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CARDIOVASCULAR & HEMATOLOGY SYSTEM MEDICATIONS

GENERAL GUIDELINES:
Antihypertensive side effect of orthostatic hypotension is very common (particularly in older adults).
Monitor parameters of blood pressure and heart rate prior to giving many cardiovascular medications.
Multiple medication-medication interactions with cardiovascular drugs.
High risk for hemorrhage with anticoagulants & thrombolytics; bleeding with antiplatelets
Note that classifications can have multiple therapeutic uses for cardiovascular conditions.

CLASSIFICATION THERAPEUTIC USES MECHANIXM OF ACTION DRUG EXEMPLARS ADVERSE EFFECTS

NURSING IMPLICATIONS
Antihypertensives

Angiotensin- Hypertension Blocks formation of angiotensin II causing: captopril (Capoten)

converting lisinopril (Zestril)
Heart failure a. vasodilation
enzyme (ACE)
MI b. excretion of aldosterone, Na & water enalapril (Vasotec)
inhibitors
Diabetic nephropathy c. reduction in pathological changes to blood
fosinopril (Monopril)
vessels and heart

Angiotensin II Hypertension Blocks angiotensin II receptors leading to: losartan (Cozaar)

receptor blockers Heart failure a. vasodilation irbesartan (Avapro)
(ARBs) b. excretion of aldosterone, Na & water
MI valsartan (Diovan)
Diabetic nephropathy

Aldosterone Heart failure post MI Blocks aldosterone receptors in kidney spironolactone (Aldactone)
antagonists Hypertension leading to:
eplerenone (Inspra)
a. increased excretion of Na & water
Potassium
Sparing diuretic b. reduced blood volume.

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Calcium channel Hypertension 1) Slows movement of calcium into smooth Selective for blood vessels:
blockers (CCBs) Angina muscle cells leading to: nifedipine (Procardia)
amlodipine (Norvasc)
Cardiac dysrhythmias a. vasodilation

2) Slows calcium channels in myocardium

leading to: Non-selective for both
blood vessels & heart:
a. decreased force of contraction
verapamil (Calan)
b. decreased heart rate
diltiazem (Cardizem)
c. slowed conduction through AV node

Alpha1 adrenergic Hypertension Selectively blocks alpha1 adrenergic receptors doxazosin (Cardura)
blockers in arterioles leading to: prazosin (Minipress)

a. vasodilation

Centrally acting Hypertension Stimulates alpha2 receptors in the brain, clonidine (Catapres)
alpha2 agonists which results in relaxation of arteries,
vasodilation, slowing of HR, and decreased
cardiac output.

Cardioselective Hypertension Blocks beta receptors in myocardium leading Metoprolol (Lopressor) Hypotension, bradycardia,
Beta1 blockers to: atenolol (Tenormin) fatigue, dizziness, GI
Angina
disturbances, mood changes,
Heart failure a. decreased force of contraction
depression, erectile dysfunction
Tachydysrhythmias b. decreased heart rate
MI
c. slowed conduction through AV node

Also blocks beta1 receptors in kidney,

reducing release of renin, angiotensin II
leading to vasodilation

Non-selective Same as above + Blocks beta1 receptors in myocardium and carvedilol (Coreg) Hypotension, bradycardia,
Beta1 & Beta2 Cardiac dysrhythmias kidney as above and also beta2 receptors in fatigue, dizziness, GI
labetalol (Trandate)
Blockers lungs disturbances.
propranolol (Inderal)

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+bronchospasm, mood changes,

reduced libido, erectile
dysfunction, hypoglycemia
masking (caution when used for
persons with DM)

Vasodilators Hypertensive Centrally acting vasodilator that results in nitroprusside

emergencies rapid reduction of blood pressure, preload, &
(Nitropress)
afterload

Medications for Heart Failure

Cardiac glycosides Heart failure Inhibits Na/K/ATPase (enzyme needed for digoxin Signs of digoxin toxicity: N/V,
Atrial fibrillation pumping Na ions out of heart cells. As Na diarrhea, visual disturbances-
accumulates in the cells, calcium ions are
blurred, yellow or green vision,
released producing :
halo effects, headache,
a. increased force of contractions confusion, drowsiness

b. improved stroke volume & CO -Monitor K, Mg, Ca levels

Also acts to suppress SA – AV node -Hold for HR < 60

conduction reducing heart rate
-Monitor serum levels 0.5 –
2ng/ml

Levels may go up with: CKD (low

Ca), low K, low Mg, dehydration
(possibly due to diuretics)

Multiple drug-drug interactions

Adrenergic Emergency treatment Stimulates Beta1 receptors in myocardium to: epinephrine Hypertension in hi doses,
agonists for cardiac arrest, heart dopamine hypotension in low doses,
a. increase heart rate
failure & shock dobutamine rebound hypotension w/ sudden
b. increase myocardial contractility withdrawal, tachycardia,
isoproterenol
arrhythmias, tissue necrosis with
c. increase cardiac output IV extravasation,
d. increase tissue perfusion vasoconstriction (peripheral

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Stimulates Beta1 receptors in kidney to ischemia)

release renin leading to:
Epinephrine/ Norepinephrine
a. vasoconstriction and increased BP
- Renal shutdown

Isoproterenol

-Increased cardiac ischemia,

bronchospasm

Extravasation:

Administer phentolamine

Contraindicated:
Pheochromocytoma, PVD,
Raynauds

Antianginal Agents

Organic nitrates Angina Dilates coronary arteries improving perfusion nitroglycerin (Nitrostat) Hypotension, headache,
of myocardium, reducing pain and coronary (Nitro-Bid) dizziness, flushing, nausea,
artery spasms. reflex tachycardia
isosorbide (Isordil)
Also dilates veins, reducing the amount of Contraindicated:
blood returning to the heart and reducing
If taking Phosphodiesterase
preload.
inhibitors (like Viagra), head
trauma

Educate:

Topical/Transdermal: Wear
gloves

Store in cool, dark place

May develop tolerance – nitrate

free breaks as prescribed

Antidysrhythmics

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Class I: Sodium V-Tachycardia Blocks Na channels thereby slowing cardiac procainamide Hypotension, bradycardia,
channel blockers conduction velocity disopyramide (Norpace) fatigue, dizziness, GI
A-Flutter
lidocaine (VT, VF) disturbances.
A-Fibrillation
+Twitching, tremors, seizure-like
symptoms, prolonged QT
interval, Torsade’s de Pointes
(rapid HR – VT)

Procainamide:

Lupus syndrome

Lidocaine:

-Monitor serum levels, neuro

checks

Class II: Beta- V-Tachycardia Prevents sympathetic nervous system propranolol (Inderal) Hypotension, bradycardia,
adrenergic stimulation of the heart adenosine fatigue, dizziness, GI
A-Flutter
blockers osmolol (Breviloc) disturbances.
A-Fibrillation
digoxin +bronchospasm, mood changes,
reduced libido, erectile
dysfunction, hypoglycemia
masking (caution when used for
persons with DM)

Adenosine:

- Rapid admin (1-2 seconds)

- Followed by a saline flush

- Transient asystole, flushing,

chest pain, dyspnea,
palpitations, headache, heart
block

Digoxin: See Above

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Class III: V-Tachycardia Blocks K Channels thereby prolonging the amiodarone Hypotension, bradycardia,
Potassium action potential & refractory period of the fatigue, dizziness, GI
A-Flutter
channel blockers cardiac cycle disturbances.
A-Fibrillation
+ blue-gray skin discoloration,
photosensitivity, visual
disturbances, thyroid
dysfunction, neuropathy or
ataxia.

-Monitor lung & liver function

(Lung fibrosis, hepatoxicity)

Class IV: Calcium V-Tachycardia Prolongs cardiac conduction verapramil (Calan) Hypotension, bradycardia,
channel blockers Decreases oxygen demand of the heart diltiazem (Cardizem) fatigue, dizziness, HA, GI
A-Flutter
disturbances (constipation
A-Fibrillation particularly in older adults).

+ peripheral edema.

Contraindicated: heart block,

severe HF, severe hypotension.

Educate:
Report s/s dizziness, palpitations

No grapefruit juice

Antilipemics

HMG-CoA Hypercholesterolemia Interferes with hepatic enzyme HMG-CoA to atorvastatin (Lipitor)

reductase Prevention of MIs reduce cholesterol precursors. Decreases
simvastatin (Zocor)
inhibitors manufacture of LDL & VLDL
(Statins) Increases manufacture of HDL

Cholesterol Same as above Inhibits intestinal absorption of cholesterol ezetimibe (Zetia)

absorption secreted in bile and food
inhibitor

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Bile-acid Same as above Binds to bile acids in intestine, causing colesevelam (Welchol)
sequestrants increased excretion of cholesterol.

Nicotinic acid Same as above Decreases LDL & triglycerides synthesis niacin
(Niacin)

Fibrates Same as above Decreases triglyceride production and gemfibrozil (Lopid)

transport. Increases HDL precursors

Medications that affect Coagulation

Parenteral Therapy for Deep vein Activates antithrombin leading to: heparin Bleeding, heparin induced
Anticoagulants thrombosis (DVT) and a. inhibition of thrombin & factor Xa fondaparinux (Arixtra) thrombocytopenia (HIT)
pulmonary emboli (PE) b. inhibition of fibrin formation
enoxaparin (Lovenox) -Monitor aPTT, platelets
Prevent DVT & PE and
stroke Educate:
Avoid concurrent NSAID use

Oral Therapy for DVT & PE Antagonizes vitamin K leading to: warfarin (Coumadin) Bleeding
Anticoagulants Prevent thrombus a. prevention of synthesis of factor VII, IX, X, apixaban (Eliquis) -Monitor INR
formation in persons and prothrombin (warfarin) dabigatran (Pradaxa)
-Antidote: Vit K
with A-fib to prevent rivaroxaban (Xarelto)
DVT, PE, stroke, MI -Multiple drug-drug interactions
b. Directly inhibits thrombin formation
Educate:
(dabigatran)
Be consistent with Vit K intake
Adherence & monitoring

c. Directly inhibits factor Xa and fibrin Avoid activities that could cause
formation trauma or bleeding
(apixaban & rivaroxaban)
Avoid concurrent NSAID use

No Grapefruit juice

Thrombolytics Dissolves clots in Dissolves clots. Converts plasminogen to alteplase (Activase) (tPA) Hemorrhage
conditions of: plasmin resulting in:
reteplase (Retavase) - No unnecessary IV punctures
CVA, MI, PE a. destruction of fibrinogen
Tenecteplase (TNKase) - Bed rest (prevent injury)
b. destruction of other clotting factors
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- Must be given ASAP (within 3h)

Monitor for reperfusion injury:

arrhythmias, exacerbation of
inflammatory processes, cardiac
ischemia

Contraindicated:

active bleeding, recent head

trauma, aneurysm, hemorrhagic
stroke, uncontrolled HTN

*Anticoagulant Adjuvants to Reverse Effects of Anticoagulants

Anti-heparin Reverse effect of When given in the presence of heparin a protamine sulfate Hypotension, bradycardia, N/V,
agent heparin anticoagulant stable salt is formed and the anticoagulant flushing.
activity of heparin is lost.

Vitamin Reverse effect of Promotes synthesis of more clotting factors, Vitamin K Injection site irritation, taste
Warfarin anticoagulant including prothrombin & factors VII, IX & X alterations.

Blood coagulation Urgent reversal of acquired coagulation factor deficiency induced by Prothrombin complex Thromboembolism, injection
factor Warfarin therapy in patients with acute major bleeding or the need for concentrate (Kcentra) site irritation
replacement urgent surgery or other invasive procedure
-Monitor liver enzymes
product

Antiplatelets

Salicylic Prevention of MI & CVA Inhibit enzymes and factors of normal arterial aspirin Bleeding, Thrombocytopenia,
clotting to: headache, dizziness (fall risk),
Glycoprotein clopidogrel (Plavix)
diarrhea
inhibitors a. prevent platelet aggregation
abciximab (ReoPro) (IV)
Avoid concurrent use of NSAIDS
ADP inhibitors b. prevent platelet clumping
Contraindicated in persons

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missing liver enzyme: CYP2C19

Educate on adherence and

monitoring tests

Hematopoietic Medications

Iron Supplements Iron-deficiency Anemia Provides iron for hemoglobin composition ferrous sulfate (Feosol)

Vitamin B12 – Pernicious Anemia Provides supplemental vitamins necessary for cyanocobalamin (B12)
Supplement Folate -Folic acid Anemia normal RBC production folic acid (Folate)

Erthyropoiesis Anemia r/t kidney Stimulates bone marrow to increase epoetin alfa (Epogen)
Growth Factors disease, chemotherapy production of RBCs

Leukopoietic Neutropenia Stimulates bone marrow to increase Filgrastim (Neupogen)

Growth Factors production of WBCs

Anxiolytic

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