Pharmacology of Drugs Used in the Treatment of Cardiovascular and Blood Disorders

I. Introduction
Cardiovascular and haematological disorders are prevalent health concerns requiring a
multifaceted pharmacological approach. This handout provides an in-depth exploration of
various drug classes used in the management of these conditions, focusing on their
composition, mechanisms of action, dosages, routes of administration, indications,
contraindications, drug interactions, side effects, adverse effects, toxicity, and the pivotal role
of nurses in patient care.

II. Haematinics and Treatment of Anaemia

A. Iron Supplements
• Composition: Ferrous sulphate, ferrous gluconate, ferrous fumarate
• Mechanism of Action: Replenishes iron stores necessary for haemoglobin synthesis
• Dosage: Typically, 100–200 mg elemental iron daily
• Route: Oral or intravenous
• Indications: Iron-deficiency anaemia
• Contraindications: Hemochromatosis, hemosiderosis
• Side Effects: Gastrointestinal discomfort, constipation, dark stools
• Nursing Role:
o Educate patients on proper administration (e.g., take on an empty stomach for
better absorption)
o Monitor for signs of gastrointestinal distress
B. Vitamin B12 (Cyanocobalamin)
• Mechanism of Action: Essential for DNA synthesis and red blood cell maturation
• Dosage: 1000 mcg intramuscularly monthly
• Indications: Pernicious anaemia, vitamin B12 deficiency
• Nursing Role:
o Monitor hematologic response
o Educate patients on the importance of adherence to therapy
C. Folic Acid
• Mechanism of Action: Vital for DNA synthesis and red blood cell production
• Dosage: 400–800 mcg daily
• Indications: Folic acid deficiency anaemia, prevention of neural tube defects in
pregnancy
• Nursing Role:
o Ensure patient understanding of dietary sources
o Monitor for improvement in anaemia symptoms

Table 1: Haematinics

Composi Mechan Rout Indicatio Contraindica

Drug Dose Side Effects
tion ism e ns tions

Iron (65
Replenis 200 Iron-
Ferrous mg Hemochromat Constipation,
hes iron mg Oral deficiency
Sulfate elemental osis nausea
stores TDS anemia
)
 Composi Mechan Rout Indicatio Contraindica
Drug Dose Side Effects
tion ism e ns tions

DNA
1–5 Megalobl
Vitamin synthesis Oral/ Undiagnosed Allergic
Folic Acid mg astic
B9 for IV anemia reactions
OD anemia
RBCs

1000
Supports
mcg
Cyanocobal Vitamin RBC Pernicious Hypersensitiv Hypokalemia,
IM IM
amin B12 maturati anemia ity itching
month
on
ly

100–
200
IV iron Chronic Non-iron
Iron Iron (20 mg Hypotension,
replacem IV kidney deficiency
Sucrose mg/mL) altern metallic taste
ent disease anemia
ate
days

Stimulat 50–
Anemia of
Erythropoie Recombi es RBC 150 SC/I Uncontrolled Thromboemb
chronic
tin nant EPO producti U/kg V hypertension olism
disease
on TIW

III. Adrenergic and Antiadrenergic Agents

A. Adrenergic Drugs for Congestive Heart Failure (CHF)
1. Dobutamine
• Mechanism of Action: Stimulates β1-adrenergic receptors, increasing cardiac output
• Dosage: 2–20 mcg/kg/min IV infusion
• Indications: Acute decompensated heart failure
• Nursing Role:
o Monitor heart rate and blood pressure
o Assess for signs of arrhythmias

Table 2: Drugs for CHF and Vasodilators

Drug Class Mechanism Dose Indications Side Effects

Cardiac Inhibits Na+/K+ 0.125–0.25 CHF, atrial Arrhythmia,

Digoxin
glycoside ATPase mg OD fibrillation nausea

Increases cardiac 2–20 Tachycardia,

Dobutamine β1-agonist Acute CHF
contractility mcg/kg/min hypertension

Releases NO, 0.3–0.6 mg Headache,

Nitroglycerin Nitrate Angina, CHF
vasodilation SOS hypotension

Direct Relaxes arterial 25–100 mg Hypertension, Lupus-like

Hydralazine
vasodilator smooth muscle BD CHF syndrome
Drug Class Mechanism Dose Indications Side Effects

Blocks
50–100 mg Hypertension, Hyperkalemia,
Losartan ARB* angiotensin II
OD CHF dizziness
receptors

B. Antiadrenergic Agents
1. Beta-Blockers (e.g., Metoprolol, Atenolol)
• Mechanism of Action: Block β-adrenergic receptors, reducing heart rate and
myocardial oxygen demand
• Dosage: Varies; commonly 50–100 mg orally daily
• Indications: Hypertension, angina, arrhythmias
• Contraindications: Asthma, bradycardia
• Nursing Role:
o Monitor vital signs
o Educate patients on not abruptly discontinuing medication

Table 3: Anti-Adrenergics

Drug Class Mechanism Dose Indications Side Effects

40–80
Non-selective β- Blocks β1/β2 Hypertension, Bradycardia,
Propranolol mg
blocker receptors angina fatigue
BD

1–10
Hypertension, Orthostatic
Prazosin α1-blocker Vasodilation mg
BPH hypotension
OD

0.5–1 Dry mouth,

Blocks muscarinic Bradycardia,
Atropine Anticholinergic mg urinary
receptors poisoning
SOS retention

Cholinergic Inhibits 15 mg Myasthenia Diarrhea,

Neostigmine
agonist acetylcholinesterase TDS gravis salivation

0.1– Hypertension,
Central α2- Reduces sympathetic Sedation, dry
Clonidine 0.3 mg opioid
agonist outflow mouth
BD withdrawal

IV. Cholinergic and Anticholinergic Agents

A. Cholinergic Agents
1. Pilocarpine
• Mechanism of Action: Stimulates muscarinic receptors, increasing secretions
• Indications: Glaucoma, xerostomia
• Nursing Role:
o Monitor for excessive salivation
o Educate patients on potential side effects
B. Anticholinergic Agents
1. Atropine
 • Mechanism of Action: Blocks muscarinic receptors, reducing parasympathetic activity
• Indications: Bradycardia, pre-anesthetic medication
• Nursing Role:
o Monitor heart rate
o Assess for anticholinergic side effects

V. Vasodilators
A. Nitrates (e.g., Nitro-glycerine)
• Mechanism of Action: Dilates blood vessels, reducing preload and afterload
• Dosage: Sublingual tablets, transdermal patches
• Indications: Angina pectoris
• Nursing Role:
o Monitor blood pressure
o Educate patients on proper use and storage

VI. Antianginal Agents

A. Calcium Channel Blockers (e.g., Amlodipine)
• Mechanism of Action: Inhibit calcium influx, leading to vasodilation
• Dosage: 5–10 mg orally daily
• Indications: Angina, hypertension
• Nursing Role:
o Monitor for peripheral oedema
o Assess blood pressure regularly

Table 4: Antianginals

Drug Class Mechanism Dose Side Effects

Blocks calcium Peripheral oedema,

Amlodipine CCB** 5–10 mg OD
channels flushing

Isosorbide 10–40 mg
Nitrate Vasodilation Headache, tolerance
Dinitrate TDS

Late Na+ channel Reduces myocardial 500–1000 Dizziness, QT

Ranolazine
blocker ischemia mg BD prolongation

5–7.5 mg
Ivabradine If channel inhibitor Lowers heart rate Luminous phenomena
BD

10–20 mg
Nicorandil K+ channel opener Vasodilation Ulceration, headache
BD

VII. Antiarrhythmic Agents

A. Amiodarone
• Mechanism of Action: Prolongs phase 3 of the cardiac action potential
• Dosage: Loading dose followed by maintenance
• Indications: Ventricular arrhythmias
• Nursing Role:
o Monitor ECG
 o Assess for signs of pulmonary toxicity

Table 5: Antiarrhythmics (Vaughan-Williams Classification)

Drug Class Mechanism Dose Indications

Ventricular
Lidocaine Class IB Blocks Na+ channels 1–4 mg/min IV
tachycardia

200–400 mg
Amiodarone Class III Prolongs action potential Atrial fibrillation
OD

Class II (β- Reduces sympathetic SVT***,

Atenolol 25–100 mg OD
blocker) activity hypertension

40–120 mg
Verapamil Class IV (CCB) Blocks Ca2+ channels PSVT****
TDS

200–400 mg
Quinidine Class IA Blocks Na+/K+ channels Atrial flutter
QID

SVT = Supraventricular Tachycardia; PSVT = Paroxysmal SVT.

VIII. Antihypertensive Agents

A. ACE Inhibitors (e.g., Lisinopril)
• Mechanism of Action: Inhibit conversion of angiotensin I to II, lowering blood
pressure
• Dosage: 10–40 mg orally daily
• Indications: Hypertension, heart failure
• Nursing Role:
o Monitor renal function
o Assess for cough

Table 6: Antihypertensives

Drug Class Mechanism Dose Side Effects

5–10 mg
Amlodipine CCB Vasodilation Edema, dizziness
OD

Inhibits angiotensin- 5–40 mg

Lisinopril ACE inhibitor Cough, hyperkalemia
converting enzyme OD

Thiazide 12.5–25 Hypokalemia,

Hydrochlorothiazide Reduces blood volume
diuretic mg OD hyponatremia

80–160 Dizziness, renal

Valsartan ARB Blocks angiotensin II
mg OD impairment

β-blocker + α- 12.5–25 Fatigue,

Carvedilol Reduces cardiac output
blocker mg BD bronchospasm
IX. Coagulants and Anticoagulants
A. Warfarin
• Mechanism of Action: Inhibits vitamin K-dependent clotting factors
• Dosage: Adjusted based on INR
• Indications: Atrial fibrillation, DVT
• Nursing Role:
o Monitor INR levels
o Educate on dietary vitamin K intake

Table 7: Coagulants

Drug Class Mechanism Dose Indications

Synthesizes clotting 1–10 mg

Vitamin K Coagulant Warfarin overdose
factors IM/IV

Tranexamic Inhibits plasminogen Menorrhagia,

Antifibrinolytic 1 g TDS
Acid activation trauma

Synthetic Releases von Willebrand 0.3 mcg/kg

Desmopressin Hemophilia A
vasopressin factor SC

Table 8: Anticoagulants
Drug Class Mechanism Dose Side Effects

Inhibits clotting Bleeding,

Warfarin Vitamin K antagonist 2–10 mg OD
factors teratogenicity

Parenteral Activates 5000–10,000 U HIT*****,

Heparin
anticoagulant antithrombin III SC osteoporosis

Rivaroxaban DOAC****** Direct Xa inhibition 10–20 mg OD GI bleeding

Direct thrombin
Dabigatran DOAC 150 mg BD Dyspepsia
inhibitor

1 mg/kg SC
Enoxaparin LMWH******* Anti-Xa/IIa activity Thrombocytopenia
BD

X. Antiplatelets and Thrombolytics

A. Aspirin
• Mechanism of Action: Inhibits cyclooxygenase, reducing thromboxane A2
• Dosage: 75–325 mg orally daily
• Indications: Prevention of myocardial infarction
• Nursing Role:
o Monitor for gastrointestinal bleeding
o Educate on signs of bleeding
Table 9: Antiplatelets

Drug Class Mechanism Dose Indications

75–325 mg
Aspirin COX inhibitor Inhibits TXA2 synthesis MI, stroke prevention
OD

Clopidogrel P2Y12 inhibitor Blocks ADP receptors 75 mg OD Post-stent placement

Acute coronary
Ticagrelor P2Y12 inhibitor Reversibly inhibits ADP 90 mg BD
syndrome

GP IIb/IIIa Prevents platelet 0.25 mg/kg

Abciximab PCI********
inhibitor aggregation IV

Table 10: Thrombolytics

Drug Class Mechanism Dose Indications

Converts plasminogen to Acute ischemic

Alteplase tPA 0.9 mg/kg IV
plasmin stroke

Bacterial 1.5 million U

Streptokinase Activates plasminogen Acute MI
enzyme IV

XI. Hypolipidemic Agents

A. Statins (e.g., Atorvastatin)
• Mechanism of Action: Inhibit HMG-CoA reductase, lowering cholesterol
• Dosage: 10–80 mg orally daily
• Indications: Hyperlipidemia
• Nursing Role:
o Monitor liver function tests
o Assess for muscle pain

• Table 11: Hypolipidemics

Drug Class Mechanism Dose Side Effects

Inhibits HMG-CoA Myopathy, elevated

Atorvastatin Statin 10–80 mg OD
reductase LFTs

Fenofibrate Fibrate Activates PPAR-α 145 mg OD Gallstones, myositis

Cholesterol
Ezetimibe Inhibits NPC1L1 protein 10 mg OD Diarrhea, fatigue
absorber

500–2000 mg Flushing,
Niacin Vitamin B3 Lowers LDL, raises HDL
OD hyperglycemia
Drug Class Mechanism Dose Side Effects

Increases LDL receptor 75–150 mg SC Injection-site

Alirocumab PCSK9 inhibitor
activity Q2W reactions

XII. Plasma Expanders and Treatment of Shock

A. Albumin
• Mechanism of Action: Increases plasma oncotic pressure
• Dosage: Based on patient needs
• Indications: Hypovolemic shock
• Nursing Role:
o Monitor for fluid overload
o Assess vital signs

XIII. Drugs Used to Treat Blood Disorders

A. Hydroxyurea
• Mechanism of Action: Inhibits DNA synthesis
• Indications: Sickle cell anaemia
• Nursing Role:
o Monitor complete blood counts
o Educate on adherence to therapy

XIV. Role of the Nurse

• Assessment: Monitor vital signs, laboratory values, and patient symptoms
• Administration: Ensure correct dosage and route
• Education: Inform patients about medications, side effects, and adherence
• Monitoring: Observe for therapeutic

XV. Case Studies

Case Studies
Case 1: Iron-Deficiency Anemia in Pregnancy
Patient: 28-year-old pregnant woman with Hb 8 g/dL.

Drugs: Ferrous Sulphate (200 mg TDS), Folic Acid (5 mg OD).

Nursing Actions: Advise taking iron with vitamin C for absorption.

Monitor for constipation and fatal well-being.

Case 2: Atrial Fibrillation on Anticoagulation

Patient: 70-year-old male with CHA2DS2-VASc score 4.

Drugs: Rivaroxaban (20 mg OD), Metoprolol (50 mg BD).

Nursing Actions: Educate on bleeding precautions.

Avoid NSAIDs and monitor renal function.

Case 3: Hypertensive Emergency
Patient: 55-year-old female with BP 200/120 mmHg.

Drugs: Labetalol (20 mg IV), Nitroglycerin infusion.