Ch 21 Cardiac Glycosides & HF

Question 0

What are the meds for choice for HF

Answer 0

ACE INHIBITORS
ARBs
Beta blockers

Question 1

The inability of the heart to pump blood sufficiently results in what

Answer 1

Decreased tissue perfusion
Left side HF- dyspnea, cough, and oliguria
Right side HF- systemic congestion with peripheral edema, jugular vein distention and wt gain

Question 2

What is a secondary med given if the choice of meds for HF Are unaffected

Answer 2

Cardiac glycosides

Question 3

What is the prototype drug of cardiac glycosides

Answer 3

Digoxin ( lanoxin, lanoxicaps, digitek)

Question 4

What is the pharmalogical action of cardiac glycosides

Answer 4

Positive inotropic effect= increased force of myocardial contraction this improves SV and cardiac output
Neg inotropic effect= decreased HR
at therapeutic levels, digoxin slows the rate of SA NODE depolarization and the rate of of impulses thru the conduction system of the heart
A decreased HR gives the ventricle more time to fill with blood coming from the atria, which leads to increased SV and increased CO

Question 5

What are the therapeutic uses of cardiac glycosides

Answer 5

Treatment of HF

dysrhythmias ( atrial fibrillation)

Question 6

What are the adverse effects of cardiac glycosides

Answer 6

Dysrhythmias
Cardio toxicity
GI effects include anorexia, nausea, vomiting and abdominal pain
CNS effects include fatigue, weakness, vision changes,

Question 7

What are serum K+ levels

Answer 7

3.5-5

Question 8

What are therapeutic serum levels of digoxin

Answer 8

0.5-2

Question 9

Cardiac glycosides are contraindicated in what

Answer 9

Pregnancy category C
cilents who have disturbances in ventricular rhythm, including ventricular fibrillation, ventricular tachycardia and 2nd and 3rd degree heart block.
Use cautiously in ppl who have hypokalemia, partial AV block, advanced HF and renal insufficiency

Question 10

What are medication food interactions of cardiac glycosides

Answer 10

Thiazides diuretics and loop diuretics may lead to hypokalemia,which increases the risk of developing dysrhythmias
Ace inhibitors and ARBs increase the risk of hyperkalemia which can lead to decreased effects of digoxin
Sympathomimetic meds such as dopamine
Quinidine increases the risk of digoxin toxicity
Verapamil increases plasma levels of digoxin
Antacids decrease absorption of digoxin

Question 11

What are indications of digoxin toxicity

Answer 11

Fatigue, weakness, vision changes, GI effects

Question 12

When administering digoxin via IV what is a priority

Answer 12

Infuse over at least 5 min and monitor for dysrhythmias

Question 13

How can a nurse manage digoxin toxicity

Answer 13

1. Digoxin and K+”sparing meds should be stopped immediately
2. Monitor k+ levels… For levels less than 3.5 administer k+ IV or PO
3. Treat dysrhythmias with phenytoin or lidocaine
4. Treat bradycardia with atropine
5. For excessive overdose, activated charcoal, cholestyramine, or digiblind can b used to bind digoxin

Question 14

How can a nurse tell if digoxin therapy is effective

Answer 14

Control of HF

Absence of cardiac dysrhythmias

Question 15

What is the prototype drug of ADRENERGIC AGONISTS

Answer 15

Catecholamines

• epinephrine ( adrenaline)
• dopamine ( Inotropic)
• dobutamine

Other meds:
* Isoprotenerol: Catecholamine
Terbutaline: noncatecholamine

Question 16

What is the purpose of alpha1?

Answer 16

Activation of receptors in arterioles of skin, viscera, and mucous membranes, and veins leads to vasoconstriction

Question 17

What is the purpose of beta1

Answer 17

Heart stimulation leads to increased HR, increased myocardial contractility, and increased rate of conduction through the AV node

Activation of receptors in the kidney lead to the release of renin

Question 18

What is the purpose of beta2

Answer 18

Activation of receptors in the arterioles of the heart, lungs and skeletal muscle leads to vasodilation
Bronchial stimulation leads to bronchodilation
Activation of receptors in the uterine smooth muscle causes muscle relaxation
Activation of receptors in the liver causes glycogenolysis
Skeletal muscle receptor activation leads to muscle contraction

Question 19

What is the purpose of dopamine

Answer 19

Activation of receptors in the kidney cause the renal blood vessels to dilate

Question 20

What is the therapeutic use of alpha1

Answer 20

Slows absorption of local anesthetics
Manages superficial bleeding
Decreased congestion of nasal mucous
Increased BP

Question 21

What Is the therapeutic use of beta1

Answer 21

Treatment of AV block and cardiac arrest

Question 22

What is the therapeutic use of beta2

Answer 22

Asthma

Question 23

A low dose of dopamine is used for what

Answer 23

Shock
HF
BY THE EFFECT OF RENAL BLOOD VESSEL DILATION

Question 24

What are adverse effects of epinephrine

Answer 24

Vasoconstriction fro activation of alpha1 receptors in the heart can lead to hypertensive crisis
Beta1 receptor activation in the heart can cause dysrhythmias, beta1 receptor activation also increases O2 demand, leading to the development of angina

Question 25

What are adverse effects of dopamine

Answer 25

Beta1 receptor activation in the heart can cause dysrhythmias, it also increases the workload of the heart and increase O2 demand, leading to development of angina
Necrosis can occur fro extravasation of high doses of dopamine

Question 26

What are adverse effects of dobutamine

Answer 26

Increased HR

Question 27

What pregnancy category is epinephrine and dopamine

Answer 27

C

Question 28

What pregnancy category is dobutamine

Answer 28

b

Question 29

Epinephrine, dopamine, and dobutamine should be used cautiously in who

Answer 29

Clients who have hyperthyroidism, angina, history of MI, HTN, and diabetes

Question 30

What drug should be avoided while using epinephrine

Answer 30

MAOIs, which can prolong the effects of epinephrine
TCAs block uptake of epinephrine, which will prolong and intensify effects of epinephrine
General anesthetics can cause the heart to become hypersensitive to the effects of epinephrine, leading to dysrhythmias

Question 31

What promotes beneficial effects of dopamine

Answer 31

Diuretics

Question 32

What drug may be used to treat epinephrine toxicity

Answer 32

Phentolamine

Question 33

What med can place a client at risk for digoxin toxicity

Answer 33

Verapamil ( Calan) a calcium channel blocker can increase digoxin levels

Question 34

What are indications of digoxin toxicity

Answer 34

Fatigue,
Anorexia
Diplopia

Question 35

If a clients digoxin level is 0.25 what should the nurse anticipate

Answer 35

An increase in the clients digoxin dose.