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Focus on
PHARMACOLOGY
ESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
21
Drugs Used to
Treat
Cardiovascular
Conditions
Cardiac Drugs
• Broadly classified according to effects
on heart:
– Rate of heartbeat
– Rhythm of heartbeat
– Amount of blood output
– Strength of contraction
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Cardiovascular System
• Pulmonary circulation: picks up oxygen,
discards carbon dioxide
• Systemic circulation (including coronary
circulation): carries oxygen and
nutrients to all active cells and
transports wastes to kidneys, liver, and
skin for excretion
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Heart
• Muscular pump with three layers:
– Endocardium (thin inner lining)
– Myocardium (heart muscle)
– Epicardium (thin outer lining)
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Figure 21-1
Anatomy of the heart.
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Figure 21-2
Electrical conduction system of the heart.
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Coronary Heart Disease (CHD)
• Ischemia: oxygen delivered to heart is
insufficient to meet needs
• Coronary artery disease:
atherosclerosis and arteriosclerosis
• Angina pectoris: episodic, reversible
oxygen insufficiency
– Classical, variant, unstable
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Coronary Artery Disease Video
Click on the screenshot to view a video on the topic of coronary artery
disease.
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Table 21-1
Organonitrates and Other Anginal Medications
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Table 21-1 (continued) Organonitrates and Other Anginal Medications
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Nitroglycerin (Nitrostat): Uses
• Dilates blood vessels in vascular
smooth muscles to decrease cardiac
oxygen demand; also relaxes spasms
of variant angina
• Used to treat stable and variant angina
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Nitroglycerin: Adverse Effects
• Headache
• Hypotension
• Tachycardia
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Nitroglycerin: Contraindications
• Hypertrophic cardiomyopathy,
pronounced hypovolemia, inferior MI,
raised intracranial pressure, and
cardiac tamponade
• Contraindicated in pregnancy and
lactation
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Nitroglycerin:
Patient Information
• Advise patients to avoid carrying
nitroglycerin close to body and to store
in cool, dark place.
• Advise patients to avoid alcohol.
• Instruct patients to seek emergency
medical attention if pain continues after
3 tablets.
• Discard unused tablets after 6 months.
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Nitroglycerin
• Nitroglycerin can cause severe
hypotension.
• People should use nitroglycerin with
caution if they:
– Are taking diuretic medication
– Have hypertension
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Other Anginal Agents
• Isosorbide dinitrate and isosorbide
mononitrate: longer-acting antianginals
• Erythrityl tetranitrate: principal use is
prophylaxis of angina in acute
situations
• Pentaerythritol tetranitrate: long-acting
organic nitrate for prophylaxis of
angina, but not for acute attack
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Beta-Adrenergic Blockers
• Beta-blockers (propranolol, atenolol)
reduce heart’s oxygen demand by
decreasing heart rate.
• Prevent development of myocardial
ischemia and pain
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Calcium Channel Blockers
• Interfere with movement of calcium
ions through cell membranes
• Can affect heart or peripheral
vasculature
• Used to treat pain of angina and to
lower blood pressure
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Myocardial Infarction
• Caused by severe, prolonged lack of
oxygen, which kills an area of heart
muscle
• Leading cause of death in industrialized
nations
• CAD, clot formation in the coronary
artery, spasm of arteries, heavy
exertion, abrupt increase in blood
pressure can all cause MI.
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Therapeutic Agents for MI
Goal is to limit damage to myocardium
IV fluids
Nitroglycerin
Aspirin and thrombolytic drugs
Morphine sulfate
Beta-blockers and calcium channel
blockers
• Oxygen
•
•
•
•
•
•
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Table 21-2
Various Dysrhythmias
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Table 21-3
Antidysrhythmic Medications
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Table 21-3 (continued) Antidysrhythmic Medications
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Table 21-3 (continued) Antidysrhythmic Medications
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Table 21-3 (continued) Antidysrhythmic Medications
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Quinidine (Quinidex): Uses
• Depresses myocardium and conduction
system to decrease contractile force of
heart and slow heart rate
• Used to treat atrial fibrillation and
flutter and ventricular tachycardia
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Quinidine: Adverse Effects
• Common: diarrhea, flatulence,
abdominal pain, fever, reduced platelet,
liver function abnormalities
• Serious: sudden ventricular fibrillation
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Quinidine: Contraindications
• Contraindicated in pregnancy, lactation,
bacterial endocarditis, myasthenia
gravis
• Interacts with digoxin, amiodarone,
verapamil
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Quinidine: Patient Information
• Instruct patients to immediately report
chest pain or a change in heart rhythm.
• Advise patients to take with food and to
report diarrhea to health-care provider.
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Propranolol (Inderal): Uses
• Affects beta receptors to slow heart
rate and lower blood pressure
• Used to treat tachycardia,
hypertension, angina, and to prevent
MI
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Propranolol: Adverse Effects
• Hypotension and bradycardia
• Diminished sex drive
• Impotence
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Propranolol: Contraindications
• Contraindicated in bronchial asthma or
bronchospasm, severe chronic
obstructive airway disease, allergic
rhinitis, pregnancy
• Interacts with clonidine, cimetidine,
epinephrine, insulin
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Propranolol:
Patient Information
• Warn patients not to discontinue
abruptly.
• Tell patients to monitor pulse and
report a rate less than 60 bpm.
• Advise patients to rise slowly from a
lying or sitting position to avoid
dizziness.
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Amiodarone: Uses
• Blocks potassium and sodium ion
channels to prolong heart’s resting
stage
• Used to treat atrial dysrhythmias in
patients with heart failure
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Amiodarone:
Adverse Effects
• Common: dizziness, nausea, vomiting,
anorexia, bitter taste, weight loss,
numbness of fingers and toes
• Serious: pulmonary fibrosis with longterm use
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Amiodarone: Contraindications
• Contraindicated in severe liver disease,
pregnancy, severe sinus bradycardia,
and in children
• Interacts with many drugs including
digoxin and phenytoin
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Amiodarone:
Patient Information
• Advise patients to immediate report
shortness of breath, cough, change in
heart rate and rhythm, or vision
changes.
• Advise patients to protect skin and eyes
from sun.
• Instruct patients to change positions
slowly to avoid dizziness.
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Verapamil (Calan, Isoptin): Uses
• Acts primarily on AV node to slow
conduction, causing depression of
myocardial contractibility and dilation of
coronary arteries
• Used to stabilize dysrhythmias and to
treat angina and hypertension
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Verapamil: Adverse Effects
•
•
•
•
•
•
•
•
Dizziness or vertigo
Emotional depression
Sleepiness
Headache
Peripheral edema
Hypotension
Nausea
Constipation
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Verapamil: Contraindications
• Contraindicated in patients with
hypotension and CHF and in pregnancy
and lactation
• Interacts with carbamazepine, lithium,
cyclosporine, digoxin, calcium salts
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Verapamil: Patient Information
• Instruct patients to monitor blood
pressure and report if less than
90/60 mm Hg.
• Advise patients to report breathing
difficulty or change in heart rhythm.
• Instruct patients to take with food and
to increase fiber intake.
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