Pharmacology, part 6: Cardiovascular Medications - Hypertension & Angina

May 04, 2020 Updated: September 23, 2021 7 min read

In this article, we cover cardiovascular medications for hypertension and angina. The Nursing Pharmacology video series follows along with our Pharmacology Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.

Calcium channel blockers - verapamil, nifedipine, diltiazem

Calcium channel blockers include verapamil, nifedipine, and diltiazem. These medications are used to treat hypertension as well as angina. Nifedipine is also used to treat preterm labor.

Cool Chicken Calcium channel blockers are "Very Nice Drugs." (Verapamil, Nifedipine, Diltiazem)

Mode of action

The mode of action of calcium channel blockers is to block calcium channels in the heart and in the blood vessels. This results in vasodilation and a decrease in heart rate.

Side effects

An important side effect of these medications to remember is peripheral edema, which is the swelling of your lower legs or hands. Whenever a medication for hypertension does its job too well, hypotension is likely going to be a key side effect. Other side effects include bradycardia because of these meds’ effect on the heart, headache and constipation.

Nursing care

When administering these medications, monitor your patient’s blood pressure and heart rate carefully, and advise them not to consume grapefruit juice.

Centrally-acting alpha-2 agonist - clonidine

The centrally-acting alpha-2 agonist you want to remember is clonidine, which is used to treat hypertension, severe cancer pain, and to treat withdrawal symptoms from various drugs. This medication is not to be confused with clozapine, an antipsychotic.

Cool Chicken Don’t confuse cloZapine (for schiZophrenia) with cloNidine (Not for schizophrenia).

Mode of action

Clonidine works by decreasing the sympathetic outflow to the heart and blood vessels, which results in decreased heart rate and blood pressure.

Side effects

An easy way to remember the key side effects of centrally-acting alpha-2 agonists is to remember the 3 Ds of clonidine: dizziness, drowsiness, and dry mouth.

Patient teaching

You can inform your patient that they can suck on hard candy or chew gum for a dry mouth.

Beta-1 blockers - metoprolol, atenolol

Beta-1 blockers include metoprolol and atenolol and are used to treat hypertension, angina, heart failure, and myocardial infarction.

Cool Chicken To remember that Metoprolol and Atenolol are cardioselective (beta 1), remember that you only have 1 (birth) ma.

Mode of action

The mode of action for these medications is that they block beta-1 receptors on the heart, which helps to decrease blood pressure as well as heart rate.

Side effects

Side effects of this medication include bradycardia, hypotension, fatigue, and erectile dysfunction.

Black box warning

This medication also carries a black box warning because if a patient discontinues taking this medication abruptly, it can cause angina as well as an myocardial infarction (heart attack).

Nursing care and patient teaching

Teach your patient to change positions slowly because of the hypotension. Monitor their blood pressure and pulse during therapy. Also, keep in mind that beta-1 blockers can mask the signs of hypoglycemia. If you have a patient who has diabetes, this is an important point to know.

Non-selective beta-blockers - propranolol, labetalol, carvedilol

Non-selective beta-blockers are used to treat hypertension, angina, and arrhythmias, or a heart attack. Medications that fall within this class include propranolol, labetalol, and carvedilol.

Cool Chicken Please Listen Carefully - these beta blockers (Propanolol, Labetalol, Carvedilol) are NON-selective. They will impact the lungs too!

What’s the difference between selective and non selective beta blockers?

Selective beta-blockers “select” the beta receptors located in the heart tissue, known as your beta1 receptors. This type of beta-blocker decreases activity around the heart and can help reduce your heart rate and your systolic pressure (the pressure your blood vessels experience when your heart beats).

Non-selective beta-blockers, on the other hand, block the beta1, beta2, and beta3 receptors in the body. So instead of only targeting the beta receptors in your heart, they also target those in your blood vessels, GI, and lungs.

Mode of action

Non-selective beta-blockers not only affect the beta-1 receptors in the heart, but they also affect the beta-2 receptors in the lungs too. They decrease blood pressure and heart rate.

Side effects

With non-selective beta-blockers, an important side effect to know is bronchospasm. Because these medications affect beta-2 receptors in the lungs, you would never want to give this medication to someone who has asthma, COPD, or other respiratory issues that could be exacerbated by bronchoconstriction.

Other side effects include fatigue, hypotension, bradycardia, as well as erectile dysfunction.


Full Transcript

In this video, we are going to talk about more medications that are used to treat hypertension. Specifically, we'll be talking about calcium channel blockers, alpha-2 agonists, beta-1 blockers, and non-selective beta blockers. If you are following along with cards, I'm on card number 15 in the Edition 2.0 deck.

Alright. Now let's talk about calcium channel blockers. So medications that fall within this class include verapamil, nifedipine, and diltiazem. And the way that I remember that these medications are calcium channel blockers is I think, "Calcium channel blockers are very nice drugs." So V for verapamil, N for nifedipine, and D for diltiazem. So these medications are used to treat hypertension as well as angina. And then nifedipine is also used to treat pre-term labor. So the mode of action of calcium channel blockers are to block calcium channels in the heart and in the blood vessels. This results in vasodilation and a decrease in the heart rate. Key side effects include peripheral edema. That's a really important one to know. As well as hypotension, which you probably could have guessed, right? Anytime we have a medication that treats hypertension and it does its job too well, hypotension is likely going to be a key side effect. Other side effects include bradycardia because we're affecting the heart rate, as well as headache and constipation. So important teaching that you need to do for your patient, you need to advise them not to consume grapefruit juice. And you're definitely going to want to monitor their blood pressure, as well as their heart rate, carefully during therapy.

Alright. Now we're going to talk about a centrally-acting alpha-2 agonist. So the medication to know in this class is clonidine. It's going to be really important that you not mix up clonidine with clozapine. So clozapine with a Z is for schizophrenia which also has a Z. Clonidine does not have a Z. It's not for schizophrenia. It's for hypertension, okay? So we use this for hypertension. It works by decreasing the sympathetic outflow to the heart and blood vessels which results in decreased heart rate and decreased blood pressure. The key side effects to remember are the 3 Ds of clonidine. And this includes dizziness, drowsiness, and dry mouth. So again, 3 Ds of clonidine. And one important teaching to give your patient is that they can suck on hard candy or chew gum for a dry mouth.

Alright. Now let's talk about beta-1 blockers which include metoprolol, as well as atenolol. So next we'll be talking about non-selective beta blockers. The way that you can remember which medications are beta-1 blockers is that you only have one mother. You might actually have more than one mother. But let's say you have one mother or one ma. And that will help you remember that beta-1 blockers are metoprolol and atenolol, which start with M and A. So these medications are used for hypertension, angina, a heart failure as well as a myocardial infarction. The mode of action is that they block beta-1 receptors which are on the heart, right. You only have one heart so those are beta-1 receptors. And this helps to decrease blood pressure as well as heart rate. So side effects of this medication include bradycardia, hypotension, fatigue, and erectile dysfunction. This medication also carries a black box warning because if you discontinue taking this medication abruptly, it can cause angina as well as an MI. So it's going to be important to teach your patient to change positions slowly because of that hypotension. You're also going to want to monitor their blood pressure and pulse during therapy. And also keep in mind that beta-1 blockers can mask signs of hypoglycemia. So if you have a patient who has diabetes, this is going to be an important point to know.

Now let's talk about non-selective beta blockers. So these are beta blockers that not only affect beta-1 receptors in the heart, they also affect beta-2 receptors in the lungs. So medications that fall within this class include propranolol, labetalol, and carvedilol. So again, they all end in that -olol, but it's important to know how you can determine that these are non-selective as opposed to the beta-1 blockers that we talked about last. So if you recall with the beta-1 blockers, you have 1 ma, in all likelihood. So beta-1 blockers include metoprolol as well as atenolol. For non-selective beta blockers, the way I remember this is I think, "Please listen carefully." And that helps me remember propranolol, labetalol, and carvedilol. "Please listen carefully." These medications not only affect the beta-1 receptors, they also affect the lungs too. And that's going to be a really important point with these non-selective beta blockers. So they are used to treat hypertension, angina, as well as arrhythmias or an MI. They work by blocking the beta-1 receptors in the heart as well as the beta-2 receptors in the lungs. They decrease blood pressure and heart rate. But a key side effect, and one that's really important for you to know, is bronchospasm. Because they are affecting those beta-2 receptors in the lungs, you would never want to give this medication to someone who had asthma or issues that would be exacerbated by bronchoconstriction. Other side effects include fatigue, hypotension, bradycardia, as well as erectile dysfunction. And again, no using this medication for patients with asthma because of that bronchospasming because we are affecting the lungs too.

Alright. In my next video, we are going to talk about vasodilators that are used for angina as well as a hypertensive crisis. So hang in there with me.


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