Cardiovascular Drugs Flashcards
Cardiotonic and inotropic indication
Used on people that still have symptoms after using ACE inhibitors, diuretics and beta blockers, but can be used in acute situations of heart failure, however their use is decreasing. Used for heart failure and atrial fibrillation
Cardiotonic/inotropic ex
Digoxin, ivabradine, milrinone (inotropic), amrinone
Cardiotonic/inotropic considerations
Stop if low blood pressure, monitor blood pressure and heart rate, caution in patients with electrolyte imbalance
Left ventricular heart failure symptoms
Decreased cardiac output, orthopnea, moist cough, frothy pink sputum, dyspnea, decreased ejection fraction
Right ventricular heart failure symptoms
Neck vein distension, peripheral edema, weight gain, haptic engorgement, nocturia
Cardiotonic/inotropic side effects
Arrhythmia, weakness, drowsy, visual disturbances, arrhythmias, anorexia, nausea
Cardiotonic/inotropic aren’t for people with
Ventricular failure, fast heart rate, cardiac tamponade, AV block, digoxin toxicity, restrictive cardiomyopathy
Cardiotonic/inotropic: what to monitor
Edema, weight gain, lung sounds, jugular veins for distension, sputum, electrolytes, renal function
Cardiotonic/inotropic signs of digoxin toxicity
Anorexia (usually the first sign), nausea, vomiting, diarrhea, weakness, lethargy, headache, drowsiness, visual disturbances, confusion, disorientation, delirium, changes in pulse rate them, electrocardiograph changes, Bradycardia, tachycardia, premature ventricular contractions
Cardiotonic/inotropic administration
IM or IV, and also give potassium supplement
Cardiotonic/inotropic toxicity antidote
Digibind
Anticoagulants indications
Prevention and treatment of DVT, prevention and treatment of atrial fibrillation with embolization, prevention and treatment of PE, adjuvant treatment of MI, prevention of thrombus formation after valve replacement surgery
Anticoagulants ex
Warfarin (oral, most common), heparin (available in low weight, mid of other drugs)
Anticoagulants side effects
Nausea, abdominal cramps, alopecia, urticaria, hepatitis, diarrhea, jaundice, thrombocytopenia, blood dyscrasias, bleeding (most common)
Anticoagulants are not for people with
Active bleeding (except when caused by DIC), TB, leukemia, high BP, ulcers, renal or hepatic disease, pregnancy (oral is cat X, and parenteral is cat C), hemorrhagic disease, lactation, aneurysms, recent eye or CNS surgery
Anticoagulants interactions
Aspirin, acetaminophen, NSAIDs, chloracne hydrate, some antibiotics, some GI drugs
Anuria
Cessation of urine production
Azotemia
Absence of urine production
Diuresis
Production of urine
Edema
Accumulation of a excess water in the body
Gynecomastia
Male Breast enlargement
Hyperkalemia
Increase in potassium levels in the blood
Hypokalemia
Low blood potassium level
Hypertension is frequently treated by
Antihypertensive drug and a diuretic (loop or thiazide)
Diuretics MOA
Altering the excretion or reabsorption of electrolytes (sodium and chloride) in the kidney,
Loop diuretics MOA
Inhibit reabsorption of sodium and chloride in the distal and proximal tubules in the kidney and in the the loop of henle
Thiazide diuretics MOA
Inhibit the reabsorption of sodium and chloride ions in the ascending portion of the loop of henle and the early distal tubule of the nephron. Sodium, chloride, and water are excreted
Potassium sparing diuretics MOA
Blocking reabsorption of sodium in the kidney tubules, reducing the excretion of potassium
Potassium sparing diuretics ex
Spironolactone,
Spironolactone MOA
Antagonize the action of aldosterone, sodium and water are excreted
Osmotic diuretics MOA
Increase the density of the filtrate in the glomerulus, sodium and chloride excretion is increased
Carbonic anhydride inhibitors MOA
Sulfonamides, Without bacteriostatic action that inhibit carbonic anhydride enzymes, and result in the excretion of sodium, potassium, bicarbonate, and water
Diuretics uses
Edema associated with heart failure, corticosteroid/estrogen therapy, cirrhosis of the liver, hypertension, renal disease (acute failure, renal insufficiency, nephrotic syndrome), cerebral edema, acute glaucoma, increased intraocular pressure, seizures, altitude sickness
Spironolactone use
Male to female hormonal therapy for gender dysphoria
Ethacrynic acid use
Short term managemtn of ascites caused by a malignancy, idiopathic edema, or lymphedema
Diuretics: what to do if the patient is at risk for potassium loss
Use potassium sparing diuretics in place of or with other diuretics
Diuretics neuromuscular system side effects
Dizziness, lightheadedness, headache, weakness, fatigue
Diuretics cardiovascular system side effects
Orthostatic hypotension, electrolyte imbalances, glycosuria
Diuretics GI system side effects
Anorexia, nausea, vomiting
Diuretics general side effects
Rash, photosensitivity, hypokalemia
Hypokalemia signs
Extremity paresthesias (numbness or tingling), or flaccid muscles
Potassium sparing diuretics side effects
Hyperkalemia
Potassium sparing diuretics: Hyperkalemia is most likely to occur in
Inadequate fluid intake and urine output, diabetes, renal disease, elderly, severely ill
Spironolactone side effects
Gynecomastia, which is related to both dose and duration of treatment
Diuretics contraindications
Electrolyte imbalances, severe kidney or liver dysfunction, anuria
Mannitol contraindications
Active intracranial bleeding (except during craniotomy)
Potassium sparing diuretics contraindications
Hyperkalemia, pediatric patients
Diuretics precautions
Renal dysfunction , pregnancy (cat C), lactation
Pregnancy cat B diuretics
Ethacrynic acid, torsemide, isosorbide, amiloride, triamterene
Thiazide diuretics pregnancy cat
B
Benzthiazide pregnancy cat
C
Methyclothiazide pregnancy cat
C
Thiazide diuretics precautions
Gout, liver disease, systemic lupus erythematosus, diarrhea, cross sensitivity with sulfonamides, sensitive to tartazine (can cause allergic type reactions or bronchial asthma)
Loop diuretics precautions
Gout, liver disease, systemic lupus erythematosus, diarrhea, cross sensitivity with sulfonamides,
Potassium sparing diuretics precautions
Liver disease or diabetes
Carbonic anhydride inhibitors interactions
Primodone decreases diuretic effectiveness
Loop diuretics interactions
I solas tin and aminoglycosides increase risk of ototoxicity, anticoagulants and thrombolytics increase risk of bleeding, digitalis increases risk of arrhythmias, increased risk of lithium toxicity, hydantoins decrease diuretic effectiveness, NSAIDs and salicylates decrease diuretic effectiveness
Potassium sparing diuretics interactions
ACE inhibitors and potassium increase risk for Hyperkalemia, NSAIDs, salicylates, and anticoagulants decrease diuretic effectiveness, increased risk of allopurinol hypersensitivity, increased effectiveness of anesthetics, antineoplastics extend leukopenia, and antidiabetics cause hyperglycemia
Dehydration signs
Thirst, poor skin turgor, dry mucous membranes, weakness, dizziness, fever, low urine output
Hyponatremia signs
(Excessive sodium loss), cold and clammy skin, decreased skin turgor, confusion, hypotension, irritability, tachycardia
Hypomagnesemia signs
Leg and foot cramps, hypertension, tachycardia, neuromuscular irritability, tremor, hyperactive deep tendon reflexes, confusion, visual or auditory hallucinations, paresthesias
Hypokalemia signs
Anorexia, vomiting, muscle twitching, depression, confusion, bradycardia, impaired thought process, drowsiness
Hyperkalemia signs
Irritability, anxiety, confusion, muscle cramps, numbness, tingling, nausea, diarrhea, arrhythmias, flaccid paralysis
Loop diuretics ex
Bumetanide, ethacrynic acid, furosemide, torsemide
Potassium sparing diuretics ex
Amiloride, spironolactone, triamterene,
Thiazide diuretics ex
Chlorothiazide, chlorthalidone, hydrochlorothiazide, indapamide, metolazone, methyclothiazide
Carbonic anhydrase inhibitors ex
Acetazolamide, methazolamide
Osmotic diuretics
Glycerin, isosorbide, mannitol, urea
Atherosclerosis
Disease characterized by deposits of fatty plaques on the inner walls of arteries
Catalyst
Substance that accelerates a chemical reaction without itself undergoing a change
Cholecystitis
Inflammation of gallbladder
Cholelithiasis
Stones in gallbladder
Cholesterols
Fat like substance produced mostly in the liver of animals
High density lipoproteins (HDLs)
Macro (big) molecules that carry cholesterol from the body cells to the liver to be excreted
Hyperlipidemia
Increase in the lipids in the blood
Lipid
Group of fats or fat-like substances
Lipoprotein
Macromolecule consisting of lipid, and protein; how fats are transported in the blood
Low density lipoproteins
Macromolecules that carry cholesterol form the liver to the body cells
Risk evaluation and mitigation strategies
(REMS) a program of the FDA designed to monitor drugs that have a high risk compared to benefit ratio
Rhabdomylosis
Condition in which muscle damage results in the release of muscle cell contents into the bloodstream
Statins (HMD-CoA reductase inhibitors)
Common name fro drugs that inhibit the manufacture or promote the breakdown of cholesterol
Triglycerides
Types of lipids that circulate in the blood
Xanthomas
Yellow deposits of cholesterol in tendons and soft tissues
Uncontrollable risk factors of hyperlipidemia
Age (men older than 45 and women older than 55), gender (LDL increases in women after menopause), family history of heart disease
Hyperlipidemia controllable factors
Diet, weight, ohycial inactivity
HMG-CoA reductase inhibitors MOA
Inhibit the manufacture of cholesterol, or promote breakdown of cholesterol, LDLs, and serum triglycerides
Statins uses
Hyperlipidemia, primary prevention of coronary events, secondary prevention of cardiovascular events
Statins side effects nature
Mild, transient, well tolerated
Statins side effects
Headache, dizziness, insomnia, memory and cognitive impairment, flatulence, abdominal cramps, constipation, nausea, hyperglycemia in non diabetic patients
Statins contraindications
Serious liver disorders, pregnancy (cat X), lactation, can elevate serum glucose and HbA1c levels in people with diabetes risk
Statins precautions
Alcoholism, non alcohol related liver disease, acute infection, hypotension, trauma, endocrine disorder, visual disturbances, myopathy
Rosuvastatin side effects
Severe muscle toxicity in people taking cyclosporine, Asian people, and with severe renal insufficiency
Statins interactions
Macrolides, erythromycin and clarithromycin increase risk for severe myopathy or rhabdomylosis, amiodarine increases risk of myopathy, niacin increases risk of severe myopathy, protease inhibitors increase plasma levels of statins, verapmil increases risk of myopathy, and increased anticoagulant effect, additive effect with bile acid resins
Lovastatin contraindications
Grapefruit
Simvastatin contraindications
Grapefruit
PCSK9 inhibitors use
Genetic familial hyperlipidemia, or are at a very high risk for cardiovascular disease, and are given if diet changes and statins don’t work
PCSK9 inhibitors ex
Alirocumab, evolocumab
PCSK9 inhibitors administration
Subcutaneous once or twice a month, but are very expensive
PCSK9 inhibitors side effects
Possible cognitive adverse reactions
Bile acid resins MOA
Bind to bile acids to form an insoluble substance that can’t be absorbed by the intestine, forcing the liver to use more cholesterol and causing a decrease in cholesterol levels
Bile acid resins uses
Hyperlipidemia (When diet and exercise don’t work), gallstone dissolution in patients where surgery isn’t recommended
Cholestyramine use
Pruritus associated with partial biliary obstruction
Bile acid resins side effects
Constipation , aggravation of hemorrhoids, abdominal cramps, flatulence, and nausea, and increased bleeding tendencies related to vitamin K malabsorption and vitamin A and D deficiencies
Cholestyramine interactions
Decreased effects of anticoagulants, loss of efficacy of thyroid and hypothyroidism with thyroid hormones,
Bile acid resins interactions
Reduced absorption of fat-soluble vitamins (A, D, E, K) and folic acid. And a decreased serum level of or decreased GI absorption of NSAIDs, penicillin, tetracycline, niacin, digitalis glycosides, furosemide, thiazide diuretics, glipizide, hydrocortisone, methyldopa, propranolol
Fenofibrate MOA
Reducing very low density lipoproteins and stimulating the catabolism of triglyceride rich lipoproteins, which decreases plasm triglycerides and cholesterol
Gemfibrozil MOA
Increases the excretion of cholesterol in the feces, and reduced the production of triglycerides by the liver, lowering serum lipid levels
Gemfibrozil use
Very high serum triglyceride levels who are at risk for abdominal pain and pancreatitis and when diet and exercise don’t work
Fenofibrate use
Adjunctive treatment for reducing LDLs, total cholesterol, and triglycerides in patients with hyperlipidemia
Fibric acid derivatives side effects
Nausea, vomiting, upset GI, diarrhea, cholelithiasis (if this is found they might discontinue), or cholecystitis
Fibric acid derivatives contraindications
Significant hepatic or renal function, primary biliary cirrhosis, lactation
Fibric acid derivatives precautions
Pregnancy (cat C)
Fibric acid derivatives interactions
Enhanced effects of anticoagulants, statins increase risk of rhabdomylosis
Gemfibrozil interactions
Decreased effects if cyclosporine, increased hypoglycemic effects of sulfonylureas
Ezetimibe MOA
Inhibits absorption of cholesterol in the small intestine, leading to decrease of cholesterol in the liver
Niacin use
Adjunctive therapy for lowering very high serum triglyceride levels in patients who are at risk for pancreatitis and for whom diet control doesn’t work
Ezetimibe use
In combinations with other antihyperlipidemics in lipid-lowering treatments
Misc antihyperlipidemics side effects
Nausea, vomiting, abdominal pain, diarrhea, flushing, warmth, itching, tingling
Niacin contraindications
Active peptic ulcer, hepatic dysfunction, arterial bleeding
Niacin precautions
Renal dysfunction, high alcohol consumption, unstable angina, gout, pregnancy (cat C)
Ezetimibe contraindications
Pregnancy and lactation
Mipomersen use
When TLC, statins, and adjuvant Drugs don’t lower LDL levels in people with genetic disorders, but carry severe hepatic Side effects, and are only prescribed as part of REMS
Lomitapide use
When TLC, statins and adjuvant Drugs don’t lower LDL in people with a genetic disorder, but they have severe hepatic reactions, and are only prescribed as a part of REMS
Severe hyperlipidemia signs
Xanthomas
Bile acid resins elderly considerations
Elderly prone to constipation
Statins ex
Atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin
PCSK9 inhibitors ex
Alirocumab, evolocumab
Bile acid resins ex
Cholestyramine, colestipol, colesevelam
Fibric acid derivatives ex
Fenofibrate, gemfibrozil
Angina
Acute pain in the chest resulting from decreased blood supply to the heart muscle
Buccal
Space in the mouth between the gum and the cheek in either the upper or lower jaw
Pulmonary arterial hypertension (PAH)
High blood pressure in the pulmonary artery (heart to lungs), which can result in heart failure if not treated
Sublingual
Under tongue
Primary treatment for angina
CCBs
How to treat PAH
Peripheral vasodilator
Nitrates MOA
Relaxes the smooth muscle layer of blood vessels, increasing the lumen of the artery or arteriole, and increases the amount of blood flowing through the vessels
What do CCBs do to the heart
Slow conduction velocity of the cardiac impulse, depress myocardial contractility, dilate coronary arteries and arterioles, which deliver more oxygen to cardiac muscle
Antianginal drugs use
Relieve pain of acute anginal attacks, prevent angina attacks, treat chronic, stable angina pectoris
Nitrates use
Relieve symptoms when an anginal attack happens
CCBs as an antianginal drug use
Prevent angina from occurring (take on a regular basis)
Nitroglycerin use
Control perioperative hypertension associated with surgical procedures (IV)
Verapmil use
Cardiac arrhythmias, and affects conduction system of the heart
CCBs side effects nature
Not usually serious and don’t require discontinuation
Nitrates side effects
Sever headache, dizziness, weakness, restlessness, hypotension, flushing, rash
Sublingual nitroglycerin side effects
Local buringin or tingling
Transdermal nitroglycerin side effects
Contact dermatitis
Nitrates side effects nature
In many cases, prolonged use causes side effects to lessen, however in other cases, adverse reactions can become more severe, so dose is lowered, until it can be slowly increased
Nitrates contraindications
Severe anemia, closed angle glaucoma, postural hypertension, head trauma, cerebral hemorrhage, constrictive pericarditis, people taking phosphodiesterase inhibitors
Sublingual nitrates contraindications
Early myocardial infarction
Transdermal nitrates contraindications
Allergy to adhesives
Nitrates precautions
Severe hepatic or renal disease, severe head trauma, hypothyroidism
Peripheral vasodilation drugs contraindications
Pregnancy
Nitrates interactions
Aspirin increases nitrate serum concentrations, CCBs increase orthostatic hypotension, dihydroergotamine increases risk of hypertension and decreases antianginal effect, decreased effect of heparin, phosphodiesterase inhibitors and alcohol can cause severe hypotension and cardiovascular collapse
Nitrates ex
Isosorbide, nitroglycerin,
Misc antianginal drugs ex
Ivabradine, ranolazine, nimodipine
Peripheral vasodilator ex
Hydralazine, minoxidil, nitroprusside
Drugs used for PAH
Ambrisentan, bosentan, epoprostenol, iloprost, macitentan, riociguat, treprostinil,
Aggregate
Clumping of blood element
Embolus
Thrombus that detaches from a blood vessel wall and travels through the bloodstream
Fibrolytic
Drug the dissolves clots already formed within blood vessel walls
Hemostasis
Complex process by which fibrin forms and blood clots
Lysis
Dissolution and destruction of cells
Petechiae
Pinpoint sized red hemorrhagic spots on the skin
Prothrombin
Substance that is essential for the clotting if the blood, clotting factor 2
Thrombolytic
Drug that helps to eliminate blood clots
Thrombosis
Formation of a blood clot
Thrombus
Blood clot
Direct thrombin inhibitors (DTIs) ex
Dabigatran (oral), argatroban, bivalirudin,
Desirudin
LMWH ex
Dalteparin, enoxaparin
oral anticoagulants ex
Apixaban, edoxaban, rivaroxaban, rivaroxaban, warfarin
How did DTIs compare to heparin and warfarin
Don’t have the difficult management properties of heparin or warfarin
LMWHs side effects nature
Produce very stable responses, and lab monitoring isn’t needed
Apixaban use
Prevent DVT in people with hip, knee, or abdominal surgeries
Edoxaban use
Prevent DVT in people undergoing hip, knee, or abdominal surgeries
Rivaroxaban use
Prevent DVT in people undergoing hip, knee, or abdominal surgeries
Fondaparinux use
Prevent DVT in people undergoing hip, knee, or abdominal surgeries
Warfarin MOA
Interferes with the manufacturing of vitamin K dependent clotting factors by the liver, resulting in the depletion of clotting factors 2, 7, 11 and 10
Heparin MOA
Inhibits the formation of fibrin clots, inhibits the conversion of fibrinogen to fibrin and inactivated several of the factors necessary for the clotting of blood, can’t be taken orally
LMWHs MOA
Inhibit clotting reactions by binding to antithrombin 3, which inhibits synthesis factor X and the formation of thrombin (no effect in existing clots)
DTIs MOA
Directly inhibit thrombin, and don’t require a cofactor to exert effect
Parenteral anticoagulants use
Prevention of postoperative DVT and PE in people undergoing major surgery, prevention of clotting in heart and arterial surgery, prevention of a repeat cerebral thrombosis in people who have had stroke, treatment of coronary occlusion, acute MI, peripheral arterial embolism, disseminated intravascular coagulation (DIC), maintaining latency of IV catheters (low dose)
Warfarin risk
Narrow therapeutic window, significant risk of hemorrhage
Subcutaneous heparin side effects
Local irritation
Anticoagulants allergic reaction signs
Fever, chills, asthma like reaction
LMWHs contraindications
People allergic to pork
Anticoagulants precautions
Fever, heart failure, diarrhea, diabetes, malignancy, hypertension, renal or hepatic disease, psychoses, depression
Apixaban administrating considerations
Monitored by REMS, because a chance of stroke with discontinuation
Apixaban interactions
Grapefruit will increase serum levels
Rivaroxaban interactions
Grapefruit increases serum levels
Anticoagulants interactions
Aspirin, acetaminophen, NSAIDs, chloracne hydrate, penicillin, aminoglycosides, isoniazid, tetracyclines, cephalosporins, beta blockers, loop diuretics, disulfiram, and cimetidine increase risk of bleeding and oral contraceptives, barbiturates, diuretics and vitamin K decrease anticoagulant effectiveness, spinal anesthesia or spinal punctures can cause spinal or epidural hematoma formation, which can lead to paralysis
Antiplatelet Drugs MOA
Decrease the platelets ability to stick together in the blood, forming a clot
Aspirin MOA as an antiplatelet
Prohibit the aggregation of platelets for the lifetime of the platelet
Adenosine diphosphate receptor blockers (ADP blockers) MOA
Alter the platelet cell membrane, preventing aggregation
Glycoprotein receptor blocker MOA
Prevent enzyme production, inhibiting platelet aggregation
Antiplatelet use
Risk for acute coronary syndrome, MI, stroke, and intermittent claudication
Antiplatelet side effects
Palpitations, bleeding, dizzy, headache, nausea, diarrhea, constipation, dyspepsia
Antiplatelet Drugs contraindications
Pregnancy, lactation, heart failure,active bleeding, thrombotic thrombocytopenic purpura (TTP)
Antiplatelets precautions
Elderly, pancytopenic people, renal or hepatic impairment
Antiplatelet pregnancy cat
C
Clopidogrel pregnancy cat
B
What to do if TTP is diagnosed
Stop antiplatelet treatment immediately
Antiplatelets interactions
Aspirin and NSAIDs increase risk of bleeding, increased effectiveness of macrolides, decreased digoxin serum levels, increased phenytoin serum levels
Thrombolytic Drugs MOA
Break down fibrin clots by converting plasminogen to plasmin (will have an effect on existing thrombus)
Thrombolytic Drugs uses
Acute stroke or MI by lyis of blood clots in coronary arteries, blood clots causing pulmonary embolism and DVT, suspected occlusion in central venous catheters
Thrombolytic Drugs side effects
Bleeding, can be internal in GI tract, genitourinary tract and brain, bleeding can also be external and seen where skin is broken (venipuncture sites and recent surgical wounds), allergic reactions
Thrombolytic Drugs contraindications
Active bleeding, history of stroke, aneurysm, recent intracranial surgery
Thrombolytic Drugs precautions
Recently undergone major surgery (within 10 days), stroke, trauma within the last 10 days, vaginal or C-section delivery, GI bleeding, hypertension, diabetic retinopathy, significant possibility of bleeding, taking oral anticoagulants
Thrombolytic Drugs pregnancy cat
C
Urokinase pregnancy cat
B
Thrombolytics interactions
When given with drugs that prevent blood clots (aspirin, dipyridamole, anticoagulant), there is an increased risk of bleeding
Parenteral anticoagulants ex
Heparin, fondapurinux
Antiplatelet ex
Abciximab, anagrelide, cilostazol, clopidogrel, dipyridamole, eptifibatide, prasugrel, ticagrelor, ticlopidone, tirofiban, vorapaxar
Thrombolytic ex
Alteplase, reteplase, tenecteplase,
Anticoagulant antagonists use
Treats heparin/warfarin overdose
Anticoagulant antagonists ex
Phytonadione, protamine, idarucizumab
Atrial fibrillation
Quivering of the atria if the heart
Cardiac output
Volume of blood discharged from the left or right ventricular per minute
Digitalis toxicity
Toxic drug effects from te administration of digoxin
Heart failure
Condition in which the heart can’t pump enough blood to meet the tissue needs of the body
Left ventricular dysfunction
Conduction in which fluids back up previous to the left ventricle of the heart and is characterized by shortness of breath, and moist cough in heart failure
Neurohormonal activity
In heart failure, increased secretions of epinephrine and norepinephrine, resulting in arteriolar vasoconstriction, tachycardia, myocardial contractility, resulting in a worsening of heart failure and reduced ability of the heart to contract effectively
Positive inotropic activity
Increase in the force of cardiac contraction
Right ventricular dysfunction
Condition in which fluid backs up previous to the right ventricle if the heart and is characterized by peripheral edema and venous congestion in heart failure
Neurohormonal responses affecting heart failure
Increased secretion of the neurohormonal compensatory mechanisms, which results in increased secretion of the neurohormones, activation of the renin-angiotensin-aldosterone system (RAA), and remodeling of cardiac tissue
Ventricular heart failure
Typically left side is affected first, followed by right ventricular involvement
Heart failure symptoms
Left ventricular dysfunction, shortness of breath with exercise, dry, hacking cough or wheezing, orthopnea, restlessness, anxiety, right ventricular dysfunction, swollen ankles, legs or abdomen, anorexia, nausea, nocturia, weakness, weight gain, tachycardia, palpitations, fatigue or pain when performing normal activities, irregular heart rate, dizziness, conduction
Digoxin is continued to be used for
Elderly who have been in the drug for many years, patients using symptoms after using other drugs, and in some cases of atrial fibrillation
Ivabradine use
Slowly replacing digoxin to treat heart failure, and when used with a beta blocker, can reduce hospitalization
milrinone use
Short term, acute management of heart failure when it isn’t controlled by digoxin
Cardiotonic MOA
Increase cardiac output through positive inotropic activity, and slow conduction velocity through the AV node in the heart, don’t cure heart failure, but only control symptoms
Ivabradine MOA
Blocks the If channel and inhibits the pacing of the SA node of the heart
Milrinone MOA
Inotropic actions
Digoxin side effects
Blurred or yellow halo around lights
Ivabradine side effects
Increased brightness
Cardiotonic precautions
Electrolyte imbalance, thyroid disorders, sever carditis, heart block, myocardial infarction, severe pulmonary disease, acute glomerulonephritis, and impaired renal or hepatic function
Digoxin pregnancy cat
C, caution in pregnancy and lactation
Ivabradine contraindications
Pregnant or lactating
Cardiotonics interactions
Absorption slowed when taken with food, but if taken with high fiber meals, absorption is decreased, thyroid hormones require a larger dosage of digoxin, thiazide and loop diuretics increase risk of digoxin induced arrhythmia
Digoxin interactions
Amiodarone, benzodiazepines, indomethacin, itraconazole, macrolides, propafenone, quinidine, spironolactone, tetracyclines, verapmil, and aminoglycosides increase serum digoxin levels (can lead to toxicity), and antacids, antineoplastics, charcoal, cholestyramine, neomycin and rifampin decrease serum digoxin levels
Cardiotonics pediatric considerations
Drug is withheld if pulse in child is below 70, or if pulse in infant is below 90
Who is at higher risk for digoxin toxicity
People with hypokalemia (on diuretics)
Digoxin elderly considerations
Elderly ar more prone to digoxin toxicity, and conditions such as dementia can have similar signs to digoxin toxicity
Action potential
Electrical impulse that passes from cel to cell in the myocardium of the heart and stimulates the fibers to shorten, causing the heart muscle to contract
Depolarization
Movement of ions in a nerve cell from inside to outside and vice versa
Myocardium
The striated, muscle tissue of the heart
Polarization
Status of a nerve cell at rest, with positive ions on the outside of the cell membrane and negative ions in the inside
Proarrhythmic effect
Creation of new arrhythmia or worsening of existing arrhythmia, resulting from administration of an antiarrhythmic Drug
Refractory period
Quiet period between the transmission of nerve impulses along a nerve fiber
Repolarization
Return of positive and negative ions to their original place in the nerve cell after an impulse has traveled along the nerve fiber
Threshold
Any stimulus if lowest intensity that will give rise to a response in a nerve fiber
