Cardiac Glycosides, Antianginals, and Antidysrhythmics Flashcards
normal value of ANP
20-77
more sensitive than ANP for diagnosing HF
BNP
normal range for BNP
less than 100 pg/mL
nonpharm measures to treat HF
2 g/day of salt
decrease alcohol intake
limit fluid intake
avoid smoking
lose weight
decrease sat fat
mild exercise (walking, biking)
agents used in HF
glycosides, phosphodiesterase inhibitors, vasodilators, ACE inhibitors, ARBs, diuretics, spironolactone, nesiritide, some beta blockers
cardiac glycoside
digoxin
3 effects of digitalis on the heart
positive inotropic (increase contractility)
negative chronotropic (decrease HR)
negative dromotropic (decreases conduction of heart cells)
cardiac glycosides are also used to correct what
a-fib and a-flutter
accomplished by negatove chronotropic and negative dromotropic effects
therapeutic serum lvl for dig for dysrhythmias
0.8-2.0 ng/mL
therapeutic serum lvl for dig for HF
0.5-1.0 ng/mL
symptoms of dig toxicity
anorexia, diarrhea, N/V, bradycardia, dysrhythmias, headaches, malaise, blurred vision, visual illusions (white, green, or yellow halos around objects), confusion, and delirium
older adults more at risk
antidote for dig
digoxin-immune Fab (digibind)
what increases the effect of digoxin at its myocardial cell site of action, resulting in dig toxicity
hypokalemia (low K+)
what can interact with dig
diuretic, cortisone (hypokalemia), and antacids (decrease absorption)
this drug group inhibits the enzyme PDE, which promotes a positive inotropic response and vasodilation
phosphodiesterase inhibitors
a phosphodiesterase inhibitor (admin IV no longer than 48-72 hrs)
need to be on EKG bc dysrhythmias may result
milrinone lactate (high alert)
decrease venous blood return to the heart and result in a decrease in cardiac filling, ventricular stretching (preload), and oxygen demand on the heart
vasodilators
dilate venules and arteriole, which improves renal blood flow and decreases blood fluid volume
ACE inhibitors
-pril
for pts who cannot tolerate ACE inhibitors
ARBs
-sartan
first-line drug treatment in reducing fluid volume
diuretics
potassium sparing diuretic
spironolactone
an ANP that inhibits ADH by increasing sodium loss; effect is achieved by promoting vasodilation, natriuresis, and diuresis
nesiritide
a combo of hydralazine (for BP) and isosorbide dinitrate (a dilator) has been approved to treat HF especially in who
african americans
new med that regulates vascular tone and contraindicated in pregnancy
vericiguat
a condition of acute cardiac pain caused by inadequate blood flow to the myocardium due to either plaque occlusions within or spasms of the coronary arteries
angina pectoris
types of angina
classic (stable)- predictable with stress or exertion
unstable (preinfarction)- frequently with progressive severity, unpredictable
variant (prinzmetal)- during rest caused by vessel spasm
types of antianginal drugs
nitrates, beta blockers, and CCBs
first agents used to relieve angina
generalized vasodilation and can cause hypotension
nitrates
decreases preload and afterload
used for variant angina
nitrates and CCBs
side effects of nitrates
headaches, hypotension, dizziness, flushing, weakness, faintness
taper dose to prevent myocardial ischemia
reflex tachycardia if given too rapidly
decrease the effects of the sympathetic nervous system by blocking the action of the catecholamines, epi and norepi, thereby decreasing the heart rate and blood pressure
beta blockers
selective beta 1 blocker (cardioselective)
atenolol and metoprolol (A BEAM)
nonselective beta blocker side effects
bronchospasm, agitation, dizziness, drowsiness, confusion, cool extremities, and ED (with propranolol)
relax coronary artery spasm and relax peripheral arterioles, decreasing cardiac oxygen demand.
negative inotropic and decrease afterload, and peripheral resistence, and they reduce the workload of the heart which decreases the need for oxygen
CCBs
check LFTs
calcium activates myocardial contraction, increasing the workload of the heart and the need for more oxygen
side effects of CCBs
headache, hypotension, dizziness, and flushing of skin
reflex tachycardia can occur as a result of hypotension
check LFTs
what IV med can decrease the effects of heparin
nitro
defined as any deviation from the normal rate or pattern of the heartbeat
rates that are too slow, too fast, or irregular
cardiac dysrhythmia
4 classes of antidysrhythmics
I sodium channel blockers
II beta blockers
III drugs that prolong repolarization
IV CCBs
slow conduction and prolong repolarization (quinidine, procainamide, disopyramide)
Class IA
slow conduction and shorten repolarization (lidocaine, mexiletine HCl)
Class IB
prolong conduction with little to no effect on repolarization (flecainide)
Class IC
reduce calcium entry
decrease conduction velocity, automaticity, and recovery time (refractory period)
Class II beta blockers
prolong repolarization during ventricular dysrhythmias
prolong action potential duration
Class III (emergency treatment of ventricular dysrhythmias) (amiodarone)
block calcium influx
slow conduction velocity
decrease myocardial contractility (negative inotropic)
increase refraction in AV node
Class IV CCBs
all antidysrhythmic drugs are potentially _____
prodysrhythmic
