This document discusses cardiovascular drugs, including inotropes, vasodilators, and vasopressors. It lists various drug types for each category and describes their modes of action, uses, side effects, and dosages. The objectives are to describe cardiovascular drugs, list the types, explain their uses and side effects, and discuss dosage. Examples of inotropes discussed are catecholamines, phosphodiesterase inhibitors, and cardiac glycosides. Nitrates, ACE inhibitors, and calcium channel blockers are some vasodilators covered. The vasopressors section outlines alpha-adrenergic drugs and vasopressin analogs.

1. Cardiovascular Drugs
DEPARTMENT
OF
MEDICAL SURGICAL NURSING
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2. LEARNING OBJECTIVES
At the end of the class the group will be able to
• Describe the cardiovascular drugs,
• List down the cardiovascular drugs,
• Enlist the types cardiovascular drugs, ,
• Explain the dosage mode of actions, uses, side
effects.
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3. INOTROPES
TYPES:
• Catecholamines: e.g. epinephrine,
norepinephrine, dobutamine, dopamine
• Phosphodiesterase (PDE) inhibi tors: e.g. mi
lrinone, enoximone Dopexamine
• Calcium sensitisers: e.g. levosimendan
• Cardiac glycosides: e.g. digoxin (weak)
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4. MODES OF ACTION
Increase force of myocardial contraction, either by
stimulating cardiac β1 adrenoreceptors (catecholamines),
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5. USES
• Myocardial failure, e.g. post-myocardial
infarction, cardiomyopathy.
• Myocardial depression, e.g. sepsis
• Augmentation of oxygen delivery in high-risk
surgical patients.
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6. SIDE-EFFECTS
• Arrhythmias
• Tachycardia
• Hypotension
• Hypertension
• Anginal chest pain, or ST-segment and T-wave
changes on ECG.
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7. DRUG DOSAGES
• Epinephrine: Infusion starting from
0.05μg/kg/min
• Norepinephrine: Infusion starting from
0.05μg/kg/min
• Dobutamine: Infusion from 2.5–5μg/kg/min
• Dopamine: Infusion from 2.5–50μg/kg/min
• Dopexamine: Infusion from 0.5–6μg/kg/min
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8. Ct---DRUG DOSAGES
• Digoxin:0.5mg given PO or IV over 10–20min.
Repeat at 4–8h intervals until loading achieved
(assessed by clinical response). Maintenance dose
thereafter is0.0625–0.25mg/day depending on
plasma levels and clinical response.
• Levosimendan: 12–24μg/kg over 10min followed
by 0.1μg/kg/min for 24h 8

9. VASODILATORS
TYPES
• Nitrates: e.g. glyceryl trinitrate, isosorbide dinitrate
• Angiotensin converting enzyme (ACE) inhibi tors:
e.g. captopril
• Smooth muscle relaxants: e.g. sodium nitroprusside,
hydralazine
• α-adrenergic antagonists: e.g. phentolamine
• β2-adrenergic agonists: e.g. salbutamol 9

10. Ct---VASODILATORS
• Calcium antagonists: e.g. nifedipine, diltiazem
• Dopaminergic agonists: e.g. dopexamine
• Phosphodiesterase inhibitors: e.g. enoximone,
milrinone, sildenafil
• Prostaglandins: e.g. epoprostenol (PGI2),
alprostadi l (PGE1)
• B-type natriuretic peptide analogues, e.g. nesiritide
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11. MODES OF ACTION
• Increase cyclic GMP concentration (by nitric
oxide donation or by inhibiting cGMP
breakdown), or acts directly on
• dopaminergic receptors leading to vasodilatation
• Reduce (to varying degrees) ventricular preload
and/or afterload.
• Reduce cardiac work.
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12. USES
• Myocardial failure, e.g. post-myocardial
infarction, cardiomyopathy.
• Angina/ischaemic heart disease.
• Systemic hypertension
• Vasoconstriction
• Peripheral vascular disease/hypoperfusion
• Pulmonary hypertension
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13. SIDE-EFFECTS
• Hypotension
• Tachycardia
• Symptoms include headache, flushing, postural
hypotension
• Renal failure (ACE inhibitors)—especially with
renal artery stenosis, hypovolaemia, non-
steroidals.
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14. DRUG DOSAGES
• Nitrates Glyceryl trinitrate: 2–40mg/h
• Isosorbide dinitrate: 2–40mg/h
• Sodium nitroprusside: 20–400μg/min
• Hydralazine: 5–10mg by slow IV bolus, repeat
after 20–30min. Alternatively, by infusion starting
at 200–300μg/min and reducing to 50–150μg/min
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15. Ct---DRUG DOSAGES
• ACE inhibitors Captopril: 6.25mg test dose
increasing to 25mg tds
• Enalapril: 2.5mg test dose increasing to 40mg od
• Nifedipine: 5–20mg PO. Capsule fluid can be
injected down nasogastric tube or given
sublingually
• Dopexamine Infusion from 0.5–6μg/kg/min
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16. VASOPRESSORS
• α-adrenergic: e.g. norepinephrine, epinephrine,
dopamine, ephedrine, phenylephrine,
methoxamine.
• Drugs reducing production of cycl ic GMP (in
septic shock): e.g. methylthioninium chloride
• Vasopressin or synthetic analogues, e.g.
terlipressin
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17. MODES OF ACTION
• Acting on peripheral α-adrenergic or vasopressin
V1 receptors
• Blocking cGMP production (methylene blue)
• Increase after load, mainly by arteriolar
vasoconstriction and restoration of vascular
reactivity Venoconstriction
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18. USES
• To increase organ perfusion pressures,
particularly in high output, low peripheral
resistance states, e.g. sepsis, anaphylaxis
• To raise coronary perfusion pressures in
cardiopulmonary resuscitation (epinephrine,
vasopressin)
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19. SIDE-EFFECTS
• Increased cardiac work
• Decreased cardiac output,
• Myocardial and splanchnic ischaemia
• Increased myocardial irritability,, leading to
arrhythmias and tachycardia
• Decreased peripheral perfusion and distal
ischaemia/necrosis
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20. DRUG DOSAGES
• Norepinephine Infusion starting from
0.05μg/kg/min
• Epinephrine Infusion starting from 0.05μg/kg/min
• Dopamine Infusion from 5–50μg/kg/min
• Methoxamine 3–10mg by slow IV bolus (rate of
1mg/min)
• Vasopressin 0.01–0.04U/min
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21. SUMMARY
In this class we discussed the
• List of the cardiovascular drugs,
• Types cardiovascular drugs, ,
• Dosage, mode of actions, uses, side effects of the
cardiovascular drugs
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22. BIBLIOGRAPHY
• Lewis et al, Medical Surgical Nursing, Mosby
Elsevier,7th edition.
• Joyce.M.Black et al, Medical Surgical
Nursing, Saunders publication.
• Brunner and Siddhartha, Medical Surgical
Nursing, Lippincott Williams and Wilkins
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