1
, Slow progression of left ventricular hypertrophy after MI (cardio
protective)
Renal protective effects in patients with diabetes
Captopril and lisinopril can be used if a patient has liver dysfunction,
unlike other ACE inhibitors that are pro-drugs
*Pro-drugs are inactive in their administered form and must be
metabolized in the liver to an active form so as to be effective
o Adverse Effects: hyperkalemia & dry, nonproductive cough
o Serious drug interaction: NSAIDs
Angiotensin II receptor blocker “sartan” losartan (Dovan)
o Mechanism of Action:
Allow angiotensin I to be converted to angiotensin II, but block the
receptors that receive angiotensin II
Block vasoconstriction and release of aldosterone
Well tolerated, do not cause a dry cough
Indications: first-line treatment for heart failure & HTN
o Adverse Effects: URI, headache
May cause occasional dizziness, inability to sleep, diarrhea
Calcium channel blockers: Amlodipine “dipine” verapamil (calan), diltiazem
(cardizem)
o Mechanism of Action: cause smooth muscle relaxation by blocking the binding
of calcium to its receptors, preventing muscle contraction
o Adverse effect: constipation
High-fiber diet with plenty of fluids will help prevent constipation
o Indications: hypertension
Angina- ch. 23
Ischemia:
o Ischemic heart disease: Poor blood supply to the heart
muscle (Atherosclerosis, Coronary artery disease)
o Myocardial infarction (MI): Necrosis, or death, of cardiac
tissue, disabling or fatal
Therapeutic Objectives
o Minimize the frequency of attacks and decrease the
duration and intensity of anginal pain
o Improve the patient’s functional capacity
o Prevent or delay the worst possible outcome: MI
Cardiac glycosides: Digoxin
o Therapeutic level: between 0.5-2ng/mL
2
, o Digoxin doses are held and the prescriber notified if the apical pulse is 60
beats/minute
o Negative chronotropic effect decreases HR
o Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose
Required use of digitab when potassium level is above 5 mEq/L, severe
sinus bradycardia that does not respond to cardiac pacing, or an
overdose of more than 10 mg of digoxin.
o Avoid bran muffins when taking digoxin
o Hypokalemia increases the chance of digitalis toxicity
Class III drugs: Amiodarone (ch. 25)
o Mechanism of action: prolonging action potential duration
o Indications: ventricular dysrhythmias
o Contraindication: hypersensitivity and bradycardia or AV block
Adverse effects: FDA black box warning: pulmonary toxicity, hepatotoxicity arrhythmia
worsening-sinus bradycardia, constipation, QT prolongation, hypotension, blue-gray coloring
of the skin on the face, arms, and neck
Unclassified antidysrhythmics: Adenosine (Ch. 25)
Slows conduction through the AV node
Used to convert paroxysmal supraventricular tachycardia to sinus
rhythm
Very short half-life (less than 10 seconds)
Flush with 20cc of normal saline
Only administered as fast IV push
May cause asystole for a few seconds
Adverse Effects
ALL antidysrhythmics can cause dysrhythmias!
Hypersensitivity reactions, nausea, vomiting, diarrhea, dizziness,
blurred vision, headache
Assessment
Obtain a thorough drug and medical history
Baseline BP, P, I&O, and cardiac rhythm
Measure serum potassium levels before initiating therapy
Conditions that may be contraindications for use of specific drugs
Potential drug interactions
During therapy,
Monitor cardiac rhythm, heart rate, BP, general well-being, skin
color, temperature, heart and lung sounds
Assess plasma drug levels as indicated
Monitor for toxic effects
3
, Slow progression of left ventricular hypertrophy after MI (cardio
protective)
Renal protective effects in patients with diabetes
Captopril and lisinopril can be used if a patient has liver dysfunction,
unlike other ACE inhibitors that are pro-drugs
*Pro-drugs are inactive in their administered form and must be
metabolized in the liver to an active form so as to be effective
o Adverse Effects: hyperkalemia & dry, nonproductive cough
o Serious drug interaction: NSAIDs
Angiotensin II receptor blocker “sartan” losartan (Dovan)
o Mechanism of Action:
Allow angiotensin I to be converted to angiotensin II, but block the
receptors that receive angiotensin II
Block vasoconstriction and release of aldosterone
Well tolerated, do not cause a dry cough
Indications: first-line treatment for heart failure & HTN
o Adverse Effects: URI, headache
May cause occasional dizziness, inability to sleep, diarrhea
Calcium channel blockers: Amlodipine “dipine” verapamil (calan), diltiazem
(cardizem)
o Mechanism of Action: cause smooth muscle relaxation by blocking the binding
of calcium to its receptors, preventing muscle contraction
o Adverse effect: constipation
High-fiber diet with plenty of fluids will help prevent constipation
o Indications: hypertension
Angina- ch. 23
Ischemia:
o Ischemic heart disease: Poor blood supply to the heart
muscle (Atherosclerosis, Coronary artery disease)
o Myocardial infarction (MI): Necrosis, or death, of cardiac
tissue, disabling or fatal
Therapeutic Objectives
o Minimize the frequency of attacks and decrease the
duration and intensity of anginal pain
o Improve the patient’s functional capacity
o Prevent or delay the worst possible outcome: MI
Cardiac glycosides: Digoxin
o Therapeutic level: between 0.5-2ng/mL
2
, o Digoxin doses are held and the prescriber notified if the apical pulse is 60
beats/minute
o Negative chronotropic effect decreases HR
o Digoxin immune Fab (Digifab) is the antidote for a severe digoxin overdose
Required use of digitab when potassium level is above 5 mEq/L, severe
sinus bradycardia that does not respond to cardiac pacing, or an
overdose of more than 10 mg of digoxin.
o Avoid bran muffins when taking digoxin
o Hypokalemia increases the chance of digitalis toxicity
Class III drugs: Amiodarone (ch. 25)
o Mechanism of action: prolonging action potential duration
o Indications: ventricular dysrhythmias
o Contraindication: hypersensitivity and bradycardia or AV block
Adverse effects: FDA black box warning: pulmonary toxicity, hepatotoxicity arrhythmia
worsening-sinus bradycardia, constipation, QT prolongation, hypotension, blue-gray coloring
of the skin on the face, arms, and neck
Unclassified antidysrhythmics: Adenosine (Ch. 25)
Slows conduction through the AV node
Used to convert paroxysmal supraventricular tachycardia to sinus
rhythm
Very short half-life (less than 10 seconds)
Flush with 20cc of normal saline
Only administered as fast IV push
May cause asystole for a few seconds
Adverse Effects
ALL antidysrhythmics can cause dysrhythmias!
Hypersensitivity reactions, nausea, vomiting, diarrhea, dizziness,
blurred vision, headache
Assessment
Obtain a thorough drug and medical history
Baseline BP, P, I&O, and cardiac rhythm
Measure serum potassium levels before initiating therapy
Conditions that may be contraindications for use of specific drugs
Potential drug interactions
During therapy,
Monitor cardiac rhythm, heart rate, BP, general well-being, skin
color, temperature, heart and lung sounds
Assess plasma drug levels as indicated
Monitor for toxic effects
3
