ANTIDYSRHYTHMIC AGENTS
Drug Class
I: Na Channel Blocker
A – Depress myocardial excitability
procainamide (Procanbid)
B – Depress myocardial ventricular excitability
lidocaine (Xylocaine)
II: β Blocker
esmolol (Brevibloc)
propranolol (Inderal)
III: K Channel Blocker
amiodarone (Cordarone)
IV: Ca2+ Channel Blocker
verapamil (Calan)
diltiazem (Cardizem)
Cardiac glycoside
digoxin (Lanoxin)
Unclassified
adenosine (Adenocard)
Drugs
α-1 blocker
prazosin (Minipress)
Doxazosin (Cardura)
nonselective α blocker
Phentolamine (Regitine)
α-2 agonist
methyldopa (Aldomet)
clonidine (Catapress)
β-1 blocker
atenolol (Tenormin)
Nonselective β Blocker
propranolol (Inderal)
of hyperthyroidism
MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
– SLE-like syndrome (fever, chills, – For emergency situations only!
– Indication: A-fib, PACs, PVCs, V-tach joint pain, swelling, skin rash)
– ↑ incidence of CNS effects, GI,
– Indication: ventricular dysrhythmias (PVCs, V-tachs, fever
V-fib)
– ↓ AV node activity → ↓ ventricular contraction rate, ↓ HR, – bradycardia, hypotension – X: P < 60
↓ CO, ↓ BP, ↓ O2 consumption – nonselective β blocker: Pt. w/ lung dz → respiratory depression
– Indication: SVT and ventricular dysrhythmias bronchospasm
– ↓ AV node conduction, ↓ adrenergic stimulation – Pulmonary fibrosis – Better than Lidocaine in emergency cases
– Indication: A-fib, V-fib, V-tach – HA, heart block, bradycardia,
hypotension, tremor, ataxia
– ↓ SA & AV nodes conduction → ↓ HR – Hypotension, peripheral edema, –
– Indication: For A-fib/A-flutter, SVT; angina, HTN contribute to CHF
– Inhibits Na+/K+ ATPase Pump – Toxic effects: – Take apical P for 1 full minute → HOLD if P < 60
– Cardiotonic; (-) dromotropic → ↓HR & automaticity – Anorexia, n/v – Long half-life: monitor digoxin serum levels
– (+) inotropic → more Ca2+ available → ↑ stroke volume – CNS effects: weakness, – Monitor serum K+ level for hypokalemia
– Indication: A-fib; CHF (promotes coronary circulation → fatigue, visual disturbances, – Digoxin toxicity antidote: Digoxin immune Fab
improves diuresis) rebound v-fib – May need Mg2+ supplement
– Indication: SVT – –
ANTIHYPERTENSIVE AGENTS - ADRENERGIC BLOCKERS
MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
– relaxes smooth muscle arterioles→ vasodilation & ↓ PVR – Syncope, dizziness, weakness, – 1st dose HS → syncope
– Indication: HTN, BPH postural hypotension, palpitation – Begin w/ low dose & titrate up slowly
– Have patients dangle in bed to check for dizziness
– ↓ plasma Epi in pt. w/ adrenal tumor → 2ndary HTN
– CNS acting: stimulation of presynaptic α-2 receptors → to – Postural hypotension, sedation, – Methyldopa = drug choice during pregnancy for
inhibit vasomotor centers → ↓ NE release into PNS ↓ libido, impotence, dry mouth, HTN
Na+ & H2O retention
– relaxes cardiac smooth muscle → vasodilation – Depression, lethargy, sexual – Monitor P → don't give if P < 60
– Cardioselective & cardioprotective effects dysfunction – Don't stop abruptly d/t rebound HTN
– (-) dromotropic; (-) chronotropic → ↓ HR; (-) inotropic → ↓ – Unsafe if used w/ CCBs
BP
– Indication: HTN w/ asthma & COPD, CHF, angina px,
arrythmias, Post-MI
– Cardiac smooth muscles relaxation & bronchoconstriction – – Contraindicated w/ respiratory dz pts → may cause
– Indication: HTN w/o respiratory dz, migraine px, symptoms respiratory depression
 ANTIHYPERTENSIVE AGENTS
Drugs MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
ACEIs → “pril” drugs – ↓ vasoconstriction, ↓ preload, ↓ BP, ↓ PVR – Dry cough @ night – X: pregnancy, renal stenosis, K+ sparing diuretics
– Indication: HTN (w/ DM, COPD, asthma), CHF, DM, – ↑ serum lithium unless advanced HF present
post MI
– Kidney protective effects
ARBs → “sartan” drugs – HTN, nephropathy, DM, stroke prevention – Rash, edema, diarrhea, muscle – For those intolerant of ACEIs S/Es
losartan (Cozaar) pain, dizziness, HA – X: pregnacy

CCBs – (-) dromotropic, (-) inotropic, relax arterial smooth – Hypotension → palpitations, reflex – Causes heart block if used w/ β-1 blocker
verapamil (Calan) muscle → ↓ PVR tachycardia – Can contribute to CHF
– Indication: HTN w/ DM, COPD, angina px, arrhythmias – GI: constipation, nausea, – Beneficial to African-Americans
nifedipine (Procardia)
(not very effective) – Bradycardia – Interaction w/ grapefruit (↑ GI absorption)
– Other: peripheral edema, rash,
flushing, dermatitis
Renin inhibitor – ↓ plasma renin activity & inhibits angiotensinogen – – Diarrhea, cough, edema –
propanolol (Inderal) angiotensin I conversion
– May be combined w/ other HTN agents

Direct vasodilators – Directly relaxes arteriole smooth muscle – –

– Indication: severe HTN, CHF

ANTIHYPERTENSIVE AGENTS - DIURETICS

Drugs MOA and other information Specific S/Es General SEs
Thiazide – Na+ reabsorption in the distal tubule – Hypokalemia – Electrolyte losses
Hcl thiazide (hydrodiuril) – Indication: uncomplicated HTN (1st line), older – Alkalosis,
people w/ ISH, minor edema hyperglycemia – Fluid losses

Loops – Na+ reabsorption in the LOH – Hypokalemia – n/v/d

furosemide (Lasix)
K+ sparing
spironolactone (Aldactone)
– PE + CHF + Edema + HTN
– dizziness
– Aldosterone antagonist – Hyperkalemia
– Na+ reabsorption in the collecting duct & tubule – myalgia
– Indication: HTN & decompensating CHF
– Can be combined w/ thiazides & loops – hyperglycemia

Carbonic anhydrase inhibitors – Adjunct w/ other diuretics for intense diuresis – Hypokalemia – hyperuricemia
acetazolamind (Diamox) – Na+ reabsorption in the collecting duct & tubule
– Indication: glaucoma & epilepsy

Osmotic – Indication: elevated ICP, renal failure, urea for ICP, –

mannitol (Osmitrol) acute glaucoma