CARDIOVASCULAR

PHARMA

•  REVIEW ON CARDIAC PHYSIOLOGY

•  REVIEW ON CARDIAC ACTION POTENTIAL
 ANTI HYPERTENSIVE DRUGS

•  GOAL : TO DECREASE BP TO NORMAL

 ANTI HYPERTENSIVE DRUGS

•  SECONDARY HYPERTENSION
•  CAUSE : PHEOCHROMOCYTOMA
 ANTIHYPERTENSIVE DRUGS

•  IF THE PROBLEM IS INCREASED SNS

•  1. ALPHA ADRENERGIC ANTAGONIST
•  PRAZOSIN
•  DOXAZOSIN
•  TERAZOSIN
 ANTIHYPERTENSIVE DRUGS

•  IF THE PROBLEM IS INCREASED SNS

•  2. ALPHA 2 ADRENERGIC AGONIST
•  CLONIDINE
•  METHYLDOPA
 ANTIHYPERTENSIVE DRUGS

•  IF THE PROBLEM IS INCREASED SNS

•  3. BETA BLOCKERS
•  PROPRANOLOL
•  METOPROLOL
•  ATENOLOL
 ANTIHYPERTENSIVE DRUGS

•  ALTERATION OF R – A – A – S ( RENIN – ANGIOTENSIN – ALDOSTERONE

SYSTEM )
 R –A – A – S SYSTEM

ACE

•  RENIN ANGIOTENSINOGEN ANGIOTENSIN 1 ANGIOTENSIN 2

INCREASE BV INCREASE SODIUM & WATER REABSORPTION RECEPTOR

INCREASE BLOOD PRESSURE VASOCONSTRICTION

 ANTI HYPERTENSIVE DRUGS

•  IF THE PROBLEM IS ALTERED RAAS

•  4. ACE INHIBITORS
•  CAPTOPRIL
•  QUINAPRIL
•  ENALAPRIL
 ANTI HYPERTENSIVE DRUGS

•  IF THE PROBLEM IS ALTERED RAAS

•  2. ANGIOTENSIN RECEPTOR ANTAGONIST
•  LOSARTAN
•  CANDESARTAN
•  TELMISARTAN
 ANTIHYPERTENSIVE DRUGS

•  IF THE PROBLEM IS ALTERED RAAS

•  6. DIURETICS
•  THIAZIDE DIURETIC
•  HYDROCHLORTHIAZIDE
 ANTIHYPERTENSIVE DRUGS

•  VASODILATORS
•  DIRECT ACTING VASODILATORS
•  INDIRECT ACTING VASODILATORS
 ANTIHYPERTENSIVE DRUGS

•  DIRECT ACTING ANTIHYPERTENSIVE DRUGS

•  HYDRALAZINE ( APRESOLINE )
•  NITRATES
•  NITROGLYCERINE
•  ISOSORBIDE DINITRATE OR MONONITRATE
•  NITROPRUSSIDE
 ANTIHYPERTENSIVE DRUGS

•  INDIRECT ACTING VASODILATORS ( CALCIUM CHANNEL BLOCKERS)

•  NIFEDIPINE
•  AMLODIPINE
•  FELODIPINE
•  VERAPAMIL
•  DILTIAZEM
 ANTI HYPERTENSIVE DRUGS

q The most common side effect of the different antihypertensive drugs is

orthostatic hypotension
q Take meds at regular basis
q Assume sitting or lying position for few minutes
q Change position gradually
q Avoid very warm bath, prolonged sitting or standing
q Avoid tyramine rich food
 DRUGS FOR ANGINA

•  ANGINA PECTORIS – IMBALANCE BETWEEN DECREASED OXYGEN AND

INCREASED CARDIAC WORKLOAD
•  GOALS
•  1. TO INCREASE OXYGEN
•  2. TO DECREASE CARDIAC WORKLOAD
 DRUGS FOR ANGINA

•  NITROGLYCERINE
•  ISOSORBIDE DINITRATE/MONONITRATE
•  BETA BLOCKERS
•  LONG ACTING CALCIUM CHANNEL BLOCKERS
 ANTI ANGINAL DRUGS

q Nitroglycerin intravenous (Nitro-Bid IV, Tridil)

q Sublingual (Nitrostat)
q Topical (Nitro-Bid, Nitrol, Nitrong, Nitrostat)

q Nursing Considerations:
q Make position changes slowly and avoid prolonged standing.
q Oral route, take on an empty stomach with a full glass of water.
q Monitor BP and apical pulse before administration and periodically after dose.
 ANTI ANGINAL DRUGS

q Assume sitting or supine position when taking the drug.

q Gradual change of position
q Burning or stinging sensation under the tongue
q Subligual route – onset of action 1-2 minutes; duration is 30 minutes
q Advise to carry 3 tablets always; NOT in pockets
q Store nitroglycerine in cool, dry place; use dark, amber colored air tight container
q Change stock every 6 months
q Observe for side effects: headache, flushed face, dizziness, faintness tachycardia
q Rotate sites of transderm patch
 DRUGS FOR DYSRHYTHMIAS

•  CLASS I
•  CLASS II
•  CLASS III
•  CLASS IV
 DRUGS FOR DYSRHYTHMIAS

•  CLASS 1
•  ACTS ON PHASE 0 – INHIBITS DEPOLARIZATION OF ABNORMAL RHYTHM
•  LIDOCAINE
 DRUG FOR DYSRHYTHMIAS

•  CLASS II – ACTS ON PHASE 4

•  PROLONGED RESTING TO SLOW DOWN IMPULSES AND REMOVE ABNORMAL
RHYTHM
•  PROPRANOLOL
 DRUG FOR DYSRHYTHMIAS

•  CLASS III – ACTS ON PHASE 3

•  PROLONG CARDIAC REPOLARIZATION
•  AMIODARONE
 DRUGS FOR DYSRHYTHMIAS

•  CLASS IV – ACTS ON PHASE 2

•  BLOCKS CALCIUM ENTRY
•  DILTIAZEM, VERAPAMIL
 DRUGS FOR DYSRHYTMIAS

•  FOR HEART BLOCKS

•  ANTICHOLINERGIC DRUGS
•  ATROPINE SULPHATE
 DRUGS FOR HEART FAILURE

•  LEFT SIDED AND RIGHT SIDED HEART FAILURE

 DRUGS FOR HEART FAILURE

•  1. DIURETICS
•  FUROSEMIDE
•  SPIRONOLACTONE
 DRUGS FOR HEART FAILURE

•  2. CARDIOTONIC DRUGS
•  SYMPATHOMIMETIC DRUGS
•  CARDIAC GLYCOSIDES
•  PHOSPHODIESTERASE INHIBITORS
•  MILRINONE
 DRUGS FOR HEART FAILURE

•  SYMPATHOMIMETIC DRUG
•  DOPAMINE
•  DOBUTAMINE
 DRUGS FOR HEART FAILURE

•  DIGOXIN
•  DIGITALIS
 DRUGS FOR HEART FAILURE

•  NURSING CONSIDERATIONS:
•  MONITOR HEART RATE BEFORE ADMINISTRATION
•  MONITOR POTASSIUM LEVEL. NORMAL IS 3.5 – 5.5 meq/L
•  MONITOR ECG
•  MAINTAIN THERAPEUTIC LEVEL ( 0.5 – 1.5 meq/L)
•  DO NOT COMBINED WITH CALCIUM CHANNEL BLOCKERS AND AMIODARONE
•  MONITOR FOR SIGNS OF TOXICITY
•  ANTICIPATE ANTIDOTE : DIGIBIND
 DRUGS AFFECTING COAGULATION

•  REVIEW ON HEMOSTASIS
•  VASOCONSTRICTION
•  PLATELET PLUG FORMATION
•  BLOOC COAGULATION
 ANTI PLATELET DRUGS

•  ASPIRIN
•  CLOPIDOGREL
 ANTOCOAGULANT DRUGS

•  PARENTERAL HEPARIN
•  ANTIDOTE: PROTAMINE SULFATE
•  ORAL WARFARIN
•  ANTIDOTE: VITAMIN K
 THROMBOLYTIC DRUGS

•  UROKINASE
•  STREPTOKINASE
•  ALTEPLASE
 DRUGS AFFECTING COAGULATION

•  Nursing Considerations:
•  Check VS, platelet count, APTT (N=20-36 sec)
•  Observe for bleeding
•  Review bleeding protocol (i.e. electric razors, soft toothbrushes, etc.)
•  Avoid ASA, may use Acetaminophen
 DRUGS AFFECTING COAGULATION

•  Nursing Considerations:
•  CBC, Hgb,Hct - monitor
•  Look for Dysrhythmias
•  Observe for bleeding
•  The vital signs must be monitored
•  Small frequent feeding
 ANTIFIBRINOLYTIC DRUGS

•  TRANEXAMIC ACID
•  AMINOCAPROIC ACID