Reference — Pharmacology
Cardiac Medication Classes Reference
A comprehensive reference for the major cardiac drug classes used in nursing practice — with mechanisms, examples, primary uses, and key adverse effects for each class.
Educational use only. Cardiac medication administration requires assessment of BP and HR before each dose. Hold parameters, dose adjustments, and titration are individualized and provider-ordered. Follow your facility protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Cardiac Drug Classes — Quick Reference
| Drug Class | Mechanism | Examples | Primary Uses | Key Adverse Effects |
|---|---|---|---|---|
| ACE Inhibitors | Block ACE → prevent angiotensin I → II → vasodilation, ↓ aldosterone | Lisinopril, enalapril, captopril, ramipril | Hypertension, HFrEF, post-MI, diabetic nephropathy | Dry cough (bradykinin), hyperkalemia, hypotension (first dose), angioedema (rare — life-threatening) |
| ARBs | Block AT₁ angiotensin receptors → vasodilation. No bradykinin effect (no cough). | Losartan, valsartan, candesartan, olmesartan | Hypertension, HF, diabetic nephropathy; used when ACE inhibitor not tolerated | Hyperkalemia, hypotension, dizziness; angioedema (rare); contraindicated in pregnancy |
| ARNIs | ARB + neprilysin inhibitor → ↑ natriuretic peptides → vasodilation and natriuresis | Sacubitril/valsartan (Entresto) | Chronic HFrEF (EF ≤ 40%) — reduces mortality | Hypotension, hyperkalemia, angioedema; never combine with ACE inhibitor (wait 36 hours after last dose) |
| Beta-Blockers | Block β₁ (cardiac) ± β₂ receptors → ↓ HR, BP, contractility, myocardial O₂ demand | Metoprolol, carvedilol, atenolol, bisoprolol | Hypertension, HFrEF, angina, post-MI, AF rate control, arrhythmias | Bradycardia, hypotension, fatigue, bronchospasm, masking of hypoglycemia; never stop abruptly |
| CCBs — Dihydropyridines | Block L-type Ca²⁺ channels in vascular smooth muscle → peripheral vasodilation | Amlodipine, nifedipine, felodipine | Hypertension, angina (vasospastic and stable) | Peripheral edema, flushing, headache, reflex tachycardia |
| CCBs — Non-Dihydropyridines | Block Ca²⁺ in cardiac + vascular → slow SA node, AV conduction, + vasodilation | Diltiazem, verapamil | AF/flutter rate control, angina, SVT, hypertension | Bradycardia, AV block, constipation (verapamil); avoid in decompensated HF or with beta-blockers |
| Nitrates | Release nitric oxide → venous vasodilation → ↓ preload, ↓ myocardial O₂ demand | Nitroglycerin (SL, IV, patch), isosorbide mononitrate, isosorbide dinitrate | Acute angina, angina prevention, acute pulmonary edema, hypertensive urgency | Headache, hypotension, reflex tachycardia, nitrate tolerance (requires nitrate-free interval); fatal with PDE-5 inhibitors |
| Loop Diuretics | Block Na-K-2Cl in loop of Henle → potent diuresis | Furosemide (Lasix), bumetanide, torsemide | Heart failure (fluid overload), pulmonary edema, hypertension, edema states | Hypokalemia, hypomagnesemia, hyponatremia, ototoxicity (high IV doses), dehydration, hypotension |
| Thiazide Diuretics | Block NaCl transporter in distal tubule → moderate diuresis | Hydrochlorothiazide (HCTZ), chlorthalidone, metolazone | Hypertension (first-line), mild edema; not effective with CrCl <30 mL/min | Hypokalemia, hyperuricemia (gout), hyperglycemia, hyperlipidemia, hyponatremia |
| Potassium-Sparing Diuretics | Block aldosterone receptors → ↓ Na reabsorption, retain K⁺ | Spironolactone, eplerenone | HFrEF (mortality benefit), hyperaldosteronism, hypokalemia prevention | Hyperkalemia (dangerous with ACE inhibitors/ARBs), gynecomastia (spironolactone) |
Nursing Monitoring Priorities
Before Every Cardiac Medication
Assess blood pressure and heart rate. Know the hold parameters for each drug. Document vitals and reason for holding if applicable.
Electrolytes
Potassium is critical. Loop and thiazide diuretics deplete K⁺. ACE inhibitors, ARBs, and potassium-sparing diuretics raise K⁺. Monitor renal function — rising creatinine may require dose adjustment.
Cardiac Monitoring
Beta-blockers and non-dihydropyridine CCBs (diltiazem, verapamil) can cause bradycardia and AV blocks. Continuous monitoring recommended when starting or dose-adjusting IV formulations.
Signs of Hypotension
Dizziness, lightheadedness, syncope — especially with first doses of antihypertensives or after aggressive diuresis. Educate to rise slowly (orthostatic precautions).
Critical Drug Interactions
- Nitrates + PDE-5 inhibitors (sildenafil, tadalafil) — severe, potentially fatal hypotension. Absolute contraindication.
- ACE inhibitor + ARB — dual RAAS blockade; increased hyperkalemia and renal failure without proven benefit
- ARNI — must wait 36 hours after last ACE inhibitor dose before starting (angioedema risk)
- Beta-blocker + verapamil/diltiazem — additive bradycardia and AV block; avoid in HF
- Spironolactone + ACE inhibitor/ARB — hyperkalemia risk; close monitoring required
- Loop diuretics + aminoglycosides — additive ototoxicity
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Institute for Safe Medication Practices (ISMP) · FDA prescribing information · The Joint Commission — National Patient Safety Goals. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →