Skip to main content

Medications Used for the Cardiovascular System

  • 1561 Accesses

Abstract

This chapter examines the commonly prescribed medications used for the treatment and management of four cardiovascular disorders. The drugs reviewed include organic nitrates, calcium-channel blockers, angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists and beta-adrenoceptor blocking drugs. Additionally, the four (IV) main classes of drugs used for the treatment and management of arrhythmias and the lipid lowering class of drug, statins, are discussed.

These drugs are reviewed in relation to their pharmacokinetics, mechanism of action, drug–drug interactions, adverse effects and contraindications. The clinical uses of these drugs are considered in the context of the management of angina pectoris, hypertension, heart failure and arrhythmias

Keywords

  • Vasodilators
  • Beta-blockers
  • Angiotensin I-converting enzyme inhibitors
  • Angiotensin II receptor antagonists
  • Nitrates
  • Antiarrhythmic
  • Statins

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-32004-1_7
  • Chapter length: 51 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   44.99
Price excludes VAT (USA)
  • ISBN: 978-3-030-32004-1
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   59.99
Price excludes VAT (USA)
Fig. 7.1
Fig. 7.2
Fig. 7.3
Fig. 7.4
Fig. 7.5
Fig. 7.6
Fig. 7.7
Fig. 7.8
Fig. 7.9
Fig. 7.10
Fig. 7.11
Fig. 7.12
Fig. 7.13

Notes

  1. 1.

    A prodrug is one that is administered in the inactive form and becomes active after metabolism.

  2. 2.

    T 1/2 half-life is the time taken for plasma concentration of the drug to fall to half of its original value.

  3. 3.

    Syncope: a transient loss of consciousness.

  4. 4.

    A hypotensive state leads to an increase in baroreceptor activity. This compensatory response triggers the sympathetic nervous system, which is coordinated in the cardiovascular centre in the medulla oblongata. Vasomotor tone increases, causing vasoconstriction increasing peripheral resistance. Sympathetic activity increases heart rate, contractility and stroke volume resulting in an increase in cardiac output increasing blood pressure. This compensatory system provides some evidence to support why organic nitrates have a lesser effect on resistance arteries. In patients who have autonomic dysfunction, this compensatory activity would be impaired.

References

  • Akel T, Lafferty J (2018) Efficacy and safety of intravenous vernakalant for the rapid conversion of recent-onset atrial fibrillation: a meta-analysis. Ann Noninvasive Electrocardiol 23(3):e12508

    CrossRef  Google Scholar 

  • Alves C, Mendes D, Batel Marques F (2018) Statins and risk of cataracts: a systematic review and meta-analysis of observational studies. Cardiovasc Ther 36(6):e12480

    CrossRef  Google Scholar 

  • ANON (1991) Med Lett Drugs Ther 33(846):55–60

    Google Scholar 

  • Bailey DG, Dresser GK, Kreeft JH, Munoz C, Freeman DJ, Bend JR (2000) Grapefruit-felodipine interaction: effect of unprocessed fruit and probable active ingredients. Clin Pharmacol Ther 68(1):468–477

    CAS  CrossRef  Google Scholar 

  • Baxter K, Stockley IH (2010) Stockley’s drug interactions, 8th edn. Pharmaceutical Press, London, Chicago

    Google Scholar 

  • Bennett PN, Brown MJ (2008) Clinical pharmacology, 10th edn. Churchill Livingstone, London

    Google Scholar 

  • British National Formulary (2019) https://bnf.nice.org.uk/drug/amiodarone-hydrochloride.html#indicationsAndDoses. Accessed 20 May 2019

  • British Thoracic Society & Scottish Intercollegiate Guideline Network (2016) British Guidelines on the management of asthma: a national clinical guideline. http://www.brit-thoracic.org.uk/document-library/clinical-information/asthma.btssign-asthma-guidelines-2016. Accessed 28 Apr 2018

  • Brown NJ, Ray WA, Snowden M, Grithin MR (1996) Black American s have an increased rate of angiotensin converting enzyme inhibitor associated with angioedema. Clin Pharmacol Ther 60(1):8–13

    CAS  CrossRef  Google Scholar 

  • Brunton L, Chabier B, Knollman B (2011) Goodman and Gilman’s The pharmacological basis of therapeutics, 12th edn. McGraw Hill Medical, New York

    Google Scholar 

  • Dicpinigaitis PV (2006) Angiotensin converting enzyme inhibitor induced cough. Chest 129(1 supp):169S–173S

    CAS  CrossRef  Google Scholar 

  • Electronic Medicines Compendium (eMC) (2019) www.medicines.org.uk. Accessed 22 Mar 2019

  • Endo A (2010) A historical perspective on the discovery of statins. Proc Jpn Acad Ser B Phys Biol Sci 86(5):484–493

    CAS  CrossRef  Google Scholar 

  • Harrison DG, Bates JN (1993) The nitrovasodilators: new ideas about old drugs. Circulation 87(5):1461–1467

    CAS  CrossRef  Google Scholar 

  • Joint Formulary Committee (2012) British National Formulary 64, British Medical Journal & Royal Pharmaceutical Society, London

    Google Scholar 

  • Joint Formulary Committee (2017) British National Formulary 74 British Medical Journal & Royal Pharmaceutical Society, London

    Google Scholar 

  • Kelson K, deSouza I (2019) Procainamide versus amiodarone for stable ventricular tachycardia. Academic Emergency Medicine. https://doi.org/10.1111/acem.13767

    CrossRef  Google Scholar 

  • Khan E, Spiers C, Khan M (2012) The heart and potassium: a banana republic. Acute Card Care 15(1):17–24

    CrossRef  Google Scholar 

  • Koruth JS, Lala A, Pinney S, Reddy VY, Dukkipati SR (2017) The clinical use of ivabradine. J Am Coll Cardiol 70(14):1777–1784

    CrossRef  Google Scholar 

  • Kostis JB, Dobrzynski JM (2019) Statins and erectile dysfunction. World J Men’s Health 37(1):1–3

    CrossRef  Google Scholar 

  • Lau W, Newman D, Dorian P (2000) Can antiarrhythmic agents be selected based on mechanism of action? Drugs 60(6):1315–1328

    CAS  CrossRef  Google Scholar 

  • Levick RJ (2000) An introduction to cardiovascular physiology, 3rd edn. Arnold, London

    Google Scholar 

  • Lisalo E (1977) Clinical pharmacokinetics of digoxin. Clin Pharmacokinet 2(1):1–16

    CrossRef  Google Scholar 

  • Marieb E, Hoehn K (2008) Anatomy and physiology, 3rd edn. Pearson Benjamin Cummings, San Francisco

    Google Scholar 

  • Marieb E, Hoehn K (2013) Human anatomy and physiology, 9th edn. Pearson, Boston

    Google Scholar 

  • McDonald MG, Au NT, Rettie AE (2015) P450-based drug-drug interactions of amiodarone and its metabolites: diversity of inhibitory mechanisms. Drug Metab Dispos 43(11):1661–1669

    CAS  CrossRef  Google Scholar 

  • McGavock H (2005) How drugs work pharmacology for healthcare professional, 2nd edn. Radcliffe, Oxford

    Google Scholar 

  • Miller MR, Withers R, Bhamra R, Holt DW (1986) Verapamil and breast feeding. Eur J Clin Pharmacol 30(1):125–126

    CAS  CrossRef  Google Scholar 

  • Moini J (2012) Cardiopulmonary pharmacology for respiratory care. Jones and Bartlett Learning LLC, Sudbury

    Google Scholar 

  • Montague S, Watson R, Herbert R (2005) Physiology for nursing practice, 3rd edn. Elsevier, Edinburgh

    Google Scholar 

  • National Institute for Health and Care Excellence (2013) Hypertension quality standard (QS28). NICE, London

    Google Scholar 

  • National Institute for Health and Care Excellence (2016) Hypertension: the clinical management of primary hypertension in adults, (CG 127). NICE, London

    Google Scholar 

  • Norton L, Ottoboni LK, Varady A, Yang-Lu CY, Becker N, Cotter T, Pummer E, Haynes A, Forsey L, Matsuda K, Wang P (2013) Phlebitis in amiodarone administration: incidence, contributing factors, and clinical implications. Am J Crit Care 22(6):498–505

    CrossRef  Google Scholar 

  • Opie LH, Gersh BJ (2009) Drugs for the heart, 7th edn. Saunders Elsevier, Philadelphia

    Google Scholar 

  • Page C, Curtis M, Walker M, Hoffman B (2006) Integrated pharmacology, 3rd edn. Elsevier, Philadelphia

    Google Scholar 

  • Petite SE, Bishop BM, Mauro VF (2018) Role of the funny current inhibitor ivabradine in cardiac pharmacotherapy: a systematic review. Am J Ther 25(2):e247–e266

    CrossRef  Google Scholar 

  • Rang HP, Dale MM, Rutter JM, Flower RJ, Henderson G (2011) Pharmacology, 7th edn. Elsevier Churchill Livingstone, Edinburgh

    Google Scholar 

  • Schwartz JB, Upton RA, Lin ET, Williams RL, Benet LZ (1988) Effect of cimetidine or ranitidine administration on nifedipine pharmacokinetics and pharmacodynamics. Clin Pharmacol Ther 43(6):673–680

    CAS  CrossRef  Google Scholar 

  • Sirtori CR (2014) The pharmacology of statins. Pharmacol Res 88:3–11

    CAS  CrossRef  Google Scholar 

  • Walker R, Whittlesea C (2011) Clinical pharmacology and therapeutics, 5th edn. Churchill Livingstone, Edinburgh

    Google Scholar 

  • Yu S, Chu Y, Li G, Ren L, Zhang Q, Wu L (2017) Statin use and the risk of cataracts: a systematic review and meta-analysis. J Am Heart Assoc 6(3):e004180

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Appendices

Multiple Choice Questions

  1. 1.

    Which of the following is the most common adverse effect of organic nitrates:

    1. (a)

      Constipation

    2. (b)

      Headache

    3. (c)

      Hypertension

    4. (d)

      Anaphylaxis

  2. 2.

    The duration of action of glyceryl trinitrate spray is:

    1. (a)

      4–8 h

    2. (b)

      8 h

    3. (c)

      30 min

    4. (d)

      60 min

  3. 3.

    Which of the following is a disadvantage of organic nitrates:

    1. (a)

      A cough

    2. (b)

      May cause swelling of the ankles

    3. (c)

      Risk of tolerance

    4. (d)

      Should not be taken with grapefruit juice

  4. 4.

    Which of the following statements are true:

    1. (a)

      Verapamil has a greater effect on vascular smooth muscle and a limited effect on conducting tissues

    2. (b)

      Verapamil has a greater effect on conducting tissue and a limited effect on vascular smooth muscle

    3. (c)

      Verapamil is an agonist and blocks L-type calcium channels

    4. (d)

      Verapamil is an antagonist and opens L-type calcium channels

  5. 5.

    Which of the following is a dihydropyridine:

    1. (a)

      Diltiazem

    2. (b)

      Amlodipine

    3. (c)

      Verapamil

    4. (d)

      Atenolol

  6. 6.

    Nitrates are used for the treatment of angina and act to:

    1. (a)

      Increase preload and decrease afterload

    2. (b)

      Decrease preload and increase afterload

    3. (c)

      Decrease venous return and decrease myocardial workload

    4. (d)

      Increase venous return and increase myocardial workload

  7. 7.

    Which of the following statements are true:

    1. (a)

      ACE inhibitors may cause hypokalaemia and diuresis

    2. (b)

      ACE inhibitors are recommended in the treatment of chronic kidney disease and renovascular disease

    3. (c)

      ACE inhibitors block the conversion of renin to angiotensin II

    4. (d)

      ACE inhibitors block the conversion from angiotensin I to angiotensin II

  8. 8.

    A patient is prescribed an ACE inhibitor, which of the following can increase the risk of hypotension:

    1. (a)

      Dehydration

    2. (b)

      Overhydration

    3. (c)

      Decreased renin level

    4. (d)

      Hyperkalaemia

  9. 9.

    Which of the following best describes the action of candesartan cilexetil:

    1. (a)

      Acts as an antagonist on adrenoceptors

    2. (b)

      Acts as an antagonist on angiotensin II receptor

    3. (c)

      Acts as an agonist on adrenoceptors

    4. (d)

      Acts as an agonist on angiotensin II receptor

  10. 10.

    Which of the following is a cardioselective beta-adrenoceptor blocking drug:

    1. (a)

      Propranolol hydrochloride

    2. (b)

      Labetalol

    3. (c)

      Nebivolol

    4. (d)

      Pindolol

  11. 11.

    Which of the following would you question before administering a beta-adrenoceptor blocking drug:

    1. (a)

      Prescribed for angina

    2. (b)

      Prescribed for hypertension

    3. (c)

      Prescribed in cardiogenic shock

    4. (d)

      Prescribed for primary open angle glaucoma

  12. 12.

    Which of the following is an example of a beta-adrenoceptor blocking drug:

    1. (a)

      Verapamil

    2. (b)

      Labetalol

    3. (c)

      Isosorbide dinitrate

    4. (d)

      Enalapril maleate

  13. 13.

    The direct mechanism of action of class IVb antiarrhythmic medications is:

    1. (a)

      Inhibition of calcium ion channels

    2. (b)

      Inhibition of potassium ion channels

    3. (c)

      Opening of potassium ion channels

    4. (d)

      Opening of sodium ion channels

  14. 14.

    When treating a patient with digoxin, which electrolyte commonly requires close monitoring:

    1. (a)

      Sodium

    2. (b)

      Potassium

    3. (c)

      Calcium

    4. (d)

      Chloride

  15. 15.

    Which of the commonly used antiarrhythmic may cause irreversible lung damage:

    1. (a)

      Amiodarone

    2. (b)

      Bisoprolol

    3. (c)

      Carvidolol

    4. (d)

      Digoxin

  16. 16.

    Which class of antiarrhythmic drugs has a limited effect on potassium ion channels:

    1. (a)

      Class 1a

    2. (b)

      Class 1b

    3. (c)

      Class 1c

    4. (d)

      Class III

  17. 17.

    Too much inhibition of potassium ion channels leads to developing the risk of:

    1. (a)

      Preexcitation

    2. (b)

      AV block

    3. (c)

      Long QT

    4. (d)

      Atrial fibrillation

  18. 18.

    Which statin does not undergo significant metabolic change:

    1. (a)

      Simvastatin

    2. (b)

      Atorvastatin

    3. (c)

      Fluvastatin

    4. (d)

      Rosuvastatin

  19. 19.

    The main adverse effect with the usage of statins is:

    1. (a)

      Rhabdomyolysis

    2. (b)

      Depression

    3. (c)

      Weight loss

    4. (d)

      Myalgia

  20. 20.

    Pleiotropic effects of statins:

    1. (a)

      Are its main clinical effect

    2. (b)

      Are additional clinically relevant effects

    3. (c)

      Are additional clinically relevant adverse effects

    4. (d)

      Describe its main effects on the atherosclerotic plaque

Answers

  1. 1.

    b

  2. 2.

    c

  3. 3.

    c

  4. 4.

    b

  5. 5.

    b

  6. 6.

    c

  7. 7.

    d

  8. 8.

    a

  9. 9.

    b

  10. 10.

    c

  11. 11.

    c

  12. 12.

    b

  13. 13.

    c

  14. 14.

    b

  15. 15.

    a

  16. 16.

    c

  17. 17.

    c

  18. 18.

    d

  19. 19.

    d

  20. 20.

    b

Rights and permissions

Reprints and Permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Adams, J., Khan, E. (2020). Medications Used for the Cardiovascular System. In: Hood, P., Khan, E. (eds) Understanding Pharmacology in Nursing Practice . Springer, Cham. https://doi.org/10.1007/978-3-030-32004-1_7

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-32004-1_7

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-32003-4

  • Online ISBN: 978-3-030-32004-1

  • eBook Packages: MedicineMedicine (R0)