As per INC Syllabus lecture is prepared for the 2nd yr B Sc Nursing students.

1. Unit 10 Cardiovascular Drugs
5 Hrs.
Mr. Dipti Y. Sorte, Associate Professor
Himalayan College of Nursing, SRHU.
Dehradun.

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. Indications / Uses
•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.

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 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)

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.
•AV blocks.
•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 AV node.
• 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. Assignment:
Plasma Expanders & Coagulants

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

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

73. 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

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

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

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

77. 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.

78. 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.

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

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

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

82. 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.

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

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

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

86. 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.

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

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

89. 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.

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

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

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

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

94. 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.

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

96. 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.

97. 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.

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

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

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

101. 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.

102. 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.

103. 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.