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Understanding Pharmacology in Nursing Practice pp 167–217Cite as

Medications Used for the Cardiovascular System

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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

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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.

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Author information

Authors and Affiliations

  1. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK

    Joan Adams & Ehsan Khan

Authors
  1. Joan Adams
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  2. Ehsan Khan
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Editor information

Editors and Affiliations

  1. (Retired) Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK

    Pauline Hood

  2. Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK

    Dr. Ehsan Khan

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

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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

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

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