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CVPR Exam I > 20. Inotropic Drugs-Limitations in Heart Failure > Flashcards

20. Inotropic Drugs-Limitations in Heart Failure Flashcards

1
Q

Why does hypocalcemia cause dig tox?

A

dig enhances Ca++ absorption by myocytes (that’s the point, but don’t overdo it)

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2
Q

Digoxin can also bind in the ____ and ____ of the heart to slow the HR and treat A-fib.

A

SA node; AV node

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2
Q

What is dobutamine?

A

inotropic drug

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3
Q

What are the s/s of dig tox?

A
  1. GI: upset/pain/vomiting**** 2. neuro: weakness, confusion 3. hyperkalemia 4. cardiac: bradycardia, heart block, arrhythmias 5. visual: sensitivity to light, yellow halos, blurred vision
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4
Q

With increased plasma NE, there is an increased risk of _____ in HF pts.

A

death

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4
Q

_____ increases PNS activity by activating baroreceptors in the carotids and the AA.

A

Digoxin

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5
Q

What is milrinone?

A

an ionotropic drug

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6
Q

_____ are like a protective shield for the heart in overproduction of NE.

A

Beta-blockers

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6
Q

What is the half life of digoxin?

A

38 hours (7-10 days to steady state)

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7
Q

The diuretics end in -____.

A

ide

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7
Q

How does digoxin increase parasympathetic activity?

A

by increasing baroreceptor sensitivity in the carotids and the AA

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8
Q

How does milrinone work?

A

it inhibits phosphodiesterase (PDE) to increase force of contraction and also causes vasodilation

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9
Q

If your pt has a life-threatening dig tox or OD, give _____.

A

digoxine immune Ab

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10
Q

_____ can also bind in the SA and AV node of the heart to slow the HR and treat A-fib.

A

Digoxin

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11
Q

What is the problem with the inotropes?

A

they can be pro-arrhythmic

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12
Q

____ is an inotrope that blocks the Na+/Ca++ ATPase.

A

Digoxin

13
Q

Beta-blockers have been shown to reduce morbidity and mortality and is recommended for all ______ pts unless contraindicated.

A

HFrEF

14
Q

What is dopamine?

A

a precursor of NE; benefits = RIP (renal, inotropic, and pressor effects depending on dose)

15
Q

You would not give _____ to someone already taking a beta-blocker.

A

dobutamine

17
Q

Beta-blockers improve the overall ____ of the heart and decrease mortality over time.

A

ejection fraction

19
Q

Digoxin is an inotrope that blocks the Na+/Ca++ ATPase, causing ____ to accumulate on the ____ side.

A

Na+; intracellular

20
Q

Why does hypomagnesemia cause dig tox?

A

can sensitize the heart to dig-induced arrhythmias

21
Q

Digoxin reduces _____ but does not impact mortality.

A

hospitalization

21
Q

Which has the shorter half life: milrinone or dobutamine?

A

dobutamine

23
Q

Is BMP production good or bad in heart failure? What does BNP do?

A

GOOD! It’s protective: causes vasodilation, lowers BP, reduces symp tone, reduces aldosterone, and causes naturesis/diuresis

23
Q

What electrolytes can cause dig toxicity when low?

A
  1. K+ 2. Ca++ 3. Mg++
24
Q

Digoxin is an inotrope that blocks the _____ channel.

A

Na+/Ca++ ATPase

26
Q

Beta-blockers end in -____.

A

olol

28
Q

Why does hypokalemia cause dig tox?

A

it causes increased dig binding, increasing its effects, bc it binds to the same receptor as K+

29
Q

How does dobutamine work?

A

binds to the beta-1 receptor to increase cAMP and increase intracellular Ca++ to increase inotropy

31
Q

Digoxin has a very _____ therapeutic window.

A

narrow

32
Q

HFpEF is _____ dysfunction.

A

diastolic

33
Q

Overstimulation of the Beta-1 receptor can cause ____.

A

myocyte toxicity and cell death; increased arrhythmias

34
Q

Who are inotropes given to?

A

pts with advanced HF and low output syndrome

35
Q

When is digoxin given?

A
  1. to HFrEF pts 2. A-fib 3. cardiomegaly
36
Q

Digoxin is an _____ that blocks the Na+/Ca++ ATPase.

A

inotrope

37
Q

Digoxin in ____ excreted.

A

renally

38
Q

Digoxin can also bind in the SA and AV node of the heart to ____ and treat ____.

A

slow the HR; A-fib

CVPR Exam I (29 decks)

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