Chapter 24 - Heart Failure

Question 1

digoxin (Lanoxin)

Answer 1

Class: Cardiac Glycoside

• MOA: Improves contractility and pumping ability of heart; (it is a positive inotrope –> lowers HR)
• Use: HF, atrial fibrillation, atrial flutter
• Admin: do not give if HR < 60 bpm, IV push given no less than over 5 minutes
• AE: dig toxicity  dysrhythmias, N/V, loss of appetite, blurred vision/yellow-green halos around lights, mental status changes
• Antidote: digoxin immune fab (Digibind)
• Digoxin level 0.8-2.0 ng/mL –> once it gets at 2.0 and above, med will get held or given Digibind to avoid toxicity

Question 2

milrinone lactate (Primacor)

Answer 2

Class: Phosphodiesterase inhibitors (cardiotonic-inotropic agents)

• Use: short term management of acute severe exacerbations of HR; last resort when patients aren’t responding to other therapies. Increases cardiac output
• AE: fatal ventricular dysrhythmias, can lower BP, chest pain
• Half-life of 80 hours (long time to get to therapeutic dose and out of system; can bolus and give maintenance dose)

Question 3

nesiritide (Natrecor)

Answer 3

Class: Human B-type natriuretic peptide

• MOA: Diuretic effect, decreases secretion of neurologic hormones (ex: norepinephrine, which increases workload of heart)
• Use: peptide is released from ventricles, telling us that patient is in HF, so draw BNP lab (anything less than 300 not worrisome, over 300, like 800-1000 range is that heart is retaining a lot of fluid and fluid overload)
• Given for acute decompensation of heart failure (stage 4 HF)
• AE: Can lower BP and HR, anxiety or headache, ventricular tachycardia