DRUGS AFFECTING THE CARDIOVASCULAR SYSTEM E- liminate smoking

• Determinants of Blood pressure 1. ANGIOTENSIN- CONVERTING ENZYME INHIBITORS

- cardiac output (systolic pressure) • MOA: blocks the conversion of angiotensin I to angiotensin II
• Uses: hypertension, MI
- Peripheral vascular resistance ( diastolic pressure) • Eg:
– benazepril (Lotesin) - moexipril (Univasc)
– captopril (capoten) - perindopril (Aceon)
– enalapril maleate (Vasotec) - lisinopril
• Baroreceptors (pressure receptors) specialized cells in the arch of – quinapril (Accupril) - ramipril
the aorta – fosinopril (Prinivil) - trandorapril
• Renin- Angiotensin Aldosterone system • SE: cough, hypotension, HA, dysgeusia (any perversion of taste
– Compensatory mechanism when blood pressure within the perception), insomia, N/V, diarrhea
kidneys fall • AE: reflex tachycardia, chest pain, angina, CHF, cardiac arrythmias,
ulcers, liver & renal problem ,photosensitivity, hyperkalemia,
• Renin- Angiotensin System neutropenia, angioedema
Dec BP/Oxygen • DI: + probenecid =
Juxtaglomerular cell (kidney) + potassium supplement & diuretics =
↓ + NSAIDS =
Renin
+ Antacids =
↓
Angiotensinogen (liver)
+ tetracycline =
↓
Angiotensin I  CI: renal disease, severe Na depletion, CHF, pregnant and lactating
↓ women
Angiotensin II Nursing Considerations
∕ \ • Encourage implement lifestyle changes
Intense vasoconstriction
• Administer on an empty stomach
> Increase peripheral resistance ↓
• Alert if patient is for surgery/ dialysis / situations which may drop
> Increase BP, restore blood flow Adrenal Cortex
↓ ↓ the fluid volume
Increase – kidney aldosterone • Parenteral form only if oral form is not available
↓ ↓ • Adjust dose if with renal failure
Decrease renin nephrons • Do not give if BP is below 90/70, monitor BP esp for 2 hours after
↓ the first dose (hypotension)
Na & water retention • Avoid ambulation (dizziness)
∕ \
• Report cough / angioedema
increase BP Na rich blood
↓
• Report dysgeusia if more than 1 month
hypothalamus
↓ 2. ANGIOTENSIN II RECEPTOR ANTAGONIST
osmoreceptors • Selectively bind the angiotensin II receptors in the blood vessels
↓ and adrenal cortex.
anti diuretic hormone • Eg: telmisartan ( Micardis)
↓ losartan ( Diovan)
further increase blood volume
irbesartan ( Aprovel)
candesartan ( Blopress)
• Hypertension- “ silent killer” valsartan ( Cozaar)
- When a person’s blood pressure is above the normal limits for a eprosartan ( Teveten)
sustained period • USES: when ACE inhibitors are not tolerated
• TYPES: • SE: HA, diarrhea, dyspepsia, cramps
– Primary • AE: angioedema, hyperkalemia
– secondary • CI: nephro dysfunction, CHF, pregnancy
• Stepped Care Approach NURSING CONSIERATIONS:
1. Lifestyle modification • +++ ensure female patient not pregnant
1. Wt reduction • Take without regard to food
2. Dec sodium intake
3. Moderate alcohol intake 3. CALCIUM CHANNEL BLOCKERS
4. Smoking cessation • MOA: prevents movement of calcium ions in the myocardium and
5. Increase physical exercise vascular smooth muscles.
2. + drug • Normally: Ca increases muscle contractility, peripheral resistance
and BP
• Health Teachings • EG: amlodipine ( Norvasc) nimodipine (Nimotopp)
P- ressure (blood) monitor diltiazem (Cardizem) felondipine (Plendil)
R- ise slowly nicardipine ( Cardene)
E- ating must be considered nifedipine (Procardia)
S- tay on medication verapamil ( Calan)
S- kipping or abrupt stopping is NO- NO USES: Angina, hypertension, atrial fibrillation
U- ndesirable responses
R- emind to exercise, decrease alcohol
 • SE/AD: HA, dizziness, hypotension, syncope, reflex AE: rebound hypertension
tachycardia, constipation, AV block, bradycardia,
peripheral edema
NURSING CONSIDERATIONS Main contraindications (ABCDE)
– Monitor ECG, CR, BP • A-
– Have “E” cart available with IV administration • B-
– Position to decrease peripheral edema • C-
– Protect drug from light and moisture • D-
– Increase OFI and fiber in the diet • E-
– Avoid overexertion when anginal pain is relieved
– May give paracetamol if with HA DI: + antacids =
– Take with meals or milk + lidocaine =
– No not chew or crush sustained released + insulin/ OHA=
+ cardiac glycosides=
4. VASODILATORS + calcium channel blockers=
• MOA: relaxes smooth muscles of blood vessels esp the arteries;
promotes increase blood flow to the brain & kidney + cimetidine=
• EG: hydralazine ( Apresoline) minoxidil (Loniten) + theophylline =
diazoxide ( Hyperstat) nitroprusside ( Nitropress) Examples:
Nonselective Beta Blockers
USES: severe hypertension, emergencies • Carvedilol ( Coreg)
• SE/ AE: • Nadolol ( Corgard)
– hydralazine: tachycardia (beta blockers), palpitations, edema • Propranolol ( Inderal)
(diuretics), HA, dizziness, GI bleed, lupus like and neurologic • Timolol ( Blocadren)
symptoms • Pindolol ( Visken)
– minoxidil: similar effects, excess hair growth, precipitates Cadioselective Beta Blockers (B1)
angina • acebutolol (Sectral)
– Nitroprusside & diazoxide (hyperglycemia) : similar • atenolol ( Tenormin)
• CI: allergy, pregnancy, lactation, cerebral insufficiency • betaxolol ( Kerlone)
• DI: + other antihypertensive drugs = additive effect • bisoprolol (Zebeta)
• NURSING CONSIDERATIONS: • esmolol (Brevibloc)
D – irectly acts on vascular smooth muscle • metoprolol (Betaloc, Cardiostat)
I – ncrease renal and cerebral blood flow
L – upus like reaction NURSING CONSIDERATIONS:
- Lifestyle modification; Compliance ( rebound hypertension)
A - ssess peripheral edema - Monitor blood sugar with diabetics
T – ake with food - Monitor triglycerides and cholesterol level (LDL)
O – ther side effects - Monitor BP & pulse before and after
R – eview BP (orthostatic hypotension), blood glucose, - Withhold if pulse is < 60 or SBP < 90
- Monitor any change in the rhythm or signs of CHF
5. SYMPATHOLYTIC DRUGS
 Blocker
BETA- BLOCKERS “OLOL” B-
 beta-adrenergic blocking agents,beta-adrenergic L-
antagonists, beta antagonists.
A.)BETA- ADRENERGIC BLOCKERS br O –
MOA: block beta 1 (Cardiac) and / or beta 2 (lungs) adrenergic C-
receptor sites; decrease the effects of the SNS by blocking the release -
of catecholamines, thereby decreasing the HR and BP K-
E–
Beta-one receptors
 are found in the heart and kidneys. R-
 When stimulated, they increase heart rate, AV conduction,
& automaticity. B.) ALPHA – ADRENERGIC BLOCKERS
Beta1-blockers • MOA: blocks alpha 1 adrenergic receptors resulting in vasodilation
 reduce heart rate, blood pressure, myocardial contractility, of arteries and veins
and myocardial oxygen consumption. - Decrease peripheral resistance; relaxes smooth mucle of bladder /
Beta-two receptors prostate
 mainly in the lungs, gastrointestinal tract, liver, uterus, - Decrease VLDL & LDL = decrease fat deposits ; increase HDL
vascular smooth muscle, and skeletal muscle. - Does not affect glucose metabolism & respiratory function
 serve to dilate bronchial & vascular smooth muscle. - Causes Na & H2O retention with edema; given with diuretics
Beta2-receptor blockade • WARNINGS: renal disease, elderly more sensitive
 inhibits relaxation of smooth muscle in blood vessels, • EG:
bronchi, the gastrointestinal system, and the genitourinary  Potent Alpha Blockers: hypertensive crisis& severe
tract. hypertension from catecholamine secreting tumors of the adrenal
USES: hypertension, dysrhythmias, angina pectoris medulla (pheochromocytoma)
 • Phentolamine
• Phenoxybenzamine
• tolazoline D.) ADRENERGIC NEURON BLOCKERS (PERIPHERALLY
• Prazosin ( Minipress) = ACTING SYMPATHOLYTICS)
• Doxazosin (Cardura) = • MOA: block norepinephrine release from the sympathetic nerve
• Terazosin (Hytrin) = endings that results in decrease BP

SE: orthostatic hypotension • SE: orthostatic hypotension, Na & water retention vivid dreams,
- 1st dose syncope (hypotension with loss of consciousness) nightmares & suicidal intention ( reserpine)
- Nausea, drowsiness, nasal congestion, weakness, loss of libido • EG: reserpine (Serpasil)
- Phentolamine – reflex tachycardia guanethidine monosulfate (Ismelin)

DI: + other antihypertensive, alcohol, nitrates = • NURSING CONSIDERATIONS: Take with meals, no alcohol

Prazosin + anti inflammatory drug =

Prazosin & nitroglycerin = E.) ALPHA1 & BETA1 – ADRENERGIC BLOCKERS
• MOA: blocks both alpha1 and beta1 receptor sites; decrease BP &
NURSING INTERVENTIONS moderately decrease PR
• Monitor BP frequently • SE: orthostatic hypotension, GI disturbances, nervousness, dry
• Protect from falling / injury mouth, fatigue
• Assess BP and HR before each dose • AE: heart block
• If dose is during the day, client must remain recumbent for 3-4 ˚ • CI: large doses could block bete2 receptors = increase airway
• Assist with ambulating if client is dizzy resistance in patients with asthma
Education: • Eg: labetalol (Normodyne)
• Implement safety precautions carteolol (Cartrol)
• Report if edema is present
• Sugarless gum, sips of tepid H2O, etc. may relieve dry mouth

C.)CENTRALLY ACTING ALPHA2 AGONIST

• MOA: decrease sympathetic response from brainstem to the
peripheral vessels; resulting in a decrease peripheral vascular
resistance & BP
- Stimulate the alpha2 receptors:
 Decrease sympathetic activity
 Increase vagus nerve
 Decrease epinephrine, norepinephrine, renin release

• SE/ AE: drowsiness, HA, dry mouth, dizziness, bradycardia,

constipation, hypotension, occasional edema or weight gain
• DI: paradoxical hypertension with propranolol
• EG: Methyldopa (Aldomet) (chronic / PIH) ***
Clonidine (Catapres)***
*** cause Na & water retention (given with diuretics)

NURSING CONSIDERATIONS:
• Monitor baseline VS ( q30 mins until stable during initial therapy)
& weight ( refer: wt gain > 4 lbs/ week)
• Abrupt D/C = hypertensive crisis ( restlessness, tachycardia,
tremors, HA, & increase BP), compliance
• Taper dose gradually over more than one week
• Recommend the last dose of the day to be taken at bed time
• Sugarless gum, sips of tepid water may relieve dry mouth