LIPA CITY COLLEGES

College of Nursing
PHARMACOLOGY
First Semester A.Y 2022-2023
DRUGS AFFECTING CARDIOVASCULAR SYSTEM • Parental Iron may cause Headache, vomiting,
Agenda nausea, and anaphylaxis
• Haematimics • Temporarily stain teeth with liquid iron
• Cardiotonics • Bronchospasm with parenteral iron
• Anti anginals Drug Interactions:
• Antihypertensive and Vasodilators • Antacids, Tetracycline, Cimetidine decrease
• Anti-arrhythmic absorption of oral iron preparation
Haematinics • Vitamin C (ascorbic acid) and chloramphenicol
• Are the drugs which used to stimulate the increases absorption of oral iron preparation
formation of RBC. These are used primarily in the Nursing Responsibilities:
treatment of anemia eg. Iron • Nurse should administer drugs according to
• Mechanism of action: Act as supplement and prescribed routes
replace depleted iron stores in the bone marrow • Should check for constipation
to assist in the erythropoiesis(RBC production). • Monitor patient CBC, HB and plasma Iron levels
• Nurse should teach the patient to:
Drug Example and Doses
– Continue regular dosing schedule after
S. Drugs Doses missing dose
No. – Drink at least 2 liters of liquid daily
– Avoids antacids, caffeine products, dairy
1 Ferrous Fumarate Up to 600 mg daily
products, egg whole grain bread for 1
2 Ferrous Sulphate 200mg TDS hour after taking oral iron preparations
– Be aware that oral iron preparations
3 Ferrous Gluconate 300mg as per may turn stool dark green or black
requirement CARDIOTONICS
4 Iron Dextran 50mg/ml IM or IV • Cardiotonic agents are drugs used to increase
the contractility and output in a hypodynamic
Indications/Uses:
heart without proportionate increase in 02
 To prevent and treat Iron deficiency anemia consumption
 In children during rapid growth period • Commonly used in the treatment of heart failure
 In pregnant and lactating mother (HF)
 As dietary supplement of iron • Cardiotonic (inotropic) drugs affect the
 Patient with post gastrectomy intracellular calcium levels in the heart muscle,
Contraindications/Precaution: leading to increased contractility.
 Patient with hemochromatosis • This increase in contraction strength leads to
increased cardiac output, which causes
 Hemolytic anemia
increased renal blood flow and increased urine
 Patient with hemosiderosis
production
 Hypersensitivity to the drug
TYPES
Adverse Effects: 1. Cardiac glycosides
• Nausea/vomiting 2. Phosphodiesterase inhibitors
• Constipation CARDIAC GLYCOSIDES
• GI distress • Digoxin (Lanoxin) commonly used drug
• Dark stool • The cardiac glycosides were originally derived
• Local pain at IV site from Digitalis purpurea (Common Foxglove)

BSN-2A
 LIPA CITY COLLEGES
College of Nursing
PHARMACOLOGY
First Semester A.Y 2022-2023
Foxglove plant Digitalis lanata Digitalis toxicity
• A serious syndrome that can occur when digoxin
levels are too high
• Normal level- 0.5 -2.0 ng/ml
• signs and symptoms – anorexia, nausea,
vomiting, malaise, depression, irregular heart
rhythms including heart block, atrial
arrhythmias, and ventricular tachycardia
Mechanism of action: Digoxin increases intracellular Antidote- Digoxin immune Fab (DigiFab):
calcium and allows more calcium to enter myocardial
cells during depolarization. That results

1. Increased force of myocardial contraction (a

positive inotropic effect)
2. Increased cardiac output and renal perfusion
3. Slowed heart rate, owing to slowing of the rate
of cellular repolarization (a negative
chronotropic effect)
4. Decreased conduction velocity through the
atrioventricular(AV) node
INDICATIONS:
Nurses responsibilities:
• Heart failure (HF)
• Assess for contraindications or cautions
• Atrial flutter
• Perform a physical assessment
• Atrial fibrillation
• Assess cardiac status closely, including pulse and
• Paroxysmal atrial tachycardia
blood pressure
Dosage:
• Monitor apical pulse for 1 full minute before
• Digoxin is available for oral and parenteral
administering the drug
administration.
• Hold the dose if the pulse is less than 60
• Oral- 0.75–1.25 mg PO
beats/min in an adult or less than 90 beats/min
• IV-0.125–0.25 mg IV
in an infant; retake the pulse in 1 hour. If the
• Onset of action - 30–120 minutes when
pulse remains low, document it, withhold the
taken orally, 5–30 minutes when given
drug, and notify the prescriber
intravenously
• Monitor the pulse for any change in quality or
Contraindications:
rhythm
• hypersensitivity to digitalis preparations
• Administer intravenous doses very slowly over
• ventricular tachycardia or fibrillation
at least 5 minutes to avoid cardiac arrhythmias
• heart block or sick sinus syndrome
and adverse effects.
• idiopathic hypertrophic subaortic stenosis (IHSS)
• Avoid administering the oral drug with food or
• acute MI
antacids to avoid delays in absorption
• Renal failure
• Obtain digoxin level as ordered; monitor the
Adverse Effects:
patient for therapeutic digoxin level (0.5–2
• headache, weakness, drowsiness and vision
ng/mL)
changes
• Maintain emergency equipment on standby if
• Digitalis toxicity ( serious side effect)
digoxin toxicity develops

BSN-2A
 LIPA CITY COLLEGES
College of Nursing
PHARMACOLOGY
First Semester A.Y 2022-2023
• Provide thorough patient teaching, including the • ventricular arrhythmias
name of the drug, dosage prescribed, technique • Pregnancy and lactation
for monitoring pulse and acceptable pulse • Assess cardiac status closely, including pulse and
parameters, dietary measures if appropriate, blood pressure
measures to avoid adverse effects, warning • Protect the drug from light to prevent drug
signs of possible toxicity and need to notify degradation
health care provider • Monitor input and output and record daily
PHOSPHODIESTERASE INHIBITORS weight
• milrinone (Primacor) • Monitor platelet counts before and regularly
• This drugs block the enzyme phosphodiesterase. during therapy to ensure that the dose is
This blocking effect leads to an increase in appropriate, inspect the skin for bruising or
myocardial cell cyclic adenosine petechiae to detect early signs of
monophosphate (cAMP), which increases thrombocytopenia
calcium levels in the cell • Provide life-support equipment on standby
INDICATIONS: • Provide thorough patient teaching, including the
• short-term treatment of HF that has not name of the drug, dosage prescribed, measures
responded to digoxin or diuretics alone or that to avoid adverse effects, warning signs of
has had a poor response to digoxin, diuretics, problems, and the need for periodic monitoring
and vasodilators and evaluation
DOSAGE: ANTIANGINALS
• Intravenous ANGINA:
• (PRIMACOR IV 10Mg/ml inj) • It is a pain syndrome due to induction of an
• dose- 50 microgram/kg iv bolus followed by 0.4- adverse oxygen supply/demand situation in a
1.0 microgram/kg/min infusion portion of myocardium
Contraindications: • Antianginal drugs are used to help restore the
• hypersensitivity to phosphodiesterase inhibitors appropriate supply-and-demand ratio in oxygen
• severe aortic or pulmonic valvular disease delivery to the myocardium.
• acute MI How they act:
Adverse Effects: • These drugs can work to improve blood delivery
• ventricular arrhythmias (which can progress to to the heart muscle
fatal ventricular fibrillation), hypotension, and 1. by dilating blood vessels (i.e. Increasing
chest pain the supply of oxygen)
• GI effects include nausea, vomiting, anorexia, 2. by decreasing the work of the heart (i.e.
and abdominal pain decreasing the demand for oxygen).
• Thrombocytopenia occurs frequently with Classification:
milrinone • Nitrates
• Precipitates form when these drugs are given in – short acting nitrates
solution with furosemide – Eg:Glyceryltrinitrate(Nitroglycerine)
Nurses responsibilities: – Long acting nitrates
• Assess for contraindications or cautions: any – Eg;Isosorbidedinitrate(sorbitrate)
known allergies to these drugs or to avoid • Beta Blockers
hypersensitivity reactions; – Eg;Atenelol,Propanalol
• acute aortic or pulmonic valvular disease, • Calcium channel blockers
• acute myocardial infarction – phenyl alkamine

BSN-2A
 LIPA CITY COLLEGES
College of Nursing
PHARMACOLOGY
First Semester A.Y 2022-2023
• Eg:verapamil • Nitroglycerin-
– benzothiazepine – 5 mcg/min via IV infusion
• Eg:Diltiazem – pump every 3–5 min;
– Dihydropyridines – 0.4-mg metered dose sublingual, up to
• Eg:Nifidipine,Amlodipine three doses in 15 min for acute attack
• Potassium channel openers Contraindications:
– Eg:Nicorandil • Hypersensitivity
• Others • Severe anemia
– Eg:Ivabradine • Head trauma or cerebral hemorrhage
Nitrates: • pregnancy or lactation
• Nitrates are drugs that act directly on smooth Adverse effect:
muscle to cause relaxation and to depress • Centralnervoussystem (CNS)
muscle tone – headache, dizziness, and weakness
– isosorbidedinitrate(Isordil) • Gastrointestinal(GI)
– isosorbidemononitrate – nausea, vomiting, and incontinence.
– nitroglycerin • Cardiovascular
Mechanism of action: – Hypotension
• The nitrates relax and dilate veins, arteries, and • Integumentary
capillaries, allowing increased blood flow – flushing, pallor, increased perspiration.
through the vessels and lowering systemic blood Nurses responsibilities:
pressure because of a drop in resistance. • Assess for contraindications
• Nitrates decreases the preload and afterload • Assess cardiopulmonary status closely, including
INDICATIONS: pulse rate, blood pressure, heart rate, and
• LONGACTINGNITRATES rhythm (30min)
– Taken before chest pain begins in • Always check the expiration date on the bottle
situations in which exertion or stress can and protect the medication from heat and light
be anticipated for prevention of angina • Instruct the patient that a sublingual dose may
in adults; taken daily for management of be repeated in 5 minutes if relief is not felt, for a
chronic angina total of three doses; if pain persists, the patient
• SHORTACTINGNITRATES should go to an emergency room
– Treatment of acute angina attack; • Rotate the sites of topical form
prevention of anginal attacks • Taper the dose gradually (over 4 to 6 weeks)
AVAILABLEFORMS: after long-term therapy
• Nitroglycerin is available as BETA BLOCKERS:
• sublingual tablet, • Beta-adrenergic blockers are used to block the
• Translingual spray, stimulatory effects of the sympathetic nervous
• Intravenous solution system.
• Transdermal patch, • Eg-
• Topical ointmentor paste, – Atenelol
• Transmucosal agent – Propanalol
DOSAGE: – Metoprolol
• Isosorbidenitrate- Mechanism of action:
– 2.5–5 mg SL • The beta-blockers competitively block beta-
– 5-mg chewable tablet; 5–20 mg PO; adrenergic receptors in the heart and decreasing

BSN-2A
 LIPA CITY COLLEGES
College of Nursing
PHARMACOLOGY
First Semester A.Y 2022-2023
the influence of the SNS on these tissues. The Treatment of:
result is a decrease in the excitability of the • Prinzmetal angina
heart, a decrease in cardiac output, a decrease • Chronic angina
in cardiac oxygen consumption, and a lowering • Effort associated angina
of blood pressure. • Hypertension.
INDICATIONS: • Verapamil is also used to treat cardiac
• Long-term management of angina pectoris. tachyarrhythmias because it slows conduction
• To prevent reinfarction in stable patients 1 to 4 more than the other calcium channel blockers
weeks after an MI do.
CONTRAINDICATIONS: Contraindications:
• Bradycardia, heart block, and cardiogenic shock • Hypersensitivity
• Pregnancy and lactation • Pregnancy and lactation
• Cautious administration to Asthma, chronic • Caution should be used with
obstructive pulmonary disease, or thyrotoxicosis • heart block or sick sinus syndrome
DOASGE: • Renal or hepatic dysfunction
• ORAL- 50-100 mg • Heart Failure
• INTRAVENOUS - 5mg -15mg Adverse Effects:
NURSES RESPONSIBILITY: • CNS -dizziness, light-headedness, headache, and
• Assess for contraindications or cautions fatigue.
• Do not stop these drugs abruptly after chronic • GI- nausea and hepatic injury related to direct
therapy, but taper gradually over 2 weeks toxic effects on hepatic cells. Cardiovascular -
• Monitor blood pressure, pulse, rhythm, and hypotension, bradycardia, peripheral edema,
cardiac output regularly and heart block.
• Continuously monitor any patient receiving an • Skin- flushing and rash
intravenous form of these drugs NURSES RESPONSIBILITIES:
CALCIUMCHANNELBLOCKERS • Assess for contraindications
• amlodipine (Norvasc), • Inspect skin for color and integrity
• diltiazem (Cardizem) • Monitor blood pressure very carefully
• nicardipine (Cardene) • Provide thorough patient teaching
• nifedipine Potassium channel openers:
• verapamil (Calan, Isoptin). • Potassium channel openers activates the ATP
MECHANISM OF ACTION: sensitive potassium channels thereby
• Calcium channel blockers inhibit the movement hyperpolarising the vascular smooth muscles.
of calcium ions across the membranes of • This results in reduction in vascular tone
myocardial and arterial muscle cells, altering the • That will lead to a decrease in preload and
action potential and blocking muscle cell afterload
contraction. • EG-Nicorandil
• This will results loss of smooth muscle tone, Dosage:
vasodilation, and decreased peripheral • Oral- 5-20mg
resistance occur INDICATIONS:
• Decreases the preload and afterload which • Prevention and long term treatment of chronic
results in decreases cardiac workload and stable angina pectoris
oxygen consumption.
INDICATIONS:

BSN-2A
 LIPA CITY COLLEGES
College of Nursing
PHARMACOLOGY
First Semester A.Y 2022-2023
• Reduction in the risk of acute coronary • Headache
syndromes in patients with chronic stable • Constipation
angina • Muscle cramps
Contraindications: Nurses responsibility:
• Hypersensitivity • Check for hypersensitivity and contraindications
• Cardiogenic shock • Assess the pulse rate and blood pressure
• hypotension • Check the liver function test regularly
Side effects: • Check for visual disturbances
• Flushing • Health education
• Palpitation HYPERTENSION
• Weakness REGULATORS OF BLOOD PRESSURE:
• Headache • Antihypertensives are the drugs that used to
• Dizziness treat hypertension
• vomiting CLASSIFICATIONS:
Nurses Responsibility: • DIURETICS
• Assess the hypersensitivity and • LOOP DIURETICS
contraindications Eg-furosemide
• Regular monitoring of vital signs
• Health education • THIAZIDE DIURETICS
• asses the oral cavity for oral ulcers Eg-Hydrochlorothiazide
OTHERS- IVABRADINE:
• Ivabradine is a newer type of drug • POTASSIUM SPARING DIURETICS
• Mechanism of action- it acts by reducing the Eg-Spirinolactone
heart rate by specific inhibition of the funny
channel (cyclic nucleotide-gated) • ADRENERGIC inhibitors
• It specifically inhibits the cardiac pacemaker and • CENTRALLY ACTING α- ADRENERGIC
thereby reducing heart rate ANTAGONISTS
Indications: Eg-Clonidine
• Chronic stable angina patients with normal sinus
rhythm • PERIPHERALLY ACTING α- ADRENERGIC
• Chronic heart failure ANTAGONISTS
Dosage: Eg-Reserpine
• Oral- 2.5-5mg
Contraindications: • α- ADRENERGIC BLOCKERS
• Resting heart rate less than 70 Eg-Prazocin
• Cardiogenic shock
• Acute MI • β- ADRENERGIC BLOCKERS
• Sick sinus syndrome Eg-Atenelol
• Severe hepatic injury
• Pregnancy and lactation • Calcium Channel Blockers
Side effects: Eg-Amlodipine Nifidipine
• Blurred vision ANGIOTENSIN INHIBITORS
• Bradycardia • ANGIOTENSIN-CONVERTING ENZYME (ACE)
• Syncope INHIBITORS

BSN-2A
 LIPA CITY COLLEGES
College of Nursing
PHARMACOLOGY
First Semester A.Y 2022-2023
Eg-Captopril,Enalapril • cautious administration with Systemic lupus
erythematous( SLE) Gout
• Angiotensin II–Receptor Blockers • Pregnancy and lactation
Eg-Losartan Telmisartan SIDE EFFECTS:
• Common side effects
• DIRECT VASODILATORS • GI upset
Eg-Nitroglycerin Sodium nitropruside • fluid and electrolyte imbalances hypotension
DIURETICS • electrolyte disturbances
• Drugs that increase the production of urine Side effects ( thiazide and loop diuretics)
LOOP DIURETICS • hypokalemia
• They inhibit the sodium and chloride • weakness, muscle cramps, and
reabsorption in the thick segment of the arrhythmia
ascending limb of the loop of Henle as well as in • hypercalcemia
the proximal convoluted tubule and the distal • decreased excretion of uric acid
diluting site Side effects ( potassium sparing diuretics)
Eg- furosemide( Lasix) 1. Hyperkalemia
Dosage: • lethargy, confusion, ataxia, muscle
• 40 mg PO t.i.d • cramps, and cardiac arrhythmias.
Thiazide diuretics
• Inhibit sodium and chloride reabsorption in the
distal convoluted tubule
• These drugs are the first-line drugs used to
manage essential hypertension when drug
therapy is needed
• Eg- Hydrochlorothiazide
• Dosage- 25–100 mg/d
Potassium Sparing Diuretics
• The potassium-sparing diuretics are not as
powerful as the loop diuretics, but they retain
potassium instead of wasting it
• Eg- spironolactone (Aldactone) amiloride
(Midamor)
Mechanism of action:
• Spironolactone acts as an aldosterone
antagonist, blocking theactions of aldosterone
in the distal tubule.
• It decreases the elimination of potassium
Dosage:
• 50–100 mg/d PO
CONTRAINDICATIONS:
• Hypersensitivity
• Fluid and electrolyte imbalances
• Severe renal failure

BSN-2A