Cardiovascular drugs are a class of medications used to treat conditions related to the heart and blood vessels. Some examples include high blood pressure, heart failure, and arrhythmias.
In this article, we will provide an overview of the different types of cardiovascular drugs, their uses, and how they work. We provided helpful practice questions on this topic as well.
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Types of Cardiovascular Drugs
There are many different types of cardiovascular drugs, including the following:
- Inotropic agents
- Antiarrhythmic agents
- Vasodilators
- Antianginal drugs
- Vasopressors
Each type has its own unique mechanism of action and is used to treat different cardiovascular conditions.
Inotropic Agents
Inotropic agents are drugs that increase the force and contractility of the heart. They are often administered to treat patients with congestive heart failure (CHF).
Some examples include:
- Digitalis
- Digoxin
These drugs work by increasing the intracellular concentration of calcium, which results in an increase in cardiac contractility.
Antiarrhythmic Agents
Antiarrhythmic agents are drugs that are used to treat cardiac arrhythmias, which are abnormal heart rhythms.
Some examples include:
- Amiodarone
- Procainamide
- Verapamil
- Lidocaine
These drugs work by affecting how the heart is beating, which is helpful in restoring a normal heart rhythm.
Vasodilators
Vasodilators are drugs that cause the blood vessels to dilate so that blood can flow more freely. This results in a decrease in blood pressure.
Some examples include:
- Nipride
- Primacor
These drugs work by relaxing the smooth muscle in the walls of blood vessels, which is helpful in treating hypertension.
Antianginal Drugs
Antianginal drugs are drugs that are used to treat conditions that cause chest pain, such as angina and myocardial infarction (heart attack).
Some examples include:
- Nitroglycerin
- Isordil
These drugs work by increasing the blood flow to the heart, which is helpful in reducing and preventing chest pain.
Vasopressors
Vasopressors are drugs that cause the blood vessels to constrict so that blood pressure is increased. This is useful in treating conditions like hypotension and shock.
Some examples include:
- Epinephrine
- Norepinephrine
- Dopamine
- Dobutamine
These drugs work by stimulating the sympathetic nervous system, which results in vasoconstriction and an increase in blood pressure.
Cardiovascular Drugs Practice Questions:
1. What is the Bohr Effect?
The presence of carbon dioxide aiding in the release and delivery of oxygen from hemoglobin.
2. What is the amount of blood that is pumped out of the heart per unit of time?
Cardiac output.
3. What is the lowest pressure reached right before ventricular ejection?
Diastolic blood pressure (DBP).
4. What is the pressure that drives blood into the tissues, averaged over the entire cardiac cycle?
Mean Arterial Pressure (MAP).
5. What are antiarrhythmic drugs?
Cardiac medications that are classified according to their mechanism of action, in some instances, they might present multiple mechanisms of action.
6. What are catecholamines?
Endogenous products that are secreted into the bloodstream and travel to nerve endings to stimulate an excitatory response.
7. What is the link between atrial depolarization and ventricular depolarization?
Atrioventricular (AV) node.
8. What is the peak pressure reached during ventricular ejection?
Systolic blood pressure (SBP).
9. What is an episode of v-fib, pulseless ventricular tachycardia, PEA or asystole leading to loss of life?
Sudden cardiac death (SCD).
10. What enzyme is responsible for the breakdown of cAMP?
Phosphodiesterase.
11. What is known as an irregular heartbeat?
Arrhythmia/dysrhythmia.
12. What is bradycardia?
It is a slow heart rate typically less than 60 beats/min.
13. What is tachycardia?
It is an overly rapid heartbeat usually greater than 100 beats/min in adults.
14. What is A-fib?
A cardiac arrhythmia in which normal atrial contractions are replaced by rapid irregular twitchings of the muscular wall.
15. What is vasopressor?
It is an agent causing contraction of the capillaries and arteries.
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16. What is an inotropic agent?
It is an agent affecting the strength of muscular contraction.
17. What agent causes dilation of blood vessels?
Vasodilator.
18. What is V-fib?
A cardiac arrhythmia in which normal ventricular contractions are replaced by rapid movements of the ventricular.
19. What three factors does tissue perfusion depend on?
Cardiac function, vascular tone, and vascular volume.
20. If a patient was in cardiogenic shock and had a decreased CO, would a pulse oximeter attached to the index finger be an accurate way to measure oxygenation status?
No, if perfusion was limited due to decreased CO the patient’s pulse rate in the finger may not be adequate enough for the proper functioning of a pulse oximeter.
21. What is the major determinant of blood pressure and ventricular contractility?
CO and the volume of blood filling in the ventricles (preload).
22. What are two determinants of MAP?
Systemic vascular resistance and CO.
23. What is stroke volume?
The amount of blood ejected from the heart during systole.
24. What would be the 1st line therapy to improve the hypotension if a patient has just suffered severe blood loss due to the arterial lines becoming dislodged?
Fluids are the mainstay for improving hypotensive episodes.
25. What measurement would likely be alerted if a patient’s hemodynamic parameters are currently being measured and patient’s fluid overloads?
CVP would be increased.
26. What is the clinical indication for the use of Levophed?
The need to increase MAP.
27. After administration of epinephrine, stimulation of what receptor type is likely to produce a net effect of tachycardia?
B receptors because they are densely populated in the myocardium.
28. Why is the use of isoproterenol which can be used to relax the smooth muscle of the bronchi, limited and what is the brand name?
Limited because of its pronounced stimulatory effect on the HR. Isuprel.
29. Why is Norepinephrine more appropriate treatment than dopamine in treating a patient with septic shock?
There is an increased risk of tachyarrhythmias as compared to the risk with other vasopressors.
30. Why do patients receiving a phenylephrine infusion has developed reflex bradycardia?
Patients on phenylephrine infusions develop a reflex bradycardia due to the unopposed alpha 1 stimulation in the vasculature causing increased SVR.
31. What condition is vasopressin used for?
Septic shock.
32. What is a clinical situation in which midodrine would be indicated?
Management of orthostatic hypotension in refractory pts with orthostatic hypotension.
33. What are the six clinical signs and symptoms of extravasation?
Pain, swelling, erythema, blistering, blanching and mottling.
34. How can the risk of extravasation be minimized?
Vasopressors should be preferentially administered via a central line rather than a peripheral line due to the large vein size and increased blood flow.
35. What is the clinical indication for dobutamine?
For the short-term treatment of decompensated heart failure secondary to depressed contractility.
36. Why would milrinone be chosen over inamrinone to manage patient’s hemodynamic status?
Milrione has a shorter half-life than inamrinone and is less likely to cause thrombocytopenia.
37. What chronic condition is Digoxin, the only drug in the cardiac glycoside class, issued in management?
Heart failure.
38. What are the four initial symptoms seen in 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,
40. When is a catheter ablation indicated and what is involved in the procedure?
A-fib. Inserting a catheter into a blood vessel. The tip causes an arrhythmia and electrical current burns a small hole.
41. What is Quinidine (Quinaglute) used to treat?
Atrial fibrillation and flutter.
42. Procainamide is indicated in the treatment of?
V-tach.
43. What is lidocaine used to control?
Ventricular arrhythmias, such as premature ventricular contraction (PVC), v-tach and v-fib.
44. A patient with severe asthma is being treated in the cardiovascular ICU for hypertension with Lopressor. What is a potential side effect of medication and is there a better medication to give to the patient?
Bronchoconstriction is a potential side effect and Esmolol is a better medication.
45. In general, amiodarone is used to treat?
Supraventricular and ventricular arrhythmias.
46. What are Class IV drugs referred to as?
Calcium channel blockers.
47. What is the indication of epinephrine in advanced life support?
Potent vasoconstrictor.
48. What is the indication of vasopressin in advanced life support?
Potent vasoconstrictor.
49. What is the indication of atropine in advanced life support?
Bradycardia.
50. What is the indication of magnesium sulfate in advanced life support?
Prolong conduction time.
51. When would interosseous (IO) needle placement be indicted?
When IV access is difficult or impossible.
52. What drugs can be administered through an endotracheal tube if IV access is not available?
Naloxone, atropine, vasopressin, epinephrine, and lidocaine. Remember NAVEL.
53. What pressure best evaluates a patient-specific response to fluid therapy and vasoactive therapy?
CVP.
54. What therapies are used in the management of shock?
Fluids, inotropes, vasopressors, and cardiac glycosides.
55. What types of drugs are norepinephrine and epinephrine?
Catecholamines.
56. What medication is best indicated for the management of septic shock?
Norepinephrine (Levophed).
57. What is the only glycoside that used in the management of chronic heart failure?
Digoxin.
58. What is not considered a major component of the hearts electrical conduction system?
Mitral valve.
59. What drug is used for the treatment of life-threating ventricular arrhythmias?
Procainamide.
60. What medication is a beta blocker?
Metoprolol.
61. What is shock?
Organ hypoperfusion and a decrease in oxygen delivery to the tissues.
62. What should not be done during chest compressions?
Chest compressions should not continue as drugs are administered through the ETT.
63. When administering medications down an endotracheal tube, how much normal saline should be used to dilute the medication?
10mL.
64. What is SCD defined as an episode of?
V-fib, PVT, PEA
65. What should be done first when a patient is in v-fib?
CPR or defibrillation.
66. What medications would be indicated to increase blood flow to the myocardium and the CNS during CPR?
Epinephrine.
67. What drug is most appropriate for patients, because of its chronotropic effects, in asystole and can be administered with epi and vasopressin?
Atropine.
68. What is the pulmonary artery catheter?
Used to monitor patient response to vasoactive therapy and used to determine cause of hypotensive episodes.
69. What is the first line therapy for hypotensive episodes?
Fluids.
70. What are two ways of increasing blood pressure?
Make the heart work harder and increase vasoconstriction in blood vessels.
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71. What is distributive/shock syndrome?
Abnormal distribution of blood flow in the smallest blood vessels results
72. What is cardiogenic shock?
Heart suddenly cannot pump enough blood to meet your body’s needs. It is most often caused by a severe heart attack.
73. What is the ejection fraction?
Percent of blood that is pumped out of a filled ventricle with each heartbeat.
74. What is dopamine (Inotropin)?
Catecholamine, directly stimulates B receptors, chronotropic and inotropic effects lead to increase CO, increases SVR and do not give to patients in septic shock.
75. What is Phenylephrine?
Catecholamine, purely an agonist, induces vasoconstriction, elevates SBP and DBP, and due to unopposed a1 stimulation, reflex bradycardia when infusing.
76. What is Vasopressin (Pitressin)?
It is an antidiuretic hormone that increases BP by increasing circulation of blood volume, catecholamine, used in the setting of septic shock, naturally occurring hormone (ADH), should not be used as a sole agent for hypotension in the setting of septic shock and should be given when other vasopressors are not enough.
77. What are the initial signs and symptoms of vasopressor-induced extravasations?
Pain, swelling, erythema, blistering, mottling and to decrease risk administer vasopressor via central line.
78. What is Dobutamine (Dobutrex)?
Inotropic agent; for short-term treatment of heart failure
79. What should be given if the goal is to diminish oxygen consumption?
Dobutamine.
80. What is Digoxin (Lanoxin)?
It is an inotropic agent used for the management of chronic heart failure, it inhibits the vagus nerve, it has no hypotensive effects, and it has a narrow therapeutic margin (0.5-2ng/ml).
81. What is the Sinoatrial Node (SV)?
Initiates electrical activity, generates action potential and depolarizes atria.
82. What is the Atrioventricular Node (AV)?
Links activity of the atria and ventricle and potential travels to bundle of His, bundle branches (Purkinje fibers).
83. What is Atrial Fibrillation?
No impulses are coming from SA node, ventricles only twitch they do not contract, therefore there is no CO.
84. Atrial Fibrillation is caused by what?
By irritation, that causes a twitch in that region and can be due to acid, hypoxemia, or imbalances in electrolytes.
85. What are the indications for a pacemaker?
Tachycardia or ventricular defibrillation that is not reversibly transient; spontaneous sustained tachycardia; syncope due to VT/VF; and, used if drug therapy is not enough.
86. What drugs can be given via the endotracheal route?
Always remember NAVEL, which stands
87. How many people in America have high blood pressure?
78 million Americans.
88. How many of the 78 million Americans are with hypertension aged 20 years or older?
33% and 18% are unaware of their condition.
89. What does hypertension affect?
Practically every organ but mostly the heart, brain, kidney, and eyes.
90. What is called to any damage to organs resulting from hypertension?
CVD cardiovascular disease.
91. What is hypertension called when it is unknown?
Primary or essential hypertension.
92. What is arterial blood pressure?
Blood pressure which is the product of SVR and CO.
93. What defines a hypertensive crisis?
Any SBP greater than 180 and any DBP greater than 120 encompasses an urgency/emergency.
94. What presents in patients if they have hypertensive urgency?
Severe headaches, SOB, nose bleeds, or severe anxiety.
95. What are the first-line drugs that are used to treat hypertension?
Thiazide-type diuretics, ACEIs, angiotensin II receptor blockers (ARB’s), and calcium channel blockers.
96. What are ACE inhibitors?
Block conversion of angiotensin I to angiotensin II by competing with physiologic substrate angiotensin I for the active site of ACE.
97. What are some examples of Inotropic Agents?
Dobutamine, Milrinone, and Digoxin.
98. What are the drug categories of Inotropic Agents?
Catecholamine, phosphodiesterase inhibitors, and cardiac glycosides.
99. What are examples of Catecholamine?
Norepinephrine, epinephrine, and
100. What are some examples of Class 2 antiarrhythmic (Beta blockers)?
Propranolol, Metroprolol (Lopressor) and atenolol.
101. What is the biggest concern for respiratory therapists when it comes to beta blockers?
May cause bronchospasm.
102. What is Adenosine?
It is used via rapid IV push to terminate SVT.
103. What is Atropine?
It is a positive chronotrope used in ACLS for bradycardias and asystole.
104. What are some acceptable alternatives to IV delivery in ACLS?
Intraosseous (IO) and direct
105. What are the drugs that may be delivered down the ET tube?
106. What are the first-line agents for hypertension?
Thiazides, ACE inhibitors, Angiotensin II blockers, and calcium channel blockers.
107. What are the second-line agents for hypertension?
Alpha 2 agonists, vasodilators, beta blockers, alpha blockers, direct renin inhibitors, and antiadrenergic.
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
Nitroglycerin and it is given for angina.
112. What are the categories of thrombolytic?
Anticoagulants, antiplatelet, and thrombolytic.
113. What are some examples of anticoagulants?
Heparin and Coumadin (warfarin).
114. What does Protamine sulfate do?
It reverses heparin.
115. What are some antiplatelet agents?
Aspirin, dipyridamole, and clopidogrel (Plavix).
116. What are examples of thrombolytic?
tPA, streptokinase, and –plase.
117. What is the first-line treatment for hypotension?
IV fluids.
118. What is the treatment for Torsades de Pointes?
Magnesium sulfate.
119. What is the arterial blood pressure formula?
BP = CO X SVR.
120. What drugs should not be taken by patients on ACE inhibitors?
NSAIDs.
Final Thoughts
There are many different types of cardiovascular drugs, each with its own unique benefits and uses. These drugs are used to treat various cardiovascular conditions, such as hypertension, heart failure, and arrhythmias.
The heart and lungs work together to pump oxygenated blood throughout the body. Therefore, cardiovascular drugs can have an effect on a patient’s ability to breathe.
That is why this is an important topic for respiratory therapists.
If you want to learn more about respiratory medications, check out our guide on adrenergic bronchodilators. Thanks for reading!
Written by:
John Landry, BS, RRT
John Landry is a registered respiratory therapist from Memphis, TN, and has a bachelor's degree in kinesiology. He enjoys using evidence-based research to help others breathe easier and live a healthier life.
References
- Rau’s Respiratory Care Pharmacology. 10th ed., Mosby, 2019.
- Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020.
- “The Impact of Cardiovascular Medication Use on Patients’ Daily Lives: A Cross-Sectional Study.” PubMed Central (PMC), 23 July 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC5918518.