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Pharmacology Cardiac Drugs · 10 min read · April 2026

Beta-Blockers, ACE Inhibitors, and the Cardiac Receptor Map

Cardiac pharmacology becomes far less overwhelming when you see it as a map of receptor locks and drug keys. Every cardiac medication targets a specific receptor on the cell membrane security gate. Once you know what that receptor normally does, you can predict exactly what the drug will do — and what cues to collect when something goes wrong.

The Cardiac Receptor Map
ReceptorNormal JobDrugs That Block ItEffect of BlockKey Cues to Collect
Beta-1 (heart)↑ Heart rate, ↑ contractilityMetoprolol, Atenolol, Carvedilol↓ HR, ↓ BP, ↓ cardiac workloadHR <60 = hold & report; dizziness, fatigue
Beta-2 (lungs)BronchodilationNon-selective beta-blockers (propranolol)Bronchoconstriction riskWheezing, SOB — report if COPD/asthma history
ACE (enzyme)Converts Angiotensin I → II (vasoconstriction + aldosterone)Lisinopril, Enalapril (-pril)Vasodilation, ↓ BP, ↓ aldosterone → less fluid retentionDry cough, angioedema (face/throat) = stop & report
Angiotensin II ReceptorVasoconstriction signalLosartan, Valsartan (-sartan)Vasodilation, ↓ BP — no cough side effectHyperkalemia; dizziness on standing
Aldosterone ReceptorSodium & water retentionSpironolactone (K⁺-sparing diuretic)Diuresis without K⁺ lossHyperkalemia risk; gynecomastia in males
Digoxin — High-Alert Medication

Digoxin strengthens cardiac contractions by blocking the Na⁺/K⁺ pump at the cell membrane, increasing intracellular calcium. Narrow therapeutic window: 0.5 – 2.0 ng/mL. Hypokalemia dramatically increases toxicity risk because low extracellular K⁺ increases digoxin binding.

Before giving digoxin: Check apical pulse for one full minute. Hold and report if HR <60 in adults (or per facility parameter). Check K⁺ level. Report nausea, vomiting, yellow-green visual disturbances — early toxicity cues.

LPN Pharmacology Rule: The LPN administers prescribed cardiac medications and collects vital signs before and after. The LPN does NOT independently adjust doses, determine loading doses, or make therapy decisions. “Hold if HR <60” is a parameter set by the provider — the LPN follows it, documents it, and reports when the parameter triggers.

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