Class III: Potassium Channel Blockers: Piperazine Acetamide:

Mechanism of Action: Block potassium channels, Action: Inhibits late sodium current, leading to a
prolonging phase 3 repolarization and increasing decrease in heart rate and a reduction in myocardial
action potential duration. Developed because some oxygen demand.
patients are so sensitive to Na channel blockers. Uses: Treatment of chronic angina in adults, as
Examples: Amiodarone, Sotalol, Dofetilide, Ibutilide. primary therapy or in combination with nitrates,
Effect: Prolongs QT interval, increases refractory amlodipine, or beta-blockers.
period. Indications: Ventricular tachycardia, atrial Example: Ranolazine.
fibrillation, atrial flutter.
Nitroglycerin
Class IV: Calcium Channel Blockers:
Mechanism of Action: Block L-type calcium channels, Prototype Summary:
slowing conduction through the AV node. Examples: Indications: Treatment of acute angina,
Verapamil, Diltiazem. Effect: Slows heart rate, prophylaxis of angina, IV treatment of angina
prolongs AV node conduction, reduces contractility. unresponsive to beta-blockers or organic nitrates,
Indications: Supraventricular tachycardias, rate perioperative hypertension, and heart failure
control in atrial fibrillation. associated with acute MI; to produce controlled
hypotension during surgery.
Antianginal Drugs Actions: Relaxes vascular smooth muscle with a
resultant decrease in venous return and decrease in
Coronary Artery Disease (CAD): Characterized by arterial blood pressure, reducing the left ventricular
narrowing or occlusion of a coronary artery. workload and decreasing myocardial oxygen
Mechanism: The narrowing deprives cells of oxygen consumption.
and nutrients, also known as myocardial ischemia. Pharmacokinetics:
Symptoms: Angina (chest pain) Route: IV, sublingual tablet, translingual spray,
Treatment: Antianginal drugs work to improve blood transmucosal tablet, oral (SR tablet), topical ointment,
delivery to the heart muscle in one of two ways: transdermal.
Dilating blood vessels: Increasing the supply of Onset: 1-2 min (IV), 1-3 min (sublingual tablet),
oxygen. 2 min (translingual spray), 1-2 min (transmucosal
Decreasing the work of the heart: Decreasing the tablet), 20-45 min (oral, SR tablet), 30-60 min (topical
demand for oxygen. ointment), 30-60 min (transdermal).
Antianginal Drug Forms: Tablets, capsules, Duration: 3-5 min (IV), 30-60 min (sublingual
sublingual tablets, patches, sprays. tablet, translingual spray), 3-5 min (transmucosal
tablet), 8-12 h (oral, SR tablet), 4-8 h (topical
Drug Classes: ointment), 24 h (transdermal).
Nitrates: Adverse Effects: Hypotension, headache,
Action: Relax vascular smooth muscle, leading dizziness, tachycardia, rash, flushing, nausea,
to vasodilation and a decrease in blood pressure. vomiting, sweating, and chest pain.
Uses: Treatment of acute angina, prophylaxis of
angina, IV treatment of angina unresponsive to beta- Nitroglycerin Administration
blockers or organic nitrates, perioperative
hypertension, and heart failure associated with acute Nursing Interventions:
MI; to produce controlled hypotension during surgery.  Give sublingual preparations under the tongue or
Examples: Amyl nitrate, isosorbide dinitrate, the buccal pouch, and encourage the patient not
isosorbide mononitrate, nitroglycerin. to swallow.
 Offer sips of water before giving sublingual
Beta-Blockers: nitroglycerin because dryness may inhibit drug
Action: Block beta-adrenergic receptors, absorption.
reducing sympathetic stimulation of the heart.  Ask the patient if the tablet "fizzles" or burns,
Uses: Treatment of angina in adults, prevention which indicates potency. Always check on the
of reinfarction within 3-10 d after MI, long-term expiration date and protect the medication from
management of angina in adults. heat and light.
Examples: Atenolol, metoprolol, nadolol,  Instruct the patient that a sublingual dose may be
propranolol. repeated in 5 minutes if relief is not felt, for a total
of 3 doses; if pain persists, the patient should go
Calcium-Channel Blockers: to an emergency room to ensure proper medical
Action: Block L-type calcium channels, slowing support if an MI occurs.
conduction through the AV node.  Wash hands thoroughly before and after applying
Uses: Treatment of angina in adults, prevention a transdermal patch.
of reinfarction within 3-10 d after MI, long-term  Apply the patch to the chest, inner side of the
management of angina in adults. upper arm, or shoulder.
Examples: Amlodipine, diltiazem, nifedipine,  Clean and dry the skin before applying the patch.
verapamil. If necessary, hair may be removed by clipping.
 To avoid skin irritation, change the treatment site Beta-Blockers: Block beta-adrenergic receptors,
daily. Do not apply to irritated or damaged skin. leading to a decrease in heart rate and blood
 If the patch becomes loose, remove it and apply pressure.
a new patch at a different site. Vasodilators: Relax smooth muscle, leading to
 After you remove the used patch, fold the sticky vasodilation and a decrease in blood pressure.
side together and throw away. Diuretics: Increase urine output, leading to a
 The patch should only be worn for up to 12 to 14 decrease in blood volume and blood pressure.
hours a day, or as directed by the doctor so that Sympathetic Adrenergic Agonists or
the client will have a 10 to 12 hour "nitrate-free" Vasopressors: Stimulate the sympathetic nervous
period each day. This is referred to as a system, leading to an increase in heart rate and blood
pharmacological vacation away from the pressure.
medication. This will prevent client tolerance to
nitrates. Magnesium Sulfate

Renin-Angiotensin-Aldosterone System Uses:

Obstetrics (Preeclampsia/Eclampsia): Used to
Mechanism: This system helps to regulate blood prevent seizures in women with preeclampsia and to
pressure. When blood flow to the kidneys decreases, treat seizures in women with eclampsia.
the kidneys release renin. Renin converts Preterm Labor: Used as a tocolytic to slow or stop
angiotensinogen to angiotensin I. Angiotensin I is preterm labor.
converted to angiotensin II by angiotensin-converting Severe Hypomagnesemia: Used to treat low
enzyme (ACE). Angiotensin II is a potent magnesium levels.
vasoconstrictor, which increases blood pressure. Cardiac Arrhythmias: Used to treat certain types of
Angiotensin II also stimulates the release of irregular heartbeats.
aldosterone from the adrenal glands, which promotes Asthma: Used to help relax airway muscles and
sodium and water retention, further increasing blood improve breathing.
pressure. Mechanism of Action:
Drugs Affecting the Renin-Angiotensin-Aldosterone Calcium Blocker: Blocks the entry of calcium into
System: smooth muscle cells, leading to muscle relaxation.
ACE Inhibitors: Block the conversion of CNS Depressant: Has central nervous system
angiotensin I to angiotensin II. depressant effects, which help reduce the risk of
Examples: Benazepril, captopril, enalapril, enalaprilat, seizures.
fosinopril, lisinopril, moexipril, perindopril, quinapril, Dosage and Administration:
ramipril, trandolapril. Route: Typically administered intravenously (IV) or
intramuscularly (IM).
Angiotensin II Receptor Blockers (ARBs): Block Dosage: Depends on the condition being treated.
the effects of angiotensin II at its receptors. A common regimen for eclampsia involves an initial
Examples: Azilsartan, candesartan, eprosartan, IV bolus followed by a continuous infusion.
irbesartan, losartan, olmesartan, telmisartan, Side Effects: Flushing, nausea, hypotension,
valsartan. drowsiness, respiratory depression (at high doses),
decreased deep tendon reflexes, magnesium toxicity.
Renin Inhibitors: Block the release of renin from Nursing Considerations:
the kidneys. Example: Aliskiren.  Monitor serum magnesium levels regularly to
avoid toxicity.
Antihypertensive Drugs  Check deep tendon reflexes and respiratory rate,
BP & HR frequently.
Mechanism of Action: Antihypertensive drugs work  Monitor intake and output accurately.
by reducing blood pressure.  Assess for signs of seizure activity, altered
Drug Classes: consciousness.
ACE Inhibitors: Block the conversion of  Ensure the patient is on a continuous fetal
angiotensin I to angiotensin II. monitor and maintain a safe environment to
Angiotensin II Receptor Blockers (ARBs): Block prevent falls, especially if the patient experiences
the effects of angiotensin II at its receptors. drowsiness or muscle weakness.
Renin Inhibitors: Block the release of renin from  Inform the patient about the purpose of the
the kidneys. medication, potential side effects, and the
Calcium-Channel Blockers: Block calcium importance of reporting any unusual symptoms.
channels, leading to vasodilation and a decrease in  Ensure calcium gluconate is readily available as
blood pressure. an antidote in case of magnesium toxicity.
Alpha-Blockers: Block alpha-adrenergic receptors,
leading to vasodilation and a decrease in blood
pressure.