood Pressure of > 90mmHg.
- Classification of Hypertension
o Primary
o Secondary
- Risk Factors for primary hypertension
o Age (>55 for men; >65 for women)
o Alcohol
o Cigarette Smoking
o Diabetes Mellitus
o Elevated Serum Lipids
o Excess Dietary Sodium
o Gender
o Family History
o Obesity (BMI >30)
o Sedentary Lifestyle
o Stress
- Clinical Manifestation
o Frequently asymptomatic until severe and target organ disease has occurred
o Fatigue, reduced activity tolerance
o Dizziness
o Palpitations, angina
o Dyspnea
- How to prevent Hypertension
o Lifestyle Modifications

A. ACE Inhibitors “the PRILS”

a. These are commonly called the ACE Inhibitors because the agents block the
conversion of AI to AII in the lungs.
b. These agents alter one of the mechanisms of blood pressure control – the
RAAS
c. Angiotension II is a very powerful vasoconstrictor and stimulus for the release
of aldosterone.
- Mechanism of Action
o These agents prevent the conversion of Angiotensin I to Angiotensin II by
inhibiting the enzyme in the lungs – the Angiotensin Converting Enzyme.
o The action leads to decreased AII and decreased aldosterone level leading to
a decrease in blood pressure.
o The effect of lowering the blood pressure is attributed to the decrease in
cardiac workload and decrease peripheral resistance and blood volume.
- Indications for the PRILS
o Hypertension
o Congestive Heart Failure
o Left Ventricular Dysfunction
o Diabetes
- Contraindications and Precautions in the Use of ACE Inhibitors
o Presence of Allergy
o Renal Dysfunction
o Pregnant women
- Adverse Effects
o CVS – Tachycardia
o CNS – Dizziness, Drowsiness, ligheadedness
o GIT – GI irritation, Nausea, vomiting, peptic ulcer, constipation and liver
damage
o Renal – Renal Insufficiency, proteinuria
o Others – Rash, photosensitivity, dermatitis, alopecia, sodium excretion,
potassium retention, fatal pancytopenia.
o COUGH – unrelenting and bothersome
- Implementation / Consideration
o Encourage to implement lifestyle changes such as weight reducation,
smoking cessation, decrease intake of alcohol, dietary restriction of dalt / fats
and increase exercise.
o Give drug on an empty stomach, either 1 hour before or 2 hours after meals
to ensure proper drug absorption.
o Monitor patient who is at risk of developing fluid volume alteration
o Provide health teaching, drug information
o Caution patient to change position slowly and to avoid hazard on delicate
tasks and driving if drowsiness is a problem.

B. Angiotensin II Receptor Blockers “ the SARTANS”

- These agents work by attaching to angiotensin II receptors in the vascular smooth
muscles and in the adrenal gland.
- The action results in Vasodilation because AII action (Constriction) is inhibited and
blockage of aldosterone release.
- Clinical Use
o Hypertension
o Used if the patient cannot tolerate the unrelenting cough associated with
ACE inhibitors
- Contraindications
o Allergy
o Pregnant women
o Lactating mothers
- Adverse Effects
o CNS – headache, dizziness, weakness, syncope, orthostatic hypotension
o GIT – Diarrhea , Abd. Pain, nausea and vomiting, dry motuhg
o Respiratory – mild cough
o Skin – rash , alopecia
- Implementation / Consideration
o Encourage to implement lifestyle changes
o Administer without regard to meals, give with food to decrease GI distress if
needed.
o Alert the surgeon if the patient is for operation, can cause hypotension.
o Ensure that patient is not pregnant before beginning the therapy.
o Provide comfort measures

C. Calcium Channel Blockers

- These agents prevent the movement of calcium into the cardiac and smooth
muscle cells when the cells are stimulated.
- The blocking of calcium will interfere with the muscle cell’s ability to contract,
leading to a loss of smooth muscle tone, vasodilation, and a decrease in
peripheral resistance.
- These effects will decrease blood pressure, cardiac workload, and myocardial
oxygen consumption.
- These are very effective in the treatment of angina because they decrease the
cardiac workload.

- Mechanism of action
o The calcium channel blocker inhibits the movement of calcium ions across
the membranes of myocardial and arterial muscle cells, altering the
action potential and blocking muscle cell contraction.
o This effect will depress myocardial contractility, slow cardiac impulse
formation in the conductive tissues, and relax and dilate arteries, causing
a fall in blood pressure and decrease in venous return.
- Contraindications
o Presence of allergy
o Patients with heart block or sick sinus syndrome
o Patients with renal and hepatic dysfunction
- Adverse Effects
o Dizziness, headache, fatigue
o Hepatic injury
o Hypotension, bradycardia, peripheral edema and heart block
o Skin flushing, rash
- Indications
o Angina
o Hypertension
o Vascular Spasm
- Implementation
o Monitor Blood pressure carefully while patient is on therapy because of
increased hypotensive episodes.
o If possible, obtain serum ECG tracing
o Provide comfort measures to help patients tolerate drug effects – serving
small frequent feeding, safety precaution due to hypotension and
dizziness.
 o Provide health teaching as to drug name, dosage, administration, side
effects and warning manifestations to report.

D. Vasodilators
- Produce relaxation of vascular smooth muscle, decreasing peripheral resistance
and reducing blood pressure.
- Use to treat severe hypertension

- Mechanism of Action

o Vasodilators act directly on vascular smooth muscle to cause muscle

relaxation, leading to vasodilation and drop in Blood pressure.
o Indicated for treatment of severe hypertension that has not responded to
other therapy;
- Contraindications
o Allergy
o Pregnancy
o Lactation
o Cerebral insufficiency
- Adverse Effects
o Dizziness, anxiety, headache
o Reflex tachycardia, CHF, Chest pain
o Edema, skin rash, lesions
o Abnormal hair growth ( Minoxidil)
o Hypotension
o Cyanide toxicity
- Implementation
o Lifestyle changes
o Monitor closely during administration to evaluate for effectiveness and to
ensure quick response if blood pressure falls rapidly or too much.
o Monitor blood glucose and serum electrolytes to avoid potentially serious
adverse effects.
o Provide comfort measures to help patient tolerate drug effects.
o Provide thorough patient teaching