Drugs Affecting the Cardiovascular System

ANTIHYPERTENSIVE DRUGS

Hypertension or high blood pressure

➢ is a quite common disorder affecting many people would typically don't even notice any symptoms

Basic Physiology of Blood or Blood Pressure Regulation

Blood pressure refers generally to the force or tension of blood pressing against artery walls. Pressure in the
arteries is maintained by among other things; contraction of the left ventricle or systemic vascular resistance,
elasticity of arterial walls, as well as blood volume. In other words, blood pressure is simply a product of cardiac
output and systemic vascular resistance.

There are couple of major symptoms involved in blood pressure regulation:

1. Arterial blood pressure is regulated by the presence of sensitive neurons called baroreceptors located in the
aortic arch and carotid sinuses.

Example; If blood pressure falls too low, those baroreceptors can send signals to the angina medula
causing release of catecholamines and thus increase sympathetic activity through the activation of alpha
and beta receptors, so activation of Beta 1 receptors causes increase in heart rate and soft volume and thus
increased cardiac output which leads to increasing the blood pressure. On the other hand, activation of
Alpha 1 receptors on smooth muscle causes vasoconstriction and thus increases in vascular resistance
which leads to increasing blood pressure.

2. Renin Angiotensin Aldosterone System, also have baroreceptors in the kidneys that respond to fall in blood
pressure or reduction of blood flow by releasing an enzyme called Renin. Additionally, renin secretion is
stimulated by sympathetic activation of beta 1 receptors in the kidneys. Renin is necessary for the
production of angiotensin 2. Angiotensin 2 is a very potent vasoconstrictor which constricts systemic blood
vessels, thus, increasing peripheral resistance. It also constricts renal blood vessels and stimulates
aldosterone secretions which leads to sodium and water retention thereby increasing blood pressure.
Cardiac output and ultimately increase blood pressure.

Hypertension

➢ either a sustainable systolic pressure of greater than 140 millimeters per mercury or a sustained diastolic
blood pressure of greater than 90 millimeters per mercury.
➢ It results from increased peripheral vascular arteriolar, smooth muscle tone.
➢ It is a state of elevated blood pressure which is the pressure exerted on the walls of the arteries.
➢ Systolic blood pressure is the blood pressure during systole or myocardial contraction.
➢ Diastolic blood pressure is blood pressure during diastole or myocardial relaxation that leads us to the
classification of the blood pressure.

Classification of BP

Normal blood Prehypertension Stage 1 Stage 2

pressure Hypertension Hypertension

Systolic lesser than 120 120 to 139 140 to 159 equal to or greater
than 160

Diastolic lesser than 80 80 to 89 90 to 99 equal to or greater

than 100

Chronic hypertension can lead to heart disease and stroke. It is also an important risk factor in the development of
chronic kidney disease and heart failures. Hypertension may occur secondary to other diseases but more than 90%
of patients have essential hypertension that happens with no identifiable cause.

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 ANTIHYPERT Therapeutic Indications Pharmacokinetics CI & Cautions
ENSIVE Action
DRUGS

Angiotensin Prevents the Hypertension and Taken orally Allergy to ACE

converting production of can be used alone or Onset: 15 mins. inhibitors to
enzymes or Angiotensin 2 in combination with Half Life: 2 hours prevent severe
ACE (potent other drugs. Liver hypersensitivity
inhibitors vasoconstrictor) Heart failure and left Urine reaction
and stimulator ventricular
antihypertensiv dysfunction, Renal
of aldosterone
e agents that act combined with impairment
release. Blood
in the lungs to diuretics and
pressure is
prevent a Digoxin. To decrease Heart failure
decreased with
conversion of in peripheral
resultant loss of
Angiotensin 1 to resistance and blood Hyponatremia
serum sodium and hypovolemia
Angiotensin 2 volume bleeding to
and fluid but
(potent the cardiac workload
with a slight Pregnancy and
vasoconstrictor)
increase in Diabeteic lactation
serum Nephropathy-in - potential
potassium. which the renal adverse effects
artery is being to the fetus and
damaged by can decrease
diabetes. Decreasing milk production
stimulation of
Angiotensin
receptors in the
kidney will slow
down the damage in
the renal artery.

Adverse Nursing Nursing Interventions / Evaluation

Effects Consideration Diagnosis Implementation

GI: Irritation, Nursing Decreased cardiac Educate patient on importance Monitor patient
Ulcer, Assessment: output related to the of healthy lifestyle choices response to
Constipation, Assess for the effect of drugs in which include regular exercise, therapy through
Liver injury mentioned increasing fluid weight loss, smoking cessation, blood pressure
contraindication volume excretion. low sodium diet to maximize monitoring
GU: Renal to this drug (To the effect of antihypertensive
Insufficiency, prevent Impaired skin therapy Monitor for
renal failure, potential integrity related to adverse effects
Proteinuria adverse effect) dermatological Administered drug on empty
effects of the drug. stomach 1 hour before or 2 Evaluate patient
CV: Reflex Obtain baseline hours after meals to ensure understanding
tachycardia, status for Increased risk for optimum drug absorption on drug therapy
chest pain, heart weight, vital infection related to by asking patient
failure, cardiac signs, overall potential decreasing Monitor renal and hepatic name the drug,
arrhythmias skin conditions effect of drug to function tests to alert the doctor its indication,
,and laboratory circulating blood for possible development of and adverse
EENT: Rash, tests like renal cells. renal or hepatic failure effects to watch
alopecia, and hepatic for
dermatitis, function tests, Monitor for presence of
photosensitivity serum manifestation that signal Monitor patients
electrolyte, and decrease in fluid volume i.e. compliance to
CBC with diarrhea, vomiting, dehydration the drug therapy
differential (To
assess patient Educate patient and family
response to the members about drugs effect to
therapy) the body and manifestations
that would need reporting to
enhance patient knowledge on
drug therapy and promote
adherence
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 ANTIHYPERT Therapeutic Indications Pharmacokinetics CI & Cautions
ENSIVE Action
DRUGS

Angiotensin Block the blood Hypertension that Taken orally Allergy to ARBs to
II-Receptor pressure raising can be used alone or Half Life: 2 hours prevent severe
Blockers effect of the in combination with Liver hypersensitivity
(ARBs) renin other Urine and Feces reaction
angiotensin antihypertensive
antihypertensive agents Renal and hepatic
aldosterone
agents that exert Heart failure for impairment
system (RAS).
their action by patients who don't
blocking respond to ACE Hypovolemia
vasoconstriction inhibitors
and release of Pregnancy and
aldosterone To slow down the lactation
through selective progress of renal - potential adverse
blocking of disease in patients effects to the fetus
Angiotensin 2 with type 2 diabetes and potential
Receptors in and hypertension by termination of
vascular smooth blocking the effects pregnancy
muscle and of angiotensin between 2nd and
adrenal cortex. receptors in vascular 3rd trimester
endothelium

Adverse Nursing Nursing Interventions / Evaluation

Effects Consideration Diagnosis Implementation

CNS: Headache, Nursing Ineffective tissue Educate patient on Monitor patient

dizziness, Assessment: perfusion related to importance of healthy response to therapy
Syncope, Assess for fluid excretory effect lifestyle choices which through blood
weakness contraindication of the drug. include regular exercise, pressure
to this drug (To weight loss, smoking monitoring
Resp: Upper prevent potential Impaired skin cessation, low sodium diet
respiratory tract adverse effect) integrity related to to maximize the effect of Monitor for adverse
infection, cough dermatological antihypertensive therapy effects
Obtain baseline effects of the drug.
GI: Diarrhea, status for weight, Administered drug with Evaluate patient
abdominal pain, vital signs, Risk for injury food to prevent GI distress understanding on
nausea, Dry overall skin related to CNS side associated with drug drug therapy by
mouth, tooth conditions, and effects of the drug intake asking patient
pain laboratory tests name the drug, its
like renal and Monitor renal and hepatic indication, and
EENT: Rash, hepatic function function tests to alert the adverse effects to
alopecia, dry skin tests, serum doctor for possible watch for
electrolyte (To development of renal or
assess patient hepatic failure As well as Monitor patients
response to the to signal need for reduced compliance to the
therapy) drug dose drug therapy

Provide comfort measure

like wide environment,
relaxation technique, to
tolerate the drug effects

Educate patient and

family members about
drugs effect to the body
and manifestations that
would need reporting to
enhance patient
knowledge on drug
therapy and promote
adherence

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 ANTIHYPERT Therapeutic Indications Pharmacokinetics CI & Cautions
ENSIVE Action
DRUGS

Calcium Inhibit the Hypertension that Taken orally Allergy to

Channel movement of can be used alone or Onset: 30-60 mins. Calcium-channel
Blocker calcium-ions in combination with Half Life: 5-7 hours blockers to
across other Liver prevent severe
antihypertensive antihypertensive Urine hypersensitivity
myocardial and
agents that agents. reaction
arterial muscle
decrease the Hypertension in
cell
blood pressure, adults Heart block (Sick
membranes. As
cardiac sinus syndrome)
a result, the For children;
workload, can be
action potential calcium channel
myocardial exacerbated by
of these cells blockers is the drug
consumption of condition slowing
are altered and group that is first
oxygen. effect of the drug
cell considered in cases
Effective in constructions of hypertension in Renal and hepatic
treatment of are blocked. this age group that impairment
Angina. The resultant needs drug therapy can alter
effects includes metabolism and
depressed This is not allowed excretion of drugs
myocardial during pregnancy. which can
contractility, increase the risk
For older adults
slow cardiac for toxicity
which are more
impulse in
susceptible to drug Pregnancy and
conductive
toxicity specially lactation
tissues and
because of - potential adverse
arterial dilation
underlying effects to the
and relaxation
conditions that fetus and should
would interfere with not be used
metabolism and unless the
excretion of drugs benefit to the
mother clearly
If not older adult is
outweighs the
taking this drug, the
risk to the fetus
renal and hepatic
function should
always be
monitored

Adverse Nursing Nursing Interventions / Evaluation

Effects Consideratio Diagnosis Implementation
n

CNS: Headache, Nursing Decreased cardiac Educate patient on Monitor patient

dizziness, Assessment: output related to importance of healthy lifestyle response to
lightheadedness, Assess for the hypotension and choices which include regular therapy through
fatigue mentioned vasodilating effect of exercise, weight loss, smoking blood pressure
contraindicatio the drug cessation, low sodium diet to monitoring
CV:hypotension, n to this drug maximize the effect of
bradycardia, (To prevent Risk for injury antihypertensive therapy Monitor for
peripheral potential related to presence of
edema, heart adverse effect) cardiovascular and Monitor blood pressure and mention the
block CNS adverse drug heart rate and rhythm to adverse effects
Monitor effects detect possible development
GI: Nausea, cardiopulmona of adverse effect Monitor for
hepatic injury ry status closely effectiveness of
as the drug can Provide comfort measures for comfort measures.
EENT: Rash, cause severe the patient to tolerate the side
skin flushing effects on this effects like small frequent Monitor for
two body meals, limiting noise, compliance to
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 systems controlling room light and drug therapy
temperature to prevent regimen
aggravation of stress which Monitor
can increase demand to the laboratory tests
heart

Educate patient and family

members about drugs effect to
the body and manifestations
that would need reporting to
enhance patient knowledge on
drug therapy and promote
adherence

Emphasize to the client the

importance of strict adherence
to drug therapy

ANTIHYPERT Therapeutic Indications Pharmacokinetics CI & Cautions

ENSIVE Action
DRUGS

Vasodilators Exert their effect Use for hypertension Given Intravenously Allergy to
by acting directly cases that do not Onset: 1-2 mins Vasodilators
direct Half Life: 2 mins To prevent severe
on smooth respond to other
vasodilators are Liver hypersensitivity
muscles. therapies.
used when the Urine reaction
Consequently,
previous drugs To slow down the
there will be
mentioned are progress of renal Cerebral
muscle
not effective so disease in patients insufficiency
relaxation and can be exacerbated
this with type 2 diabetes
vasodilation. by the drugs action
antihypertensiv and hypertension by
Both of these will to cause sudden
e agents are blocking the effects
cause a drop in drop in blood
reserved for of angiotensin
blood pressure. pressure
severe receptors in vascular
hypertension endothelium Peripheral vascular
and disease, Coronary
hypertensive artery disease
emergencies (CAD), heart
failure, tachycardia
can be exacerbated
Nitroprusside by the drugs action
- used in to cause sudden
maintaining drop in blood
controlled pressure
hypotension
Pregnancy and
during surgery
lactation
and lastly and
- potential adverse
administered IV
effects to the fetus
Hydralazine - and should not be
available for used unless the
oral, IV, and IM benefit to the
used mother clearly
outweighs the risk
Minoxidil - is to the fetus bc the
available for oral drug can enter the
use only breast milk and
can cause
potential adverse
effects to the
neonate. If
needed by
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 lactating mothers
another method
of feeding is
instituted.

Adverse Nursing Nursing Interventions / Evaluation

Effects Consideration Diagnosis Implementation

CNS: Headache, Nursing Decreased tissue Educate patient on Monitor patient

dizziness, Assessment: perfusion related to importance of healthy response to therapy
anxiety Assess for changes in volume of lifestyle choices which through blood
contraindication blood pumped out by include regular exercise, pressure
CV: Reflex to this drug (To the heart weight loss, smoking monitoring
tachycardia, prevent potential cessation, low sodium diet
heart failure, adverse effect) Acute pain related to to maximize the effect of Monitor for
edema, chest GI distress, antihypertensive therapy presence of
pain Obtain baseline headache, and skin mention the
status for weight, effects of the drug Monitor blood pressure adverse effects (e.g.
GI: nausea, vital signs, and heart rate and rhythm Hypotension, GI
vomiting, GI overall skin closely to evaluate for the distress, skin
upset conditions, and effectiveness and ensure reactions)
laboratory tests quick response should the
EENT: Rash, like renal and blood pressure falls rapidly Monitor for
lesions (e.g. hepatic function effectiveness of
Minoxidil is tests, serum Provide comfort measures comfort measures
associated with electrolyte (To to tolerate the side effects
abnormal hair assess patient like small frequent meals, Monitor for
growth) response to the limiting noise, controlling compliance to drug
therapy) room light and temperature therapy regimen
If using to prevent aggravation of
Nitroprusside stress Monitor laboratory
which is tests
metabolized into Monitor patient for any
cyanide so it can manifestations that could
cause cyanide decreased fluid volume
toxicity which is inside the body like
characterized by vomiting, diarrhea and
excessive sweating to detect
dyspnea, ataxia,
and treat excessive
loss of
hypotension
consciousness,
distant heart Educate patients and
sound and family members about
dilated pupils drugs effect to the body and
Nitroprusside manifestations that would
need reporting
suppresses
iodine uptake
Emphasize to the client the
which leads to
importance of strict
the development adherence to drug therapy
of
hypothyroidism

Other Antihypertensive Agents:

a. Diuretics
➢ increase the excretion of sodium and water from the kidney

Thiazide and thiazide-like diuretics:

● Bendroflumethiazide
● Chlorothiazide
● Hydrochlorothiazide
● Hydroflumethiazide
● Methyclothiazide
● Trichlormethiazide

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 b. Ganglionic Blocker
● Mecamylamine
➢ Occupies the receptor sites of autonomic neurons, blocking the effect of acetylcholine at both sympathetic
and parasympathetic ganglia

c. Renin Inhibitor
● Aliskerin
➢ directly inhibits renin, leading to decreased plasma renin activity and inhibiting the conversion of
angiotensinogen to angiotensin

d. Sympathetic Nervous System Blocker

➢ They block the vasoconstriction, and decrease heart rate, decreased muscle contraction, and tend to
increase release of renin
● Beta-blockers (acebutolol, atenolol, metoprolol, nebivolol )
● Alpha and Beta-blockers (Carvedilol, guanabenz)
● Alpha-adrenergic blockers
● Alpha-blockers
● Alpha agonists

ANTIHYPOTENSIVE AGENTS

➢ severe hypotension or shock puts the body in serious jeopardy. It is often an acute emergency situation
with treatment required to save the patient's life.

ANTIHYPOTENSIVE Example of Drugs Therapeutic Action Adverse effects /

AGENTS Vasopressors

Sympathetic Adrenergic ● Dobutamine It increases BP, ● Decreased GI activity:

Agonists or Vasopressors
React with sympathetic
adrenergic receptor to post
the effects of a sympathetic
stress response
● Dopamine increases blood Nausea and Constipation
● Ephedrine volume, increases the ● Increased RR and changes
● Epinephrine strength of cardiac in BP
● Isoproterenol muscle contraction ● Headache
● Metaraminol ● Changes in peripheral
● Norepinephrine blood flow with numbness
● Phenylephrine ● Tingling
● Gangrene in extreme cases

Example of Drugs Therapeutic Action Adverse effects

Alpha-Specific ● Midodrine Activates alpha ● Piloerection, chills and

Adrenergic Agents receptors in arteries rash
and veins to produce ● Hypertension and
an increase in bradycardia
vascular tone and an ● Dizziness, vision changes,
increase in blood Vertigo and headache
pressure

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