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NRSG195 - CARDIOVASCULAR PHARMACOLOGY - Coggle Diagram
NRSG195 - CARDIOVASCULAR PHARMACOLOGY
CARDIOVASCULAR PHYSIOLOGY
Heart Anatomy
Cardiac Cycle
Cardiac Output
Heart Rate (HR)
Stroke Volume (SV)
Blood Pressure
Systolic
Diastolic
CO × SVR
Normal Values
Myocardial Oxygen Supply
RAAS (Renin-Angiotensin-Aldosterone System)
Cardiac Conduction System
HYPERTENSION
Definition
Classification
Normal
Elevated
Stage 1
Stage 2
Hypertensive Crisis
Types
Essential (Primary)
Secondary
Malignant
White Coat
Causes
Signs & Symptoms
Complications
Stroke
Myocardial Infarction (MI)
Heart Failure (HF)
Chronic Kidney Disease (CKD)
Retinopathy
Drug Therapy
ACE Inhibitors
ARBs
Beta Blockers
Calcium Channel Blockers
Diuretics
Vasodilators
Lifestyle Management
Diet (↓ Na⁺)
Exercise
Smoking Cessation
Stress Management
ANGINA
Pathophysiology (Myocardial Ischemia)
Types
Stable Angina
Unstable Angina
Prinzmetal (Variant) Angina
Symptoms
Treatment
Nitrates
Beta Blockers
Calcium Channel Blockers
Nitroglycerin Algorithm
1 SL tablet at onset
Wait 5 minutes
If no relief → Call 911
Repeat every 5 minutes (max 3 tablets)
Nursing Care
Assess pain (PQRST)
Monitor BP, HR
Evaluate response to Nitro
Patient education (triggers, storage, when to seek help)
DYSRHYTHMIAS
Definition
Causes
Cardiac Electrophysiology
ECG Components
P wave
PR interval
QRS complex
ST segment
T wave
Supraventricular Dysrhythmias
Atrial Fibrillation
Atrial Flutter
Sinus Tachycardia
Sinus Bradycardia
PSVT
Ventricular Dysrhythmias
PVCs
Ventricular Tachycardia
Ventricular Fibrillation
AV Blocks
Decreased Cardiac Output
Hypotension
Dizziness
Fatigue
Confusion
DRUG THERAPY
ACE INHIBITORS
Prototypes
Captopril
Enalapril
Lisinopril
Mechanism
Inhibits ACE → ↓ Angiotensin II → ↓ Aldosterone
Vasodilation & Diuresis
RAAS Connection
Therapeutic Effects
↓ BP
↓ Preload & Afterload
Cardioprotective (post-MI)
Kidney Protection
↓ Proteinuria
Slows Diabetic Nephropathy
Diabetic Benefits
Adverse Effects
Dry Cough
Hyperkalemia
Angioedema
First-dose Hypotension
Contraindications
Pregnancy
History of Angioedema
Severe Renal Artery Stenosis
Nursing Assessment
BP
Renal Function
K⁺ Levels
Signs of Angioedema
Patient Teaching
Avoid salt substitutes
Report cough, swelling, dizziness
NCLEX Tips
ACE = Dry Cough
Monitor K⁺ and renal function
ARBs
Prototypes
Losartan
Valsartan
Mechanism
Block Angiotensin II Receptors
↓ Vasoconstriction & ↓ Aldosterone
Comparison with ACE Inhibitors
Similar BP effect
No dry cough
Less angioedema
Adverse Effects
Dizziness
Hyperkalemia (less than ACEi)
Headache
Nursing Care
Monitor BP, K⁺, renal function
Patient Teaching
Avoid K⁺ supplements
Report dizziness, swelling
BETA BLOCKERS
Selective
Beta-1 (Cardioselective)
Metoprolol
Atenolol
Nonselective
Beta-1 & Beta-2
Propranolol
Mechanism
↓ HR
↓ Contractility
↓ Myocardial O₂ Demand
Exercise Intolerance
Fatigue
Dizziness with exertion
Mask Hypoglycemia
Blunt tachycardia in diabetics
Contraindications
Severe Bradycardia
Heart Block
Acute HF
Asthma (nonselective)
Adverse Effects
Bradycardia
Hypotension
Fatigue
Depression
Nursing Assessment
HR (Apical)
BP
Signs of HF (edema, SOB)
Teaching
Never stop abruptly
Check pulse before dose
Report HR < 60 BPM
CALCIUM CHANNEL BLOCKERS
Types
Dihydropyridines
Amlodipine
Non-Dihydropyridines
Verapamil
Diltiazem
Mechanism
Block Ca²⁺ influx
Smooth muscle relaxation
↓ SVR & ↓ BP
Uses
Hypertension
Angina
Dysrhythmias (rate control)
Adverse Effects
Hypotension
Peripheral Edema
Constipation
Bradycardia (non-DHP)
Contraindications
Acute MI
Second/Third-degree AV Block
Hypotension
Nursing
Monitor BP, HR
Assess edema
Teach high-fiber diet
DIURETICS
Loop Diuretics
Furosemide
Mechanism: Block Na⁺/Cl⁻ reabsorption in Loop of Henle
Strong diuresis
Thiazide Diuretics
Hydrochlorothiazide
Mechanism: Inhibit Na⁺/Cl⁻ reabsorption in distal tubule
Potassium-Sparing Diuretics
Spironolactone
Mechanism: Aldosterone antagonist, saves K⁺
Mechanisms
↓ Plasma Volume
↓ BP
Electrolytes
Loop/Thiazide: Lose K⁺
Spironolactone: Save K⁺
Adverse Effects
Hypokalemia (Loop/Thiazide)
Hyperkalemia (Spironolactone)
Dehydration
Nursing Assessment
I&O
Daily Weight
BP
Electrolytes
Patient Teaching
Take in morning
Monitor weight
Report muscle weakness, cramps
NITRATES
Nitroglycerin
Routes
Sublingual (SL)
Spray
Patch
Ointment
IV
SL Administration
1 tablet at onset of chest pain
Repeat every 5 minutes (max 3)
If no relief → Call 911
Storage
Dark glass bottle
Replace every 3–6 months
Patch
Apply to clean, hairless skin
Rotate sites
Remove at night to prevent tolerance
IV
Use pump
Special tubing
Tolerance
Avoid continuous 24h dosing
PDE-5 Interaction
Viagra/Cialis → Severe hypotension
Patient Teaching
Sit/lie down before taking
Avoid alcohol & hot environments
ANTIDYSRHYTHMICS
Class I (Na⁺ Channel Blockers)
Procainamide
Lidocaine
Class II (Beta Blockers)
Metoprolol
Class III (K⁺ Channel Blockers)
Amiodarone
Class IV (Ca²⁺ Channel Blockers)
Diltiazem
Adenosine
PSVT conversion
Very short half-life
Mechanisms
Alter conduction & refractoriness
Indications
SVT
Ventricular Dysrhythmias
ECG Monitoring
QT interval
Bradycardia
QT Prolongation
Risk of Torsades de Pointes
Adverse Effects
Hypotension
Proarrhythmias
Nursing Care
Continuous ECG
Monitor electrolytes
Assess for dizziness, syncope
HEART FAILURE CONNECTIONS
ACE Inhibitors
ARBs
Beta Blockers
Loop Diuretics
Spironolactone
Digoxin
↓ Preload
↓ Afterload
↑ Cardiac Output
↓ Mortality
NURSING PROCESS
Assessment
Vitals
BP
Apical Pulse
Radial Pulse
Respirations
ECG
Daily Weight
I&O
Electrolytes
Renal Function
Therapeutic Response
↓ BP
↓ Edema
↓ SOB
Improved Exercise Tolerance
Adverse Effects
Hypotension
Bradycardia
Electrolyte Imbalance
Patient Education
Evaluation
NCLEX HIGH-YIELD
ACE = Dry Cough
ARB = No Cough
Beta Blockers = Never Stop Abruptly
Loop Diuretics = Lose K⁺
Spironolactone = Save K⁺
Digoxin + Low K⁺ = Toxicity
CCB = Constipation
Nitro + Sildenafil = Severe Hypotension
Pulse < 60 → Hold Beta Blocker/Digoxin
Nitro SL: 1 tab → 5 min → Call 911 → Repeat q5min (max 3)