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HLT-LPN37-02 · Lesson 8 · 18 clock hours · theory

Drug Classifications Part 1: Cardiovascular, Respiratory, and Analgesic Agents

Objective. The student will describe the mechanism of action, therapeutic uses, major adverse effects, contraindications, and LPN nursing implications for cardiovascular, respiratory, and analgesic drug classes.

⚠ Pending professional review

This lesson, its worked examples and its practice questions has not yet been verified by a licensed clinician in the field or by a certification or approval body. It is a study draft and may contain errors. Do not use it to make decisions about any patient or medication. Always follow your instructor, your supervising professional, and current official references and regulations.

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Drug Classifications Part 1: Cardiovascular, Respiratory, and Analgesic Agents

Understanding how drugs work—and what to watch for when giving them—is one of the most important skills you will carry into every clinical shift. This lesson covers three major body-system categories: cardiovascular agents, respiratory agents, and analgesic agents.

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Cardiovascular Agents

Antihypertensives

ACE Inhibitors (examples: lisinopril, enalapril) block the enzyme that converts angiotensin I to angiotensin II, a potent vasoconstrictor. By preventing that conversion, blood vessels relax and blood pressure falls. Therapeutic uses include hypertension, heart failure, and protection of the kidneys in diabetic patients. Key adverse effects are a persistent dry cough, hypotension (especially after the first dose), and hyperkalemia. A rare but life-threatening effect is angioedema—swelling of the lips, tongue, or throat. If angioedema occurs, stop the drug and call for emergency help immediately. ACE inhibitors are contraindicated in pregnancy.

Beta-Blockers (examples: metoprolol, atenolol, carvedilol) block beta-adrenergic receptors in the heart, slowing heart rate and reducing the force of contraction. Uses include hypertension, angina, heart failure, and certain arrhythmias. Adverse effects include bradycardia, fatigue, and bronchospasm (especially with non-selective agents). Nursing priority: Always check the apical pulse for a full minute before giving a beta-blocker. Hold the dose and notify the nurse in charge or provider if the heart rate is below 60 beats per minute (or per facility policy). Never stop a beta-blocker abruptly—rebound tachycardia or angina can result.

Calcium Channel Blockers (examples: amlodipine, diltiazem, verapamil) prevent calcium from entering cardiac and smooth-muscle cells, reducing heart rate and dilating arteries. Uses include hypertension, angina, and some arrhythmias. Adverse effects include hypotension, reflex tachycardia (with dihydropyridines such as amlodipine), constipation, and peripheral edema. Monitor blood pressure and pulse before each dose.

Antiarrhythmics

Antiarrhythmic drugs (examples: amiodarone, lidocaine, adenosine) work through several mechanisms to restore normal heart rhythm. Amiodarone, one of the most commonly used, prolongs the cardiac action potential. Because amiodarone can cause serious toxicity—pulmonary fibrosis, thyroid dysfunction, and liver damage—patients require close monitoring. As an LPN, your responsibilities include monitoring vital signs, watching for signs of toxicity, and reporting changes promptly. Administration of antiarrhythmics via IV infusion is generally managed by the RN; know your facility's scope-of-practice policy.

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Respiratory Agents

Bronchodilators

Short-acting beta-2 agonists (SABAs) such as albuterol are the first-line rescue inhalers for acute bronchospasm in asthma or COPD. They stimulate beta-2 receptors in the lungs, relaxing bronchial smooth muscle and opening airways within minutes. Adverse effects include tachycardia, tremor, and nervousness. Teach patients to use the rescue inhaler for sudden symptoms, not for routine daily control.

Long-acting beta-2 agonists (LABAs) such as salmeterol are for maintenance, not rescue. Using a LABA without an inhaled corticosteroid in asthma carries safety risks and is generally avoided per clinical guidelines.

Inhaled Corticosteroids

Inhaled corticosteroids (ICS) (examples: fluticasone, budesonide) reduce airway inflammation and are the cornerstone of long-term asthma control. They do not provide immediate relief of bronchospasm. Key adverse effects are oral candidiasis (thrush) and hoarseness. Nursing implication: Teach patients to rinse the mouth and throat with water and spit after each use to prevent thrush. ICS have far fewer systemic side effects than oral steroids, but long-term high-dose use can affect bone density.

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Analgesic Agents

Opioid Analgesics

Opioids (examples: morphine, oxycodone, hydromorphone, tramadol) bind to opioid receptors in the brain and spinal cord, reducing perception of pain. They are used for moderate-to-severe pain, post-operative pain, and cancer pain. Critical adverse effect: respiratory depression. Monitor respiratory rate before and after administration. A respiratory rate below 12 breaths per minute is a warning sign; below 10 is a medical emergency. Hold the dose and notify the provider immediately if the respiratory rate is dangerously low. Other adverse effects include sedation, constipation (anticipate and plan bowel regimen), nausea, and urinary retention. Naloxone is the reversal agent for opioid overdose and must be available wherever opioids are given. Opioids are controlled substances; follow all facility policies for documentation and disposal.

NSAIDs

Non-steroidal anti-inflammatory drugs (examples: ibuprofen, naproxen, ketorolac) inhibit cyclooxygenase (COX) enzymes, reducing prostaglandin synthesis and thus decreasing pain, fever, and inflammation. Uses include mild-to-moderate pain, arthritis, and fever. Major adverse effects are gastrointestinal irritation and bleeding, renal impairment, and increased cardiovascular risk with long-term use. Give oral NSAIDs with food or milk. Contraindications include active GI bleeding, severe renal impairment, and allergy to aspirin or other NSAIDs. Use cautiously in older adults and patients already on anticoagulants.

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The Six Rights and Safety

For every drug in every category, apply the rights of medication administration: right patient, right drug, right dose, right route, right time, and right documentation. For cardiovascular and opioid drugs especially, assessment before and after administration is non-negotiable. When in doubt, hold the dose and consult the charge RN or provider—this is always within your scope as an LPN.

Key terms10

ACE inhibitorA drug that blocks the angiotensin-converting enzyme, preventing the formation of angiotensin II, thereby lowering blood pressure and reducing cardiac workload.
AngioedemaRapid swelling of the deeper layers of skin, often affecting the lips, tongue, or throat; a rare but life-threatening adverse effect of ACE inhibitors requiring immediate emergency response.
Beta-blockerA drug that blocks beta-adrenergic receptors, decreasing heart rate and blood pressure; the apical pulse must be checked before each dose.
BronchodilatorA drug that relaxes bronchial smooth muscle to widen airways; short-acting agents (e.g., albuterol) are used for acute rescue, while long-acting agents are used for maintenance.
Inhaled corticosteroid (ICS)An anti-inflammatory steroid delivered by inhaler used for long-term control of asthma; associated with oral candidiasis if the mouth is not rinsed after use.
Opioid analgesicA controlled substance that binds opioid receptors to relieve moderate-to-severe pain; the most critical adverse effect is respiratory depression.
NaloxoneAn opioid antagonist used to rapidly reverse opioid-induced respiratory depression; must be readily available wherever opioids are administered.
NSAIDNon-steroidal anti-inflammatory drug that inhibits COX enzymes to reduce pain, fever, and inflammation; major risks include GI bleeding and renal impairment.
BradycardiaA heart rate below 60 beats per minute; a key adverse effect of beta-blockers that requires the LPN to hold the dose and notify the provider.
Calcium channel blockerA drug that blocks calcium entry into cardiac and vascular smooth-muscle cells, reducing blood pressure and heart rate; used for hypertension, angina, and arrhythmias.
In class: Students complete a drug-classification grid for antihypertensives (ACE inhibitors, beta-blockers, calcium channel blockers), antiarrhythmics, bronchodilators, corticosteroids (inhaled), opioid analgesics, and NSAIDs—filling in mechanism, use, adverse effect, and nursing priority for each. · Case study analysis in small groups: each group receives a patient scenario (e.g., patient prescribed metoprolol with a heart rate of 52, or a patient on morphine with a respiratory rate of 10) and must identify the problem, state the LPN action, and cite which right of administration was relevant. · Flashcard competition: instructor calls out a drug name, students race to write mechanism and one key nursing implication on individual whiteboards; answers are discussed and corrected immediately.
Materials: Pharmacology textbook; drug-classification grid worksheet; case study packets; individual student whiteboards or dry-erase sleeves; drug handbook (Davis's Drug Guide or Nursing Drug Handbook)
Check: Drug classification quiz covering 30 drugs across the three categories; student must score 80% or higher to proceed.

Practice check8

Answer each question, then check it. Nothing is recorded; this is your own practice.

Pharmacological and Parenteral Therapies
1. A patient prescribed lisinopril reports new swelling of the lips and difficulty swallowing. What is the LPN's priority action?
Pharmacological and Parenteral Therapies
2. Before administering metoprolol 25 mg orally, the LPN assesses an apical heart rate of 52 beats per minute. Which action is most appropriate?
Pharmacological and Parenteral Therapies
3. A patient on morphine PCA has a respiratory rate of 10 breaths per minute and is difficult to arouse. What is the LPN's immediate priority?
Pharmacological and Parenteral Therapies
4. A patient with asthma asks why they must rinse their mouth after using their fluticasone inhaler. What is the best explanation?
Pharmacological and Parenteral Therapies
5. Which drug classification works by inhibiting cyclooxygenase enzymes to reduce inflammation and pain?
Pharmacological and Parenteral Therapies
6. A patient with a history of active gastrointestinal bleeding is prescribed ketorolac for post-operative pain. What is the LPN's best action?
Health Promotion and Maintenance
7. A patient using albuterol inhaler reports it is not working as quickly as it used to. The LPN observes that the patient is using it daily for routine symptom control. Which teaching point is most important?
Pharmacological and Parenteral Therapies
8. Which adverse effect is most closely associated with long-term use of amiodarone?
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