Cardiovascular

1. Step 1 – Overview of Cardiovascular Medications
2. Step 2 – Key Drug Classes
3. Step 3 – Nursing Considerations
4. Step 4 – Practice Questions & Scenarios

Let’s begin.

🩺 Step 1 – Overview of Cardiovascular Medications

Purpose:

Cardiovascular medications are used to:

• Control blood pressure
• Improve heart function
• Prevent blood clots
• Treat heart failure, arrhythmias, and angina

They work by targeting one or more of the following:

• Heart rate (HR)
• Contractility (force of heart’s pumping)
• Vascular tone (blood vessel constriction/dilation)
• Blood volume (via diuretics or fluid balance)

Major categories include:

1. Antihypertensives (lower BP)
2. Antianginals (relieve chest pain)
3. Antidysrhythmics (regulate rhythm)
4. Heart failure drugs (strengthen pumping)
5. Anticoagulants & antiplatelets (prevent clots)
6. Lipid-lowering agents (reduce cholesterol)

Arrythmias notes: Yes, arrhythmia and dysrhythmia are synonyms used to describe an abnormal heart rhythm. They refer to a condition where the heart beats irregularly, too fast, too slow, or with skipped beats.

💊 1. Beta Blockers ("-olol")

🧠 Mechanism of Action

They block beta-adrenergic receptors in the heart and blood vessels → this stops the effects of epinephrine and norepinephrine.

💥 Results:

• ↓ Heart rate (negative chronotrope)
• ↓ Contractility (negative inotrope)
• ↓ Cardiac output
• ↓ Blood pressure
• ↓ Oxygen demand of the heart

So: the heart works slower and softer — like putting it in “energy-saving mode.” ⚡❤️

🩺 Used for:

• Hypertension (↓ BP)
• Angina (↓ oxygen demand)
• Heart failure (↓ workload)
• Post-MI (protects heart muscle)
• Dysrhythmias (slows HR in atrial fibrillation)

⚠️ Nursing Considerations

• Check HR & BP before giving

➤ Hold if HR < 60 bpm or SBP < 100 mmHg

• Don’t stop suddenly → rebound tachycardia or MI risk
• Monitor for bronchospasm (especially non-selective beta blockers like propranolol — avoid in asthma/COPD)
• Can mask symptoms of hypoglycemia in diabetics (no tachycardia warning sign)

🧩 Selective vs Non-selective

🧠 Mnemonic:

“BETA = Block Everything That’s Accelerated”

(HR ↓, BP ↓, anxiety ↓, O₂ demand ↓)

💡 Checkpoint Question:

A patient with asthma is prescribed Propranolol.

Which of the following is the greatest concern?

A. Bradycardia

B. Hypotension

C. Bronchoconstriction

D. Fatigue

👉 What’s your answer?

Notes: Na and Water retention with elimination of K

💊 3. ARBs — Angiotensin II Receptor Blockers ("-sartan")

These are the cousins of ACE inhibitors, working a little later in the same pathway — but without the cough! 😌

🧠 Mechanism of Action

Instead of blocking the enzyme like ACE inhibitors,

ARBs block the receptor sites where Angiotensin II normally binds on blood vessels and adrenal glands.

So the heart pumps easier, and BP decreases — just like ACE inhibitors, but with no bradykinin buildup, so no cough.

🧩 Differences from ACE Inhibitors

🧠 Mnemonic:

“SARTANs let your arteries start to relax.” 🩸

💡 Checkpoint Question:

A patient was switched from Lisinopril to Losartan because of a persistent cough.

Which electrolyte should the nurse monitor closely while on Losartan?

A. Sodium

B. Calcium

C. Potassium - Correct

D. Magnesium

👉 What’s your answer?

💊 4. Calcium Channel Blockers ("-dipine", plus Diltiazem & Verapamil)

🧠 Mechanism of Action

These drugs block calcium entry into cardiac and smooth muscle cells.

Remember: calcium is what makes muscle fibers contract.

So if we block calcium → muscles can’t contract as strongly.

💥 Results:

• Vasodilation of arteries → ↓ BP
• ↓ Heart contractility (negative inotrope) → ↓ workload
• ↓ Heart rate (especially with diltiazem/verapamil)
• ↑ Coronary blood flow → better oxygen to heart

Basically, the heart relaxes and works easier 🩸💗

🩺 Used for:

• Hypertension (↓ BP)
• Angina (↑ oxygen to heart muscle)
• Certain dysrhythmias (especially atrial fibrillation or SVT)

🧩 Major Types

⚠️ Key Side Effects & Nursing Considerations

🧠 Mnemonic:

“Calms the heart” ❤️

(↓ HR, ↓ BP, ↓ contractility)

🩺 Nursing Focus:

💡 Checkpoint Question:

Which patient should NOT receive Verapamil?

A. A patient with hypertension and chest pain

B. A patient with atrial fibrillation and HR 120 bpm

C. A patient with heart failure and bradycardia -Correct

D. A patient with angina after exercise

👉 What’s your answer?

💧 5. Diuretics — “The Fluid Controllers”

🧠 Mechanism of Action

Diuretics increase urine output by blocking sodium (Na⁺) and water reabsorption in the kidneys.

Less sodium reabsorbed → more water excreted → lower blood volume → lower blood pressure.

💥 Overall effects:

• ↓ Blood volume
• ↓ Preload (less fluid returning to heart)
• ↓ Blood pressure
• ↓ Edema

💊 Main Types of Diuretics

💥 Let’s Go by Class:

💊 A. Loop Diuretics – “The Big Guns”

• Example: Furosemide (Lasix)
• Mechanism: Blocks Na⁺, Cl⁻, and water reabsorption in the loop of Henle
• Results: Massive diuresis → ↓ preload & ↓ BP

Watch for:

• ⚠️ Hypokalemia (↓ K⁺)
• ⚠️ Hypotension
• ⚠️ Dehydration
• ⚠️ Ototoxicity (ringing in ears if given IV too fast)
• 💡 Give in morning to prevent nocturia

💊 B. Thiazide Diuretics – “The Everyday BP Helper”

• Example: Hydrochlorothiazide (HCTZ)
• Mechanism: Blocks Na⁺ & water reabsorption in distal tubule
• Results: Moderate fluid loss → ↓ BP

Watch for:

• ⚠️ Hypokalemia (↓ K⁺)
• ⚠️ Hyponatremia
• ⚠️ Photosensitivity
• 🩺 Take with food to prevent GI upset

💊 C. Potassium-Sparing Diuretics – “The K⁺ Keeper”

• Example: Spironolactone, Amiloride
• Mechanism: Blocks Aldosterone → keeps K⁺, excretes Na⁺ & water
• Results: Mild diuresis, less K⁺ loss

Watch for:

• ⚠️ Hyperkalemia (↑ K⁺)
• ⚠️ Endocrine effects (Spironolactone can cause gynecomastia or irregular menses)
• 🚫 Avoid salt substitutes

💊 D. Osmotic Diuretics – “The Pressure Relievers”

• Example: Mannitol (IV)
• Mechanism: Creates osmotic pull → draws fluid from brain/eyes into circulation → excreted by kidneys
• Used for: ↓ intracranial or intraocular pressure, not for BP

Watch for:

• ⚠️ Pulmonary edema
• ⚠️ Dehydration
• ⚠️ Electrolyte imbalance
• Manny → Mannitol (Manny is Tall), Small eyes and small head. Reduces intracranial and intraocular pressure, not affect the rest of the body, that’s why he is soo big and fat( Did i said fat, that’s just water)

🧠 Mnemonic:

“Loop → Lose everything, Thiazide → Trim fluid, Spiro → Spare potassium”

💡 Checkpoint Question:

A patient taking Furosemide (Lasix) reports muscle cramps and irregular heartbeat.

Which lab value should the nurse check first?

A. Sodium

B. Potassium

C. Magnesium

D. Calcium

👉 What’s your answer?