Cardiovascular Drugs: Overview and Practice Questions (2025)

The cardiovascular system is essential for maintaining the body’s overall health and well-being, facilitating blood circulation, and ensuring that organs receive the oxygen and nutrients they need to function properly.

However, when issues such as heart disease, high blood pressure, or arrhythmias arise, medical intervention often becomes necessary to manage these conditions and prevent further complications. Cardiovascular drugs are vital tools in the treatment and management of various heart and blood vessel disorders.

Understanding the different types of cardiovascular drugs and how they work can provide insight into how these medications support heart health and improve patients’ quality of life.

Types of Cardiovascular Drugs

Cardiovascular drugs encompass a wide range of medications designed to treat various heart and blood vessel conditions. These drugs play a crucial role in managing heart health, blood pressure, and circulation, ensuring proper cardiac function, and reducing the risk of complications.

Here are some key types of cardiovascular drugs:

• Inotropic agents
• Antiarrhythmic agents
• Vasodilators
• Antianginal drugs
• Vasopressors

Each type of cardiovascular drug targets specific heart or vascular functions, contributing to a comprehensive approach to cardiovascular health management.

Inotropic Agents

Inotropic agents are medications that affect the force of heart muscle contractions. These drugs are commonly used in conditions where the heart is failing to pump blood effectively, such as in heart failure or cardiogenic shock. Positive inotropes, like digoxin and dobutamine, strengthen the heart’s contractions, improving blood flow and reducing the symptoms of heart failure.

Conversely, negative inotropes decrease the strength of heart contractions and may be used in cases of conditions like hypertrophic cardiomyopathy where the heart’s workload needs to be reduced. By modulating the force of contraction, inotropic agents play a crucial role in maintaining cardiovascular function in compromised hearts.

Antiarrhythmic Agents

Antiarrhythmic agents are drugs designed to treat and prevent irregular heart rhythms (arrhythmias). These medications work by modifying the electrical impulses in the heart to promote a normal, steady rhythm. They are categorized into different classes based on their mechanisms of action, such as sodium channel blockers, beta-blockers, potassium channel blockers, and calcium channel blockers.

Each class targets specific phases of the cardiac action potential to correct various types of arrhythmias. By stabilizing the electrical activity of the heart, antiarrhythmic agents help reduce symptoms like palpitations, dizziness, or fainting and prevent potential complications such as stroke or sudden cardiac arrest.

Vasodilators

Vasodilators are medications that help widen (dilate) blood vessels, improving blood flow and reducing the heart’s workload. These drugs work by relaxing the smooth muscle in the vessel walls, allowing blood to pass more freely through arteries and veins. Vasodilators are often prescribed for conditions such as hypertension, heart failure, and angina.

By lowering blood pressure and increasing oxygen delivery to the heart and other organs, they can alleviate chest pain and improve overall cardiovascular function. Common examples include nitrates like nitroglycerin, as well as hydralazine and ACE inhibitors. The main goal of vasodilators is to enhance circulation and support the cardiovascular system in managing stress and demand.

Antianginal Drugs

Antianginal drugs are medications used to alleviate and prevent angina pectoris, which is chest pain or discomfort due to inadequate blood flow and oxygen supply to the heart muscle. These drugs work by improving blood flow, reducing the heart’s oxygen demand, or both. The main classes of antianginal drugs include nitrates (such as nitroglycerin), beta-blockers, and calcium channel blockers.

Nitrates help by dilating the blood vessels, making it easier for blood to reach the heart. Beta-blockers reduce heart rate and the force of contraction, decreasing oxygen demand. Calcium channel blockers relax blood vessels and reduce the workload on the heart. Collectively, antianginal drugs help manage angina symptoms, reduce the frequency of episodes, and enhance quality of life for those with coronary artery disease.

Vasopressors

Vasopressors are a class of drugs used to constrict blood vessels and increase blood pressure, particularly in cases of severe hypotension or shock where blood flow to vital organs is compromised. These agents work by stimulating the contraction of vascular smooth muscles, thereby narrowing the blood vessels and elevating blood pressure.

Common vasopressors include norepinephrine, epinephrine, dopamine, and phenylephrine. They are typically administered in critical care settings to stabilize blood pressure and improve perfusion to essential organs such as the brain and heart. By supporting blood pressure and cardiac output, vasopressors play a vital role in the management of life-threatening conditions, ensuring that organs receive sufficient oxygen and nutrients.

Cardiovascular Drugs Practice Questions

1. What is the Bohr Effect?
The effect where the presence of carbon dioxide enhances the release and delivery of oxygen from hemoglobin to the tissues.

2. What is cardiac output?
The volume of blood pumped out of the heart per unit of time, typically measured in liters per minute.

3. What is diastolic blood pressure (DBP)?
The lowest pressure in the arteries reached just before the heart’s ventricles contract and eject blood.

4. What is mean arterial pressure (MAP)?
The average pressure that drives blood into the tissues during the cardiac cycle, ensuring adequate perfusion.

5. What are antiarrhythmic drugs?
Medications used to treat irregular heart rhythms, classified based on their specific mechanisms of action, with some having multiple modes of action.

6. What are catecholamines?
Natural substances produced by the body that are released into the bloodstream and act on nerve endings to stimulate an excitatory response, such as epinephrine and norepinephrine.

7. What is the role of the atrioventricular (AV) node?
It acts as the electrical bridge between atrial depolarization and ventricular depolarization, ensuring coordinated heart contractions.

8. What is systolic blood pressure (SBP)?
The peak pressure in the arteries when the heart’s ventricles contract and eject blood.

9. What is sudden cardiac death (SCD)?
An unexpected loss of life resulting from an episode of ventricular fibrillation (V-fib), pulseless ventricular tachycardia, pulseless electrical activity (PEA), or asystole.

10. What enzyme breaks down cAMP?
Phosphodiesterase, which helps regulate cellular responses by degrading cyclic AMP.

11. What is an arrhythmia or dysrhythmia?
An irregular heartbeat that can affect the rhythm or rate of heart contractions.

12. What is bradycardia?
A condition characterized by a slow heart rate, typically defined as fewer than 60 beats per minute.

13. What is tachycardia?
A condition in which the heart rate is excessively fast, usually greater than 100 beats per minute in adults.

14. What is atrial fibrillation (A-fib)?
An irregular heart rhythm where normal atrial contractions are replaced by rapid, disorganized twitching of the atrial muscle.

15. What is a vasopressor?
A medication or agent that causes the constriction of blood vessels, leading to an increase in blood pressure.

16. What is an inotropic agent?
A substance that affects the force or strength of heart muscle contraction, influencing cardiac output.

17. What is a vasodilator?
An agent that causes the dilation of blood vessels, helping to lower blood pressure and improve blood flow.

18. What is ventricular fibrillation (V-fib)?
A life-threatening arrhythmia where normal ventricular contractions are replaced by erratic, rapid quivering of the heart muscle.

19. What are the three main factors that influence tissue perfusion?
Cardiac function, vascular tone, and the volume of circulating blood.

20. Is a pulse oximeter reliable for measuring oxygenation in a patient with decreased cardiac output (CO) due to cardiogenic shock?
No, in cases of reduced CO, peripheral perfusion may be inadequate, leading to unreliable readings from a pulse oximeter attached to the finger.

21. What is the major determinant of blood pressure and ventricular contractility?
Cardiac output (CO) and the volume of blood filling the ventricles (preload).

22. What are two primary determinants of mean arterial pressure (MAP)?
Systemic vascular resistance (SVR) and cardiac output (CO).

23. What is stroke volume?
The volume of blood ejected by the heart during each systole.

24. What would be the first-line therapy to improve hypotension if a patient has suffered severe blood loss due to dislodged arterial lines?
Fluid resuscitation is the mainstay treatment for improving hypotensive episodes.

25. Which measurement would be altered if a patient’s hemodynamic parameters are monitored and there is fluid overload?
Central venous pressure (CVP) would be increased.

26. What is the clinical indication for the use of Levophed (norepinephrine)?
To increase mean arterial pressure (MAP) in cases of severe hypotension or shock.

27. After administering epinephrine, which receptor type stimulation is likely to result in tachycardia?
Beta receptors, as they are densely located in the myocardium.

28. Why is the use of isoproterenol (Isuprel), which can relax bronchial smooth muscle, limited?
Its use is limited due to its strong stimulatory effect on heart rate.

29. Why is norepinephrine preferred over dopamine for treating septic shock?
Norepinephrine has a lower risk of causing tachyarrhythmias compared to dopamine.

30. Why might patients receiving a phenylephrine infusion develop reflex bradycardia?
Due to unopposed alpha-1 stimulation, which increases systemic vascular resistance (SVR), causing reflex bradycardia.

31. For what condition is vasopressin commonly used?
Septic shock

32. In which clinical scenario would midodrine be indicated?
Management of refractory orthostatic hypotension.

33. What are six clinical signs and symptoms of extravasation?
Pain, swelling, erythema, blistering, blanching, and mottling.

34. How can the risk of extravasation be minimized?
Administering vasopressors via a central line rather than a peripheral line to ensure a larger vein size and increased blood flow.

35. What is the clinical indication for dobutamine?
Short-term treatment of decompensated heart failure due to decreased contractility.

36. Why might milrinone be chosen over inamrinone to manage a patient’s hemodynamic status?
Milrinone has a shorter half-life and a lower risk of causing thrombocytopenia compared to inamrinone.

37. For what chronic condition is digoxin, the only cardiac glycoside, used?
Heart failure

38. What are the four initial symptoms of digoxin toxicity?
Nausea, vomiting, anorexia, and abdominal pain.

39. What are the five major components of the heart’s electrical conduction system?
SA node, AV node, bundle of His, bundle branches, and Purkinje fibers.

40. When is catheter ablation indicated, and what does the procedure involve?
Indicated for atrial fibrillation (A-fib); it involves inserting a catheter into a blood vessel, using an electrical current at the tip to create a small burn to stop abnormal electrical signals.

41. What is Quinidine (Quinaglute) used to treat?
Atrial fibrillation and atrial flutter.

42. For what condition is procainamide indicated?
Treatment of ventricular tachycardia (V-tach).

43. What is lidocaine used to control?
Ventricular arrhythmias, including premature ventricular contractions (PVCs), ventricular tachycardia (V-tach), and ventricular fibrillation (V-fib).

44. A patient with severe asthma is being treated for hypertension in the cardiovascular ICU with Lopressor (metoprolol). What potential side effect should be considered, and is there a better alternative?
Potential bronchoconstriction; esmolol may be a better alternative due to its shorter half-life and selective beta-1 blocking properties.

45. What is amiodarone generally used to treat?
Supraventricular and ventricular arrhythmias.

46. What are Class IV drugs referred to as?
Calcium channel blockers

47. What is the indication for epinephrine in advanced life support?
A potent vasoconstrictor used to increase blood flow during cardiac arrest.

48. What is the indication for vasopressin in advanced life support?
A potent vasoconstrictor used to improve blood flow during resuscitation.

49. What is the indication for atropine in advanced life support?
Used to treat bradycardia.

50. What is the indication for magnesium sulfate in advanced life support?
Used to prolong conduction time and stabilize the cardiac membrane, particularly in cases of torsades de pointes.

51. When is intraosseous (IO) needle placement indicated?
When IV access is difficult or impossible, especially in emergency situations.

52. What drugs can be administered through an endotracheal tube if IV access is unavailable?
Naloxone, atropine, vasopressin, epinephrine, and lidocaine (use the acronym NAVEL).

53. What pressure best evaluates a patient’s response to fluid and vasoactive therapy?
Central venous pressure (CVP)

54. What therapies are commonly used in the management of shock?
Fluids, inotropes, vasopressors, and cardiac glycosides.

55. What type of drugs are norepinephrine and epinephrine?
Catecholamines

56. Which medication is best indicated for the management of septic shock?
Norepinephrine (Levophed)

57. What is the only glycoside used in the management of chronic heart failure?
Digoxin

58. What is not considered a major component of the heart’s electrical conduction system?
The mitral valve

59. What drug is used for the treatment of life-threatening ventricular arrhythmias?
Procainamide

60. What medication is a beta blocker?
Metoprolol

61. What is shock?
A state of organ hypoperfusion and decreased oxygen delivery to the tissues.

62. What should not be done during chest compressions?
Do not stop chest compressions when administering drugs through the endotracheal tube.

63. When administering medications down an endotracheal tube, how much normal saline should be used to dilute the medication?
Typically, 10 mL.

64. Sudden cardiac death (SCD) is defined as an episode of what?
Ventricular fibrillation (V-fib), pulseless ventricular tachycardia (PVT), pulseless electrical activity (PEA), and asystole.

65. What is the initial action that should be taken when a patient is found to be in ventricular fibrillation?
Initiate CPR and defibrillation.

66. What medications are indicated to increase blood flow to the myocardium and CNS during CPR?
Epinephrine

67. What drug, due to its chronotropic effects, is appropriate for treating asystole and can be administered with epinephrine and vasopressin?
Atropine

68. What is a pulmonary artery catheter used for?
Monitoring patient response to vasoactive therapy and determining the cause of hypotensive episodes.

69. What is the first-line therapy for hypotensive episodes?
Fluid resuscitation

70. What are two primary ways to increase blood pressure?
Increase the workload of the heart and enhance vasoconstriction in the blood vessels.

71. What is distributive shock syndrome?
An abnormal distribution of blood flow in the smallest blood vessels, leading to an inadequate supply of blood to the body’s tissues and organs. It is often caused by sepsis, a life-threatening complication of infection.

72. What is cardiogenic shock?
A condition where the heart suddenly cannot pump enough blood to meet the body’s needs, most commonly due to a severe heart attack.

73. What is ejection fraction?
The percentage of blood that is pumped out of a filled ventricle with each heartbeat.

74. What is dopamine (Inotropin)?
A catecholamine that directly stimulates beta receptors, producing chronotropic and inotropic effects that increase cardiac output (CO) and systemic vascular resistance (SVR). It is not recommended for use in patients with septic shock.

75. What is phenylephrine?
A catecholamine and pure alpha-agonist that induces vasoconstriction and elevates both systolic and diastolic blood pressure. Reflex bradycardia may occur due to unopposed alpha-1 stimulation during infusion.

76. What is vasopressin (Pitressin)?
An antidiuretic hormone (ADH) that increases blood pressure by increasing circulating blood volume. It is used in septic shock as an adjunct to other vasopressors and should not be used as the sole agent for hypotension in septic shock.

77. What are the initial signs and symptoms of vasopressor-induced extravasation?
Pain, swelling, erythema, blistering, and mottling. To minimize risk, vasopressors should be administered via a central line.

78. What is dobutamine (Dobutrex)?
An inotropic agent used for the short-term treatment of heart failure due to depressed contractility. The R-isomer causes positive inotropic and chronotropic effects. Adverse effects include tachyphylaxis, tachycardia, and hypotension.

79. What should be administered to reduce oxygen consumption in a patient?
Dobutamine

80. What is digoxin (Lanoxin)?
An inotropic agent used for the management of chronic heart failure. It inhibits the vagus nerve, has no hypotensive effects, and has a narrow therapeutic range (0.5-2 ng/mL).

81. What is the sinoatrial (SA) node?
The heart’s natural pacemaker that initiates electrical activity, generates action potential, and depolarizes the atria.

82. What is the atrioventricular (AV) node?
The structure that links atrial and ventricular activity and conducts impulses to the bundle of His and Purkinje fibers.

83. What is atrial fibrillation?
A cardiac arrhythmia where the SA node does not generate impulses, causing the atria to twitch without contracting, resulting in no effective cardiac output.

84. What commonly causes atrial fibrillation?
Irritation in the atrial region due to factors like acid, hypoxemia, or electrolyte imbalances.

85. What are the indications for a pacemaker?
Conditions such as tachycardia or ventricular fibrillation that are not reversible or transient, sustained tachycardia, syncope due to ventricular tachycardia/fibrillation, and inadequate response to drug therapy.

86. What drugs can be given via the endotracheal route?
Use the mnemonic NAVEL: Naloxone, Atropine, Vasopressin, Epinephrine, and Lidocaine. These can be administered directly through an endotracheal tube.

87. How many people in the United States have high blood pressure?
Approximately 78 million Americans.

88. What percentage of those 78 million Americans with hypertension are aged 20 or older?
33%, with 18% being unaware of their condition.

89. What organs are primarily affected by hypertension?
Hypertension impacts nearly every organ, but especially the heart, brain, kidneys, and eyes.

90. What is the term for organ damage resulting from hypertension?
Cardiovascular disease (CVD)

91. What is hypertension called when the cause is unknown?
Primary or essential hypertension.

92. What is arterial blood pressure?
The pressure exerted by blood against the arterial walls, which is the product of systemic vascular resistance (SVR) and cardiac output (CO).

93. What defines a hypertensive crisis?
A systolic blood pressure (SBP) greater than 180 mmHg or a diastolic blood pressure (DBP) greater than 120 mmHg, encompassing both urgency and emergency situations.

94. What symptoms may present in a patient with hypertensive urgency?
Severe headaches, shortness of breath (SOB), nosebleeds, or severe anxiety.

95. What are the first-line drugs used to treat hypertension?
Thiazide-type diuretics, ACE inhibitors (ACEIs), angiotensin II receptor blockers (ARBs), and calcium channel blockers.

96. What are ACE inhibitors?
Medications that block the conversion of angiotensin I to angiotensin II by competing with angiotensin I for the active site of the angiotensin-converting enzyme (ACE).

97. What are some examples of inotropic agents?
Dobutamine, milrinone, and digoxin.

98. What are the drug categories of inotropic agents?
Catecholamines, phosphodiesterase inhibitors, and cardiac glycosides.

99. What are examples of catecholamines?
Norepinephrine, epinephrine, and isoproterenol (Isuprel).

100. What are some examples of Class II antiarrhythmic drugs (beta blockers)?
Propranolol, metoprolol (Lopressor), and atenolol.

101. What is the biggest concern for respiratory therapists when using beta blockers?
They may cause bronchospasm.

102. What is adenosine?
A medication administered via rapid IV push to terminate supraventricular tachycardia (SVT).

103. What is atropine?
A positive chronotropic agent used in Advanced Cardiac Life Support (ACLS) for treating bradycardia and asystole.

104. What are some acceptable alternatives to IV delivery in ACLS?
Intraosseous (IO) access and direct instillation via an endotracheal (ET) tube.

105. What are the drugs that can be delivered down an ET tube?
Naloxone, atropine, vasopressin, epinephrine, and lidocaine (NAVEL).

106. What are the first-line agents for treating hypertension?
Thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers (ARBs), and calcium channel blockers.

107. What are the second-line agents for treating hypertension?
Alpha-2 agonists, vasodilators, beta blockers, alpha blockers, direct renin inhibitors, and antiadrenergic drugs.

108. What are examples of ACE inhibitors?
Captopril, enalapril, and lisinopril.

109. What are examples of alpha-2 agonists?
Clonidine, midodrine, and phenylephrine.

110. What are examples of alpha-1 antagonists?
Doxazosin, silodosin, and prazosin.

111. What is an example of a nitrate?
Nitroglycerin, used for treating angina.

112. What are the categories of thrombolytic drugs?
Anticoagulants, antiplatelet agents, and thrombolytic agents.

113. What are some examples of anticoagulants?
Heparin and warfarin (Coumadin)

114. What does protamine sulfate do?
It reverses the effects of heparin.

115. What are some examples of antiplatelet agents?
Aspirin, dipyridamole, and clopidogrel (Plavix).

116. What are examples of thrombolytic agents?
Tissue plasminogen activator (tPA), streptokinase, and drugs ending in “-plase” (e.g., alteplase).

117. What is the first-line treatment for hypotension?
Intravenous (IV) fluids

118. What is the treatment for Torsades de Pointes?
Magnesium sulfate

119. What is the formula for arterial blood pressure?
BP = CO × SVR (Blood Pressure = Cardiac Output × Systemic Vascular Resistance)

120. What drugs should be avoided by patients taking ACE inhibitors?
Nonsteroidal anti-inflammatory drugs (NSAIDs)

Final Thoughts

A solid understanding of cardiovascular drugs and their mechanisms is vital for effective patient management in clinical practice. These medications, ranging from inotropic agents to vasopressors, each play a specific role in addressing heart and blood vessel conditions.

For students and medical professionals, mastering the nuances of these drugs enhances their ability to make informed decisions, provide accurate treatments, and ensure the well-being of their patients.

Continued study and practical experience with these medications will empower healthcare providers to deliver better cardiovascular care and adapt to the dynamic nature of medical treatment.