Unit 10: cardivascular drugs

Haematinics
•Haematinics are the drugs which used to stimulate the formation of RBC’s These are used
primarily in the treatment of Anemia. Eg. Iron.

Mechanism of action
•They act as supplement and replace depleted iron stores in the bone marrow to assist in
the erythropoiesis (RBC production)

Drugs Doses

1 Ferrous Fumarate Up to 600 mg daily.

2 Ferrous Sulphate 200mg TDS
3 Ferrous Gluconate 300mg as per requirement.
4 Iron Dextran 50mg/ml IM or IV

Indications / Uses
•To prevent and treat iron deficiency anemiaǤ
•In children during rapid growth periodǤ
•In pregnant and lactating motherǤ
•As dietary supplement of ironǤ
•Patient with post gastrectomyǤ

Contraindication / Precautions
•Patient with hemochromatosisǤ •Hemolytic anemiaǤ •Patient with hemosiderosisǤ
•Hypersensitivity to the drugǤ

Adverse effects
•Nausea / vomitingǤ •ConstipationǤ •GI distressǤ •Dark stoolǤ •Local pain at IǤVǤ siteǤ
•Parental iron may causes, headache, Vomiting nausea and anaphylaxisǤ •Temporarily stain
teeth with liquid ironǤ •Bronchospasm with parenteral ironǤ

Drug interactions
•Antacids, Tetracyclines, Cimetidine decrease absorption of oral iron preparationsǤ
•Vit C (ascorbic acid) and chloramphenicol increases absorption of oral iron prepartionsǤ
• Be aware that oral iron preparations may turn stool dark green or black.
• Avoids antacids, caffeine products, dairy products, egg, whole grain breads for
1hour after taking oral iron preparations.
• Drink at least 2 liters of liquid daily.
• Continue regular dosing schedule after missing dose.

Nursing Responsibilities
• Nurse should administer drugs according to prescribed routesǤ
• Should check for constipationǤ
• Monitor patient CBC count, HB and plasma iron levelsǤ
• Nurse should teach the patient to:

Cardio-tonics (Cardiac - Glycosides)

Introduction
•These are the drugs which have a positive inotropic effect on heartǤ They increase the
force of myocardial contraction without corresponding increase in O2 consumption. They
are used for the treatment of congestive heart failure.

Mechanism of Action
•Cardiac glycosides inhibit the enzyme Na-K-ATPase present in cardiac muscle. This cause
an increase intracellular Na & Ca in heart muscle cells that leads to increase in force of
contraction.

Drugs Doses
1 Digoxin 0.125- 0.75 mg PO per day
2 Digitoxin 125-500 mcg once daily.

Indication / uses
•To treat congestive heart failure (commonly given with diuretics)
•To control the ventricular rate in arterial fibrillation, paroxysmal arterial tachycardia.

Contraindication/precautions
• Contraindicated in uncontrolled ventricular arrythmias, constrictive pericarditis,
complete heart block.
• Risk of Digoxin toxicity is increases with hypercalcemiaǤ
• Hypokalemia, Hypomagnesemia, renal failureǤ
• Elderly patients have more risk of toxicity because they are more sensitive to drug’s
effects, anorexia may be an early warning sign of toxicity.

Adverse Effects
• BradycardiaǤ • WeaknessǤ • FatigueǤ • Nausea, vomitingǤ • May cause digoxin toxicity such
as anorexia, nausea, vomiting, visual disturbance, confusion, bradycardia, heart block,
premature ventricular contractions.

Drug interactions.
•With potassium wasting diuretics because they may cause potassium loss increase the risk
of digoxin toxicity.
•Antacids, aminoglycosides metoclopramide decrease GI absorption of digoxin.

Nursing Responsibilities
•Before giving digoxin, assess apical pulse, srǤ drug and electrolyte level of patient with
hold drug and notify physician if pulse rate is bellow 60 beat per min or minimum.
•The nurse should keep a watch a sign and symptoms of toxicity. (eg. Anorexia, nausea,
vomiting, palpitation ) and if occurs further administration of drugs should stop if pulse
rate increases to more than 120 it may indicate toxicity.
•Nurse should know that dose must be reduced in patients with renal failure.

Teach patient to:

• Take prescribed drug properlyǤ
• Consult physician before discontinuing drugǤ
• Count his pulse before taking each doseǤ
• Assess signs and symptoms of digoxin toxicity and heart failure.

Anti anginals (Drug used in Angina)

•Angina pectoris is the chest pain due to anoxia of heart muscles generally due to
obstruction or spasm in coronary artery. The drugs used in angina pectoris prevent
terminate attacks of angina pectoris are called antianginal drugs.

•These drugs are mainly classified as:

1. Nitrates.
2. Beta - Blockers. (already described)
3. Calcium channel blockers. (already described)

Nitrates
•Nitrates are the drugs which are vasodilator effects thus used in angina pectorisǤ

Mechanism of action
•Nitrates release NO (Free radical nitric oxide) which is powerful muscle relaxantǤ So they
produce vasodilation, decreased preload and afterload, reduce myocardial oxygen
consumption.

Drugs Doses
1 Isosorbide Mononitrate 10-20mg orally twice daily.
2 Isosorbide dinitrate 30-480mg orally in divided dose (5-10mg sublingually)
3 Nitroglycerine 0.3mg sublingually.

Indications / Uses
•Acute anginaǤ
•Prevention of expected and chronic anginal attacksǤ
•Long term prevention of anginaǤ
•Nitroglycerine is also administer I.V to treat surgical hypertension.

Adverse effects
•Headache is most commonǤ
•Orthostatic hypertensionǤ
•FlushingǤ •Nausea, vomitingǤ •DizzinessǤ •TachycardiaǤ •PalpitationsǤ
Contraindication / Precautions
•Hypersensitivity to nitratesǤ
•Severe anemiaǤ •Orthostatic hypertensionǤ •Early MIǤ •Increased ICPǤ
•Use cautiously in patients with hypotensionǤ

Drug interactions
•Antihypertensives, and sildenafil, tadalafil may increase hypotension effectsǤ

Nursing Responsibilities
• Nurse should teach the patient about proper use and storage of nitroglycerine sublingual
tablets.
• Instruct the patient to sit down and take the drug at the first sign of an acute angina
attack.
• Teach the patient to repeat the dose if no relief occurs in 5minutes and take emergency
medical help if no relief occurs after taking 3tablets in 15mins.
• Inform patient that headache is common side effect of nitrates and typically subsides with
continued therapy.
• Advise patient to avoid beveragesǤ
• Advise the patient that sublingual tablets may be taken at the onset of activities known to
cause angina such as sexual activity.

Antihypertensives
•Hypertension is a disease characterized by abnormally high blood pressureǤ

Classification of Antihypertensive drugs

• Beta blockers. Eg. Atenolol, timolol, metoprolol, propanol.
• Calcium channel blockers. Eg. Nifedipine, Amlodipine, verapamil, diltiazem.
• ACE inhibitors. Eg. Captopril, Ramipril, lisinopril, enalpril.
• Diuretics. EgǤ Furosemide, Amiloride, SpironolactoneǤ • VasodilatorsǤ EgǤ Hydralazine,
minoxidil, diazoxideǤ • Angiotensin antagonistǤ Eg. Losartan.

Mechanism of action
(Beta - Adrenergic Blockers). •Beta adrenergic receptors causes vasoconstriction in
blood vessels. Thus these drugs prevents stimulation of beta - adrenergic receptors of
sympathetic nervous system, thereby decreasing cardiac output.

Drugs Doses
1 Atenolol 50-100mgBD orally
2 Timolol 10-20mg orally twice a day.
3 Propranolol 20-80 mg orally.
4 Betaxolol 10mg orally BD.
5 Metoprolol 50mg every 4-6hrly.

Indications / Uses
•To treat mild hypertensionǤ •Angina pectorisǤ
Contraindication / Precautions
•Contraindicated in patients with asthma, sinus bradycardia, cardiogenic shock, second or
third degree heart block.
•Use these drugs with cautiously in pregnant and breast feeding women and in those with
impaired hepatic function.

Adverse effects
•Orthostatic hypertensionǤ •FatigueǤ •BradycardiaǤ •Nausea, vomitingǤ

Drug interactions
•These drugs cause additive hypotension when used concurrently with alcohol and
antihypertensives or calcium channel blockers.

Nursing Responsibilities
•Donot discontinue drug abruptly.
•Administer propranolol constituently with food, food may increase absorptionǤ

Mechanism of action (Calcium channel blockers).

•They are chemically different but pharmacologically similar drugsǤ They have commen
mechanism of action. They block the entry of Ca⁺⁺ ions into the smooth and cardiac muscle
cells that leads to decreased intracellular Ca⁺⁺ ions there by smooth muscle relaxation leads
to vasodilation.

Graphically: •They block the entry of Ca⁺⁺ ions into the smooth and cardiac muscle cells.
•Decrease intracellular Ca⁺⁺ ionsǤ •Smooth muscle relaxationǤ • VasodilationǤ

Drugs Doses
1 Amlodipine 5-10mg OD
2 Verapamil. 80mg TDS orally.
3 Nifedipine 30-60mg orally OD
4 Diltiazem 80-100 mg orally.
5 Perhexiline. 200-400 mg orally in divided dose.

Indications / Uses
•To treat the mild hypertensionǤ •Angina pectorisǤ

Contraindication / Precautions
•Contraindicated in patient with asthma, sinus bradycardia, cardiogenic shock, second and
third heart block.
•Use these drugs cautiously pregnant and breast feeding women and in those with
impaired hepatic function.

Adverse effects
•DizzinessǤ •HeadacheǤ •FlushingǤ •AV blocksǤ •EdemaǤ •NauseaǤ

Drug interactions
•They may increase risk digoxin toxicity when used with digoxinǤ
•May cause heart block when used with other calcium channel blocker.

Nursing Responsibilities
•Nurse should know that nifedipine may be given sublinguallyǤ
•Warn patient not to stop drug abruptlyǤ

Mechanism of action (ACE inhibitors).

•These drugs are also used in the treatment of hypertension, It acts by inhibiting
angiotensin converting enzyme and prevents the conservation of angiotensin- I &
angiotensin - II and preventing peripheral vasoconstriction.

Drugs Doses
1 Captopril 25mg TDS
2 Enalapril 2.5 mg daily, 40 mg daily in divided dose.
3 Lisinopril 5-10mg daily
4 Ramipril 2.5mg - 5mg daily.

Indications / Uses
•To treat mild hypertensionǤ
•Ramipril also used to treat heart failure after myocardial infarction.
•To reduce the risk of MI and death from cardiovascular causesǤ

Adverse effects
•DizzinessǤ •FaintingǤ •PalpitationsǤ •ProteinuriaǤ •Light headednessǤ •TachycardiaǤ •RashǤ

Contraindication / Precautions
•Contraindicated in patient with asthma, sinus bradycardia, cardiogenic shock, second and
third heart block.
•Use these drugs cautiously pregnant and lactating mother and in those with impaired
hepatic function.

Drug interactions
•Antihypertensives, diuretics may increase hypertensive effects.
•NSAID’S may decrease it effectsǤ
•They may increase hypoglycemic effects if used with insulin and oral antidiabeticsǤ
•ACE inhibiters may increase diuretic effects and increase the risk of hyperkalemia with
concurrent use with potassium sparing diuretics.

Nursing Responsibilities
•Antihypertensives captopril on empty stomachǤ
•Teach patient to report light headedness and avoid sudden position changes to minimize
orthostatic hypertension.

Vasodilators (Peripheral vasodilator)

•These are the drugs which are also vasodilator effects thus reduce blood pressureǤ

Mechanism of action
•They are potent direct relaxant of vascular smooth muscle and reduce both systolic and
diastolic B.P.

Drugs Doses
1 Hydralazine 10-20mg slowly I.V. injection. 25-200mg daily orally divided doses.
2 Minoxidil 5-50 mg daily orally.

Indications / Uses
•Used in moderate to severe hypertensionǤ
•To treat severe and essential hypertensionǤ

Contraindication / Precautions
•Contraindicated in patient with asthma, sinus bradycardia, Cardiac failureǤ
•Use these drugs cautiously pregnant and breast feeding women and in those with
impaired hepatic function.

Adverse effects
•Fluid retentionǤ •Orthostatic hypertensionǤ •Tachycardia.
•Severe hypertensionǤ (with IV doses)
•Minoxidil also can causes excessive hair growthǤ

Drug interactions
•Sildenafil, hypertensive drugs may potentiate antihypertensive effects of nitroprusside
sodium.

Nursing Responsibilities
•Nurse should closely monitor patient for fluid volume excess, monitor patients blood
pressure every 5 mins at start of infusion and at least every 15mins during infusion.
•Assess weight of patient daily and record intake and output.
•Advise the patient taking minioxidil that excessive hair growth is likely to occur 3to6
months after therapy begins. Reassure the patient that extra growth should be disappear
1to 6 month after therapy ends.

Antiarrhythmics
•Arrhythmias means abnormal cardiac rhythm. It occur due to an abnormal excitability of a
part of cardiac muscle or due to an abnormality in conduction system of heart. So these
drugs are used for arrhythmia.

Mechanism of action
• These drugs block Na⁺ (Sodium) channel of cell membranes and reduces excitability of
cardiac muscle and slows the conduction in heart.
• Verapamil drug block Ca⁺ channels and prevents accumulation of Ca⁺⁺ ion in myocardial
cells and shows the conduction of AV node.
• Beta blockers also blockage beta adrenoreceptor at heart and reduced excitability of the
heart.

Drugs Doses
1 Quinidine 200-300 mg 3-4 times daily orally.
2 Lidocaine 1mg/kg IV/2% injection
3 Lignocaine 100mg IV
4 Verapamil 80mg thrice daily
5 Propranolol 20-80 mg daily
6 Atenolol 50-100 mg twice daily.
7 Bretylium 5-10mg/kg loading dose.
8 Ibutilide 1mg I.V. given over 10minutes

Indications / Uses
•Ventricular arrhythmiasǤ •Ventricular tachycardiaǤ •Lidocaine used to treat life
threatening ventricular arrhythmiasǤ •To treat sinus tachycardia (Propranol)Ǥ •Also used to
treat hypertension.

Contraindication / Precautions
•Persistent severe bradycardiaǤ •Cardiac failureǤ •Hypersensitivity to these drugsǤ
Cardiogenic shock. •Complete atrioventricular blockǤ •2nd & 3rd degree heart blockǤ

Adverse effects
•HypotensionǤ •Heart failureǤ •DizzinessǤ •FatigueǤ •Nausea / VomitingǤ

Drug interactions
•Simultaneously use with antihypertensives causes additive hypotensionǤ
•Propranolol may increases hypotensive effects when used with NSAID’s indomethacin, Ca⁺
channel blockers.
•Concurrent use with digoxin may increased digoxin levels and worsen arrhythmiasǤ

Nursing Responsibilities
•Before administering lidocaine always check label to prevent administering from
containing epinephrine, or preservatives.
•After administering Bretylium keep patient supine and observe for hypotensionǤ
•Teach patient to change position slowly if taking BretyliumǤ
•Administer IV bolus for ventricular arrhythmias followed by continuous IV infusion as
ordered.

Anticoagulants
•These are the agents which inhibit the process of clotting, thus they are used to prevent
unwanted thrombosis.
Mechanism of action
•They prevent extension and formation of clots by inhibiting factors in the clotting cascade.

Drugs Doses
1 Heparin 5,000-10,000 unit by I.V.
2 Warfarin 20-30mg PO
3 Phenindione 200-300mg PO

Indications / Uses
•Thrombosis in deep veinsǤ •Unstable angina in PTCAǤ •Open heart surgeryǤ
•To treat and prevent thromboembolic disorders and ischemic complicationsǤ

Contraindication / Precautions
•Bleeding including thrombocytopeniaǤ
•Peptic ulcer diseaseǤ •Recent surgeryǤ •Coagulation disordersǤ

Adverse effects
•HyperlipidemiaǤ •HemorrhagesǤ •NauseaǤ •InsomniaǤ •ThrombocytopeniaǤ
•Pain at injection siteǤ •ConstipationǤ

Drug interactions
•Chloramphenicol, metronidazole, androgens, quinidine, thrombolytics increase the risk of
bleeding and may increase effects the risk of warfarin.
•Alcohol, barbiturates, estrogen containing hormonal contraceptives and some food rich in
vit. K increase the risk of clotting and may decrease the effects of warfarin.
•Prolonged or regular use with other drugs that effect platelet function such as aspirin,
NSAID’s may increase the risk bleedingǤ

Nursing Responsibilities
• Don’t give heparin by IM routeǤ
• Asses the early signs of unusual bleeding.
•Nurse should minimize venipunctures and injections, apply pressure to all puncture sitesǤ
• Monitor hemoglobin and clotting factor and platelet levelǤ
• Nurse should teach the patient to:
1. Not to take drugs or vitamins, including over the counter or herbal products, without
medical approval.
2. Inform physician and dentist of therapy regimens before undergoing any medical
treatment.

Antiplatelets
•These are the drugs which interfere with platelet function and are useful in the
prophylaxis of thrombosis disorders.

Mechanism of action
•They interfere with platelets function and inhibits platelets clumpingǤ
Drugs Doses
1 Aspirin
2 Clopidogrel
3 Dipyridamole
4 Ticlopidine.

Indications / Uses
•Used as prophylaxis for thromboembolic eventsǤ
•Aspirin used in patients with previous MI or unstable angina to reduce the risk of death
from these conditions and in men to reduce the risk of transient ischemic stroke.
•Clopidogrel is use to reduce a cardiovascular eventsǤ •Myocardial infarctionǤ

Contraindication / Precautions
•Active bleedingǤ •Coagulation disorderǤ •Ulcer disorderǤ •Recent surgeryǤ •CancerǤ
•ThrombocytopeniaǤ

Adverse effects
•Bleeding/HemorrhageǤ •NeutropeniaǤ •Abnormal stoolǤ •RashǤ •Pain in injection siteǤ
•PancytopeniaǤ •DizzinessǤ •HeadacheǤ •NauseaǤ

Drug interactions
•Prolonged or regular use with other drugs that effect platelet function such as aspirin,
NSAID’s may increase the risk of bleedingǤ

Nursing Responsibilities
•Monitor patient for bruising or bleeding.
•Assess the early signs of unusual bleedingǤ
•Nurse should minimize venipuncture and injections, apply pressure to all puncture sitesǤ
•Monitor hemoglobin and clotting factor and platelets levelǤ

Thrombolytics (Fibrinolytics)
•These drugs are used to lyse (Dissolve) thrombus or clotǤ

Mechanism of action
•These agents activate plasminogen to form plasmin thus dissolve clot or thrombosisǤ
(Plasminogen Plasma Clot dissolution).

Drugs Doses
1 Streptokinase 5,00,000 units IV.
2 Urokinase 5,000 units
3 Alteplase 100mg IV in divided doses.

Indications / Uses
•Myocardial infarctionǤ •Deep vein thrombosisǤ •Pulmonary embolismǤ •StrokeǤ
Contraindication / Precautions
•Recent streptococcal infectionǤ •Recent strokeǤ •Ulcer diseaseǤ •CancerǤ •Active internal
bleedingǤ •Coagulation disordersǤ •Recent surgeryǤ

Adverse effects
•BleedingǤ •Hypersensitivity reactionsǤ •HemorrhageǤ •UrticariaǤ •ArrhythmiasǤ

Drug interactions
•Prolong or regular use with other drugs that effect platelet function such as aspirin,
NSAID’s may increase the risk of bleedingǤ

Nursing Responsibilities
•Assess the early signs of unusual bleedingǤ
•Nurses should minimize venipunctures and injections, apply pressure to all puncture sites.
•Monitor hemoglobin and clotting factor and platelets levelǤ
•Avoid IM injectionsǤ
•Avoid subclavian catheters for central venous linesǤ

Hypolipidemics
•These drugs are used in the treatment of atherosclerosis and hyperlipidemia.

Mechanism of action
•They inhibit the synthesis of cholesterol in liver also they inhibit the transfer of
triglycerides from liver to plasma and block HMG- COA reductase in the liver preventing
cholesterol synthesis.

Drugs Doses
1 Atorvastatin 10-20mg daily
2 Simvastatin 10-40mg at night daily.
3 Lovastatin 10-20mg daily at night.
4 Clofibrate 1-2gm daily PO individual doses.
5 Colestipol 15-30gm daily.

Indications / Uses
•CAD •HyperlipidemiaǤ •HypertriglyceridemiaǤ •Secondary prevention of cardiovascular
eventsǤ •AtherosclerosisǤ •HypercholesterolemiaǤ •Increase in SrǤ level of HDLsǤ

Contraindication / Precautions
•Hypersensitivity to these drugsǤ
•Elevated liver function test resultsǤ
•Hepatic and severe renal dysfunctions.
•Cautiously in pregnancy and breast feeding womenǤ

Adverse effects
•HeadacheǤ •PhotosensitivityǤ •Progression of cataractsǤ •InsomniaǤ •Blurred visionǤ
•Nausea / vomitingǤ •DiarrheaǤ •ConstipationǤ •DyspepsiaǤ •RhabdomyolysisǤ •Abdominal
crampsǤ •FlatulenceǤ •Hypersensitivity reactionǤ •MyopathiesǤ

Drug interactions
•Use with erythromycin, cyclosporin, nicotinic acid may increase the risk of
Rhabdomyolysis and myopathy.
•May increase digoxin levelsǤ
•Concurrent use of simvastatin, atorvastatin with warfarin sodium may increase the effects
of warfarin.

Nursing Responsibilities
•These drugs should start only after diet therapy has provan ineffectiveǤ
•Advise patient to avoid alcohol consumptionǤ
•Give lovastatin with evening meal because absorption is enhanced and cholesterol
biosynthesis is greater in evening.
•Monitor liver function test periodicallyǤ
•Monitor blood level of fat soluble vitamin, serum cholesterol, and triglyceride levels and
liver function tests during therapy.