UNIT X CARDIAC DRUGS

1. CARDIAC
DRUGS
AY

2. INC Syllabus
• Haematinics.
• Cardiotonics.
• Anti anginals.
• Antihypertensives & Vasodilators.
• Anti – arrhythmic.
• Plasma expanders.
• Coagulants &Anticoagulants.
• Antiplatelets & thrombolytics.
• Hypolipidemics.
Composition, Action, Dosage,
Route, Indications,
Contraindications, Drug
Interactions, Side effects,
Adverse effects, Toxicity &
Role of nurse

3. 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.

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

5. Drug example and doses
S.
No.
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

6. •To prevent and treat iron deficiency
anemia.
•In children during rapid growth period.
•In pregnant and lactating mother.
•As dietary supplement of iron.
•Patient with post gastrectomy.
Indications / Uses

7. Contraindication / Precautions
•Patient with hemochromatosis.
•Hemolytic anemia.
•Patient with hemosiderosis.
•Hypersensitivity to the drug.

8. Adverse effects
• Nausea / vomiting.
• Constipation.
• GI distress.
• Dark stool.
• Local pain at I.V. site.
• Parental iron may causes, headache, Vomiting nausea and
anaphylaxis.
• Temporarily stain teeth with liquid iron.
• Bronchospasm with parenteral iron.

9. Drug interactions
•Antacids, Tetracyclines, Cimetidine
decrease absorption of oral iron
preparations.
•Vit C (ascorbic acid) and
chloramphenicol increases
absorption of oral iron prepartions.

10. Nursing Responsibilities
• Nurse should administer drugs according to prescribed routes.
• Should check for constipation.
• Monitor patient CBC count, HB and plasma iron levels.
• Nurse should teach the patient to:
Continue regular dosing schedule after missing dose.
Drink at least 2 liters of liquid daily.
Avoids antacids, caffeine products, dairy products, egg, whole grain
breads for 1hour after taking oral iron preparations.
Be aware that oral iron preparations may turn stool dark green or
black.

11. Cardio-tonics
(Cardiac – Glycosides)

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

13. 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.

14. Drug examples & Doses:
S No. Drugs Doses
1 Digoxin 0.125- 0.75 mg PO per
day
2 Digitoxin 125-500 mcg once
daily.

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

16. Contraindication/precautions
•Contraindicated in uncontrolled ventricular arrythmias,
constrictive pericarditis, complete heart block.
•Risk of Digoxin toxicity is increases with
hypercalcemia.
•Hypokalemia, Hypomagnesemia, renal failure.
•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.

17. Adverse Effects
•Bradycardia.
•Weakness.
•Fatigue.
•Nausea, vomiting.
•May cause digoxin toxicity such as anorexia, nausea,
vomiting, visual disturbance, confusion, bradycardia,
heart block, premature ventricular contractions.

18. 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.

19. Nursing Responsibilities
• Before giving digoxin, assess apical pulse, sr. 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.

20. Teach patient to:
•Take prescribed drug properly.
•Consult physician before discontinuing drug.
•Count his pulse before taking each dose.
•Assess signs and symptoms of digoxin toxicity and
heart failure.

21. Anti anginals (Drug used inAngina)
•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)

22. Nitrates
•Nitrates are the drugs which
are vasodilator effects thus
used in angina pectoris.

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

24. Drug example and doses
S.
No.
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.

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

26. Adverse effects
•Headache is most common.
•Orthostatic hypertension.
•Flushing.
•Nausea, vomiting.
•Dizziness.
•Tachycardia.
•Palpitations.

27. Contraindication / Precautions
•Hypersensitivity to nitrates.
•Severe anemia.
•Orthostatic hypertension.
•Early MI.
•Increased ICP.
•Use cautiously in patients with hypotension.

28. Drug interactions
•Antihypertensives, and sildenafil,
tadalafil may increase hypotension
effects.

29. 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 beverages.
• Advise the patient that sublingual tablets may be taken at the onset of
activities known to cause angina such as sexual activity.

30. Antihypertensives
•Hypertension is a disease
characterized by abnormally
high blood pressure.

31. 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. Eg. Furosemide, Amiloride, Spironolactone.
•Vasodilators. Eg. Hydralazine, minoxidil, diazoxide.
•Angiotensin antagonist. Eg. Losartan.

32. 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.

33. Drug example and doses
S.
No.
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.

34. Indications / Uses
•To treat mild hypertension.
•Angina pectoris.

35. 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.

36. Adverse effects
•Orthostatic hypertension.
•Fatigue.
•Bradycardia.
•Nausea, vomiting.

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

38. Nursing Responsibilities
•Do not discontinue drug
abruptly.
•Administer propranolol constituently
with food, food
may increase absorption.

39. Mechanism of action (Calcium channel blockers).
•They are chemically different but
pharmacologically similar drugs. 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.

40. Graphically:
• They block the entry of Ca⁺⁺ ions into the smooth and
▪ cardiac muscle cells.
• Decrease intracellular Ca⁺⁺ ions.
• Smooth muscle relaxation.
• Vasodilation.

41. Drug example and doses
S.
No.
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.

42. Indications / Uses
•To treat the mild hypertension.
•Angina pectoris.

43. 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.

44. Adverse effects
•Dizziness.
•Headache.
•Flushing.
•AVblocks.
•Edema.
•Nausea.

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

46. Nursing Responsibilities
•Nurse should know that
nifedipine may be given
sublingually.
•Warn patient not to stop drug
abruptly.

47. 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.

48. Drug example and doses
S.
No.
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.

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

50. Adverse effects
•Dizziness.
•Fainting.
•Palpitations.
•Proteinuria.
•Light headedness.
•Tachycardia.
•Rash.

51. 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.

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

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

54. Vasodilators (Peripheral vasodilator)
•These are the drugs which are
also vasodilator effects thus
reduce blood pressure.

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

56. Drug example and doses
S.
No.
Drugs Doses
1 Hydralazine 10-20mg slowly I.V. injection.
25-200mg daily orally divided
doses.
2 Minoxidil 5-50 mg daily orally.

57. Indications / Uses
•Used in moderate to severe hypertension.
•To treat severe and essential
hypertension.

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

59. Adverse effects
•Fluid retention.
•Orthostatic hypertension.
•Tachycardia.
•Severe hypertension. (with IV doses)
•Minoxidil also can causes excessive hair growth.

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

61. 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.

62. 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.

63. 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 AVnode.
•Beta blockers also blockage beta adrenoreceptor at
heart and reduced excitability of the heart.

64. Drug example and doses
S.
No
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

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

66. Contraindication / Precautions
•Persistent severe bradycardia.
•Cardiac failure.
•Hypersensitivity to these drugs.
Cardiogenic shock.
•Complete atrioventricular block.
•2nd & 3rd degree heart block.

67. Adverse effects
•Hypotension.
•Heart failure.
•Dizziness.
•Fatigue.
•Nausea / Vomiting.

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

69. 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 hypotension.
• Teach patient to change position slowly if taking Bretylium.
• Administer IV bolus for ventricular arrhythmias followed
by continuous IV infusion as ordered.

70. Plasma Expanders &
Coagulants

72. Blood:
Blood is a fluid connective tissue that circulate
continuously around the body, allowing constant
communication between tissues distant from each
other.
Plasma:
A clear, straw coloured, watery fluid in which several
different types of blood cells are suspended.

73. Blood and plasma volume expanders
 Plasma expanders are agents that have relatively high molecular
weight and boost the plasma volume by increasing the osmotic
pressure.
 They are used to treat patients who have suffered
hemorrhage or shock.

74. Volume Expanders contd..
 Volume expanders are the intravenous fluid solutions
that are used to increase or retain the volume of fluid
in the circulating blood.
 Generally volume expanders are used to replace fluids
that are lost due to illness, trauma or surgery.
 These are used to correct hypovolemia due to loss of
plasma or blood.

75. Types of volume expanders
There are two main types of volume expanders:
1.Crystalloids: crystalloids are aqueous solutions of
mineral salts or other water-soluble molecules. E.g.
normal saline, dextrose, Ringer’s solution etc.
2.Colloids: Colloids are larger insoluble molecules, such as
dextran, human albumin, gelatin, blood. Blood itself is a
colloid.

76. Colloids are better than Crystalloids because:
 The larger molecules of colloids are retained more easily
in the intravascular space & increase osmotic pressure.
 So, more effective resuscitation of plasma volume occurs
by colloids than produced by that of crystalloids.
 Duration of action is relatively longer than crystalloids.

77. COLLOID
↑Plasma volume
Less Peripheral Edema
Smaller volumes for
resuscitation
IV half life 3-6 hours
CRYSTALLOID
Inexpensive
Use for maintenance fluid
and initial resuscitations
Restore 3rd space loss
IV half life 20 minutes

78. Ideal properties of PVEs.
 Iso-oncotic with plasma
 Distributed to intravascular compartment only
 Pharmacodynamically inert
 Non-pyrogenic, non-allergenic & non-antigenic
 No interference with blood grouping or cross-matching
 Stable, easily sterilizable and cheap.

79. Generally used Plasma expanders
 Human albumin
 Dextran
 Degraded gelatin polymer
(Polygeline)
 Hydroxyethyl starch
(Hetastarch/HES)
 Polyvinyl pyrrolidone (PVP)

82. Mechanism of action:
 Generally works on the principle of osmosis.
 Increases Plasma osmotic pressure, drawing water into
plasma from interstitial fluid.
 Since the lost blood is replaced with a suitable fluid, the
now diluted blood flows more easily, even in small vessels.
As a result of chemical changes, more oxygen is released
to the tissues.

83. Uses Of Plasma Expanders
 Used in conditions where blood or plasma has been lost or
has moved to extravascular compartments e.g., in burns,
hypovolaemic shock, endotoxin shock, severe trauma and
extensive tissue damage.
 Can also be used as a temporary measure in cases of
whole blood loss till the same can be arranged.
 Note: They do not have oxygen carrying capacity.

84. Some Volume Expanders
1.Human Albumin
 It is obtained from pooled human plasma.
 It can be used without regard to patient’s blood group and
doesn’t interfere with coagulation.
 It is free of risk of transmission of hepatitis because the
preparation is heat treated.
St. ofAlbumin

85. Contd…
 Crystalloid solution must be infused concurrently for
optimum benefit.
 It has been used in acute hypoproteinaemia, acute liver
failure and dialysis.
 It is comparatively expensive.
 Available products:
 Albudac, Albupan 50, 100 ml inj.,
 Albumed 5%, 20% infusion (100 ml)

86. 2.Dextran
 It is highly branched polysaccharide molecule obtained
from sugar beat .
 It is produced by using the bacterial enzyme dextran
sucrase from the bacterium Leuconostoc mesenteroides
which grows in a sucrose medium.
 Most commonly used plasma expanders and is available in
two forms.
1.Dextran 70
2.Dextran 40

87. a) Dextran 70
1. It is most commonly used preparation.
2. It expands plasma volume for nearly 24 hrs.
3. Excreted slowly by glomerular filtration as well as
oxidized in body over weeks .
4. and some amount is deposited in retuculo-
endothelial cells.

88. Dextran 70 has nearly all the properties of an ideal
plasma except:
 It may interfere with blood grouping and cross matching.
 It can interfere with coagulation and platelet function
and thus prolong bleeding time .
 Some polysaccharide reacting antibodies, if present, may
cross react with dextran and trigger anaphylactic reaction
like Urticaria, itching, bronchospasm, fall in BP
.

89. b) Dextran 40
 It is 10% solution in Dextrose or Saline.
 It acts more rapidly than dextrose-70.
 It reduces blood viscosity .
 It is excreted through renal tubules and occasionally may
produce acute renal failure.
 The total dose should not exceed 20 ml/kg in 24 hr.
 Dextrans can be stored for 10 years and are cheap so are
the most commonly used plasma expanders.
 Caution: Dextran doesn’t provide necessary electrolytes
and can cause hyponatremia or other electrolyte
disturbances.

90. 3. Degraded gelatin polymer (polygeline)
 It is synthetic polymer (polypeptide) of MW-30,000.
 It doesn’t interfere with blood grouping and cross
matching and is non-antigenic.
 Expands plasma volume for 12 hrs.
 It is more expensive than dextran and can also be used for
priming of heart-lung and dialysis machines.
 Brands:
Haemaccel; Seraccel 500 ml vaccine.

91. 4. Hydroxyethyl starch(Hetastarch)
▪  It is a complex mixture of ethoxylated
amylopectin of various molecular sizes; average
MW 4.5 lacs.
▪  It maintains blood volume longer.
▪  It doesn’t cause acute renal failure or
coagulation disturbances.
▪  It improves hemodynamic status for 24 hrs.

92. Hetastarch contd..
 Adverse effects:
Vomiting, mild fever, itching, chills, flu like symptoms,
swelling of salivary glands, Urticaria, bronchospasm etc.
 Brand:
Expan 6% inj (100 , 500 ml vac)
It has also been used to improve harvesting of granulocytes
because it accelerates erythrocyte sedimentation.
Adverse effects: Anaphylactic reactions, mild fever, chilling,
periorbital edema, Urticaria, itching .

93. 5. Polyvinylpyrrolidine(PVP)
 It is a synthetic polymer of average MW 40,000 used as a
3.5% solution.
 PVP was used as blood plasma expander for trauma
victims after the 1950s.
 It interferes with blood grouping and cross matching and is
histmine releaser.
 It binds to penicillin and Insulin.

94. Contd….
 It is excreted by kidney and small amounts by liver into
bile.
 A fraction is stored in RE cells for prolonged periods.
 It is less commonly used plasma expander.
Sample of PVP

95. Other uses of PVP:
 PVP is also used in personal care products such as
shampoos and toothpaste, hair sprays and gels.
 It is used as binder in many pharmaceutical tablets.
 PVP added to Iodine forms a complex called Povidone-
Iodine that posses disinfectant properties. And known
under the trade name of Betadine and Pyodine.

96. Some Crystalloids:
1. Normal Saline (Isotonic):
It is the crystalloid fluid containing 0.9% Nacl.
The pH of isotonic saline is considerably lower than the plasma pH.
Ns is frequently used in patients who cannot take fluids orally and have
developed dehydration or hypovolemia.
2. Lactated Ringer’s solution
It was introduced in 1880 by Sydney ringer, a British physician.
The solution was designed to promote the contraction of frog hearts and
was contained with calcium and potassium in a NaCl diluents .
It is contraindicated as diluents for blood transfusions.

97. 3. Dextrose solutions:
Generally 5% dextrose solutions are used which provides 170
kcal/lit.
It is IV sugar solution which provides some energy to the body
parts.
Osmolarity is lower than serum.
Useful when Kidney function is Impaired.

98. Contraindications to plasma
expanders
 Allergy
 Heart failure
 Severe anaemia
 Thrombocytopenia
 Pulmonary edema
 Renal insufficiency.

99. Some commercially used Plasma volume
expanders.

100. THANK YOU FOR LISTENING

101. Anticoagulants
•These are the agents which inhibit
the process of clotting, thus they are
used to prevent unwanted
thrombosis.

102. Mechanism of action
•They prevent extension and
formation of clots by inhibiting
factors in the clotting cascade.

103. Drug example and doses
S.
No.
Drugs Doses
1 Heparin 5,000-10,000 unit by I.V.
2 Warfarin 20-30mg PO
3 Phenindione 200-300mg PO

104. Indications / Uses
•Thrombosis in deep veins.
•Unstable angina in PTCA.
•Open heart surgery.
•To treat and prevent thromboembolic
disorders and ischemic complications.

105. Contraindication / Precautions
•Bleeding including thrombocytopenia.
•Peptic ulcer disease.
•Recent surgery.
•Coagulation disorders.

106. Adverse effects
•Hyperlipidemia.
•Hemorrhages.
•Nausea.
•Insomnia.
•Thrombocytopenia.
•Pain at injection site.
•Constipation.

107. 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 bleeding.

108. Nursing Responsibilities
• Don’t give heparin by IM route.
• Asses the early signs of unusual bleeding.
• Nurse should minimize venipunctures and injections, apply
pressure to all puncture sites.
• Monitor hemoglobin and clotting factor and platelet level.
• 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.

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

110. Mechanism of action
•They interfere with platelets
function and inhibits platelets
clumping.

111. Drug example and doses
S.
No.
Drugs Doses
1 Aspirin
2 Clopidogrel
3 Dipyridamole
4 Ticlopidine.

112. Indications / Uses
•Used as prophylaxis for thromboembolic
events.
•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
events.
•Myocardial infarction.

113. Contraindication / Precautions
•Active bleeding.
•Coagulation disorder.
•Ulcer disorder.
•Recent surgery.
•Cancer.
•Thrombocytopenia.

114. Adverse effects
•Bleeding/Hemorrhage.
•Neutropenia.
•Abnormal stool.
•Rash.
•Pain in injection site.
•Pancytopenia.
•Dizziness.
•Headache.
•Nausea.

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

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

117. Thrombolytics (Fibrinolytics)
•These drugs are used to
lyse (Dissolve) thrombus
or clot.

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

119. Drug example and doses
S.
No.
Drugs Doses
1 Streptokinase 5,00,000 units IV.
2 Urokinase 5,000 units
3 Alteplase 100mg IV in divided doses.

120. Indications / Uses
•Myocardial infarction.
•Deep vein thrombosis.
•Pulmonary embolism.
•Stroke.

121. Contraindication / Precautions
•Recent streptococcal infection.
•Recent stroke.
•Ulcer disease.
•Cancer.
•Active internal bleeding.
•Coagulation disorders.
•Recent surgery.

122. Adverse effects
•Bleeding.
•Hypersensitivity reactions.
•Hemorrhage.
•Urticaria.
•Arrhythmias.

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

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

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

126. 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-
COAreductase in the liver
preventing cholesterol synthesis.

127. Drug example and doses
S.
No.
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.

128. Indications / Uses
•CAD
•Hyperlipidemia.
•Hypertriglyceridemia.
•Secondary prevention of cardiovascular
events.
•Atherosclerosis.
•Hypercholesterolemia.
•Increase in Sr. level of HDLs.

129. Contraindication / Precautions
•Hypersensitivity to these drugs.
•Elevated liver function test results.
•Hepatic and severe renal dysfunctions.
•Cautiously in pregnancy and breast
feeding women.

130. Adverse effects
•Headache.
•Photosensitivity.
•Progression of cataracts.
•Insomnia.
•Blurred vision.
•Nausea / vomiting.
•Diarrhea.
•Constipation.
•Dyspepsia.
•Rhabdomyolysis.
•Abdominal cramps.
•Flatulence.
•Hypersensitivity
reaction.
•Myopathies.

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

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

133. References
1. Dr. P
.K. Panwar, Essentials of pharmacology for nurses,AITBS pub. 2017,
India, Pg no. 118 – 134.
2. Dr. Suresh k sharma, Textbook of pharmacology, pathology & genetics for
nurses, Jaypee pub. 2016 India Pg no 362 – 452.
3. Tara v. Shanbhag, Smita shenoy, Pharmacology preparation manual for
undergraduate, Elsevier pub. 2014. Pg no. 101 – 147.
4. Marilyn Herbert – Ashton, Nancy Clarkson, Pharmacology, Jones & Barllet
pub 2010 India, Pg no 303 – 391.
5. Govind s. mittal, Pharmacology at a glance, Paras medical book pub. 2009
India 31 – 34.
6. Madhuri Inamdar, Pharmacology in nursing, Vora medical pub. 2006 India
1st edition, Pg no 61 – 91.