NCLEX Cardiovascular Drugs In‑Depth: From ACE Inhibitors to Amiodarone

May 6, 2025

Olivia Carter

NCLEX Cardiovascular Drugs In‑Depth: From ACE Inhibitors to Amiodarone

New to our series? Review
NCLEX Pharmacology Part 1 – Core PK/PD Concepts and
Part 2 – Drug‑Dosage Calculations & High‑Yield Classifications and, **Part 3 – Medication Safety Essentials & Smart Study Strategies**then dive into this cardio cheat‑sheet.


Why Cardiovascular Pharmacology Matters

  • 13–19 % of the NCLEX® is pharmacological and parenteral therapies.
  • The Next‑Generation NCLEX tests clinical‐judgment—understanding why drugs work, what can go wrong, and how to respond quickly and safely.

Foundational Pharmacology for Safe Practice

Pharmacokinetics (ADME) — What the body does to the drug

Phase Key Points NCLEX Pearl
Absorption Route, drug form, first‑pass effect Oral meds may need higher doses than IV because of first‑pass metabolism
Distribution Protein binding, tissue perfusion Only the free drug is active—low albumin ↑ toxicity risk
Metabolism Mostly hepatic (CYP‑450) Liver impairment = dose ↓ or longer interval
Excretion Mostly renal Check BUN/Cr; poor kidneys → drug accumulation

Pharmacodynamics — What the drug does to the body

  • MOA (Mechanism of Action): how a drug produces its effect (receptor agonist, enzyme inhibitor, etc.).
  • Therapeutic effect vs. adverse effect: knowing the MOA predicts both.
  • Clinical judgment: if you know why a drug lowers BP, you know what vitals to monitor and which side effects to anticipate.

The “Rights” of Medication Administration

Right Patient • Drug • Dose • Route • Time • Documentation • Reason • Response • Refuse
Each “Right” involves critical thinking, not just a checklist.


Key Cardiovascular Drug Classes – NCLEX Deep Dive

I. Drugs Affecting the Renin‑Angiotensin‑Aldosterone System (RAAS)

ACE Inhibitors (‑pril)

Cheat‑Sheet
Examples Lisinopril • Captopril • Enalapril
MOA Blocks Ang I → Ang II conversion → vasodilation & ↓ aldosterone
Indications HTN • HF • post‑MI • diabetic nephropathy
Side‑Effects Angio‑edema • Dry cough • ↑ K⁺ • first‑dose hypotension
Nursing Monitor BP & K⁺ • watch for angio‑edema • avoid pregnancy
Mnemonic A C E → Angio‑edema, Cough, Electrolytes

Quick NCLEX vocab tune‑up before the exam?
Review our 50 Must‑Know Nursing Terms for the 2025 NCLEX — complete with definitions, examples, and quick tips to make every question feel familiar.

ARBs (‑sartan)

  • MOA: block Ang II receptors (no cough).
  • NCLEX alerts: hyper‑K⁺, hypotension, angio‑edema (rare), contraindicated in pregnancy.

II. Beta‑Adrenergic Blockers (‑lol)

Cardio‑selective Non‑selective
Examples Metoprolol • Atenolol Propranolol
4 B’s (major risks) Bradycardia • low BP • Bronchospasm plus Blood‑glucose masking
Nursing Hold HR < 60/SBP < 90 • caution in asthma/COPD • taper off

NCLEX Antidote: severe bradycardia → give glucagon (± atropine).

III. Calcium‑Channel Blockers (CCBs)

Dihydropyridines (‑dipine)

  • MOA: arterial vasodilation.
  • Side‑effects: hypotension, peripheral edema, reflex tachycardia.

Non‑DHP — Verapamil, Diltiazem

  • MOA: vascular + cardiac effects (↓ HR, ↓ AV conduction).
  • Indications: HTN, angina, rate control in A‑fib/SVT.
  • Watch: bradycardia, AV block, constipation.

Grapefruit juice ↑ CCB levels → avoid!

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IV. Diuretics

Class Prototype Key NCLEX Points
Loop Furosemide Most potent • hypo‑K⁺/Na⁺/Ca²⁺/Mg²⁺ • ototoxic IV push
Thiazide HCTZ Hypo‑K⁺ • hyper‑Ca²⁺/glycemia/uricemia
K‑Sparing Spironolactone Hyper‑K⁺ • endocrine effects (gynecomastia)

V. Digoxin (Cardiac Glycoside)

  • MOA: + inotrope, – chronotrope.
  • Therapeutic range: 0.5–2 ng/mL.
  • Toxicity signs: anorexia → N/V → vision halos → arrhythmias.
  • Hold if HR < 60; monitor K⁺ (low K⁺ → ↑ toxicity).
  • Antidote: Digoxin immune Fab.

VI. Anti‑arrhythmics

Drug Class High‑Alert Issues
Amiodarone Class III Pulmonary fibrosis • liver & thyroid toxicity • photosensitivity • corneal deposits • long QT
Lidocaine Class IB CNS toxicity (Slurred speech, AMS, Seizures)
Procainamide Class IA Lupus‑like syndrome • blood dyscrasias • QT prolongation

VII. Nitrates (Nitroglycerin, Isosorbide)

Key Facts Nursing Pearls
Venous > arterial dilation → ↓ preload/afterload Sit/lie for SL tablets (1 tab q5 min × 3 then 911)
Common: headache, flushing, hypotension Patch: rotate sites, 10–12 h nitrate‑free interval
Contra: PDE‑5 inhibitors → fatal hypotension Store SL tabs cool/dry, replace q6 mo

VIII. Anticoagulants

Drug Route Monitor Antidote
Warfarin PO INR 2–3 Vitamin K
Heparin (UFH) IV/SQ aPTT 1.5–2.5× Protamine
Enoxaparin SQ Anti‑Xa (PRN) Protamine (partial)

IX. Antiplatelets

  • Aspirin: GI bleed, tinnitus, stop 7–10 d pre‑op, no kids w/ viral illness.
  • Clopidogrel: stop 5–7 d pre‑op, watch GI bleed, PPIs may ↓ effect.

X. Statins (‑statin)

  • MOA: ↓ LDL, ↓ TG, ↑ HDL.
  • Side‑effects: hepatotoxicity, myopathy → rhabdo.
  • Nursing: check LFTs & CK, take in evening, avoid grapefruit juice, pregnancy X.

Universal Nursing Checklist for Cardio Meds

Domain What to Monitor Teaching Points
Vitals Hold HR < 60, SBP < 90 How to self‑check pulse/BP
Weights & I&O ±2 lb/day or ±5 lb/week Report rapid gains (HF)
Electrolytes K⁺, Na⁺, Ca²⁺, Mg²⁺ Diet: K⁺ foods vs. restrictions
Renal / Hepatic BUN/Cr, AST/ALT Importance of lab follow‑ups
Coag Labs INR, aPTT, platelets Bleeding precautions
Lifestyle Adherence, no abrupt stops, avoid grapefruit (statins/CCB), slow position changes Know red‑flag symptoms: chest pain, SOB, swelling, severe dizziness

Conclusion – Your NCLEX Cardio Edge

Link the mechanism of action to side‑effects and nursing interventions, drill the hold parameters, and practise NGN case questions. Pair this cheat‑sheet with GoodNurse’s AI tutor and question bank, and you’ll walk into the NCLEX ready to ace every cardio‑drug scenario.

Next up:

  • [High‑Alert Meds & Error Prevention]
  • [Pediatric Dosage Calculations Made Easy]

Good luck—your future patients’ hearts are counting on you!