E1:CardiacGLyCOsides

Question 1

What are the three ways the body tries to make up for congestive heart failure? HOW DO WE STOP THIS FROM HAPPENING???

Answer 1

1.increase HR 2.Increase peripheral resistance 3.increase O2 demand….BLOCK THE Sympathetic NERVOUS system!!!

Question 2

Congestive Heart Failure ALMOST ALWAYS causes:

Answer 2

Atherosclerotic coronary artery disease

Question 3

With acute CHF you will likely see?

Answer 3

Acute: shortness of breath

Question 4

Goals of CHF Tx: ______ heart rate to increase the filling time

Answer 4

SLOW

Question 5

Goals of CHF Tx: \_\_\_\_\_\_\_ contractile force to improve the
ejection fraction (make the heart more efficient)

Answer 5

INCREASE (counterintuitive right?!)

Question 6

WHAT IS THE DRUG OF CHOICE FOR CHF? whats its duration? Where is it metabolized?

Answer 6

DIG-OX-in..intermediate duration (6 days)…kidney

Question 7

BIG TOPICDIGOXIN MECH OF ACTION: inhibits the ______ resulting in increased Ca+ inside the cell. This ______ contraction of the heart and causes a _______ INOTRPIC effect.

Answer 7

Na/K PUMP!….INCREASES….POSITIVE

Question 8

DIGOXIN MECH OF ACTION: Directly suppresses ______ conduction to increase _____ and DECREASE conduction velocity…has a ______ CHRONOTROPIC effect

Answer 8

AV node …ERP…NEGATIVE

Question 9

DIGOXIN MECH OF ACTION: causes _______ and therefore decreases venous return…decreases filling pressure, decreases heart rate, decreases heart size

Answer 9

DIURESIS

Question 10

99 Problems and CHF AINT ONE; Increased vagal output = can be blocked by ______ (anticholinergic drug)

Answer 10

Atropine

Question 11

99 Problems and CHF AINT ONE; Slowing of AV conduction = can slow too much, which allows for ectopic foci = _________*** can arise

Answer 11

uncoordinated arrhythmias

Question 12

99 Problems and CHF AINT ONE; Low therapeutic index = therapeutic dose is approximately __-__% of the toxic dose

Answer 12

50-60

Question 13

Digoxin Toxicity: mainly and issue of bradycardia due to an _____ block..Can also cause _______!

Answer 13

AV(between SA and AV)…arrythimias!

Question 14

Digoxin Toxicity: _______ result from stimulation of chemoreceptor zones and vagal nucleus

Answer 14

GI Effects

Question 15

OHHHH what was the one where the Pt sees a green/yellow aura!?!?

Answer 15

DIG-OX-IN toxicity!!

Question 16

How the hell do we treat a Digoxin toxicity???

Answer 16

1. Discontinue the drug (no fuckin way) 2.GIVE ANTIDOTE (digiBIND, digiFAB) (you’ll just pee it out!)

Question 17

More Tx of digoxin toxicity: Administer ________ and anti- arrhythmic medications

Answer 17

potassium chloride

Question 18

THIS IS ONE OF OUR RED FLAG DRUGS IN DENTISTRY!!!Digoxin can be INCREASED if the patient is also on these 2 drugs….

Answer 18

1. Systemic Azole Antifungals 2.Macrolide antibiotics

Question 19

ALSO caution with Digoxin and _________: they can cause arrythmias!

Answer 19

vasoconstrictors

Question 20

What are the 3 drugs that work well with Digoxin to Tx CHF??

Answer 20

1.ACE Inhibitors (decrease H2O/NaCl retention) 2.B1 agonists (increase force of contraction) 3.Vasodilators (decrease work of the heart)

Question 21

Digoxin Tx - Dental Considerations: Decrease ______ for the patient…Caution with use of local anesthetics with
_________…Avoid using gingival retraction cords due to potency of ________… Do not _____ patient fully: hard to breathe…__________ decreases cardiac output and decreases perfusion = dangerous to a patient with CHF….General anesthesia done in ______ setting

Answer 21

stress… vasoconstrictors…. vasoconstrictors… recline….General anesthesia… hospital

Question 22

REMEMBER: decreased intracellular ____ POTENTIATES the effects of DIGITALIS

Answer 22

K+

Question 23

_________ (like an antidote if toxicity) DECREASES the effects of digitalis!!!

Answer 23

INCREASING K+

Question 24

INCREASED ______ INSIDE THE CELL INCREASES CONTRACTION OF THE HEART.

Answer 24

Calcium

Question 25

Digitalis glycosides DECREASE all except which one? Edema, Urine flow, heart size, heart rate, residual diastolic volume.

Answer 25

Urine flow (i think :)

Question 26

Primary action of Digitalis on cardiac muscle is an INCREASE in ______

Answer 26

force of contraction…it SHORTENS ERP in atria and ventricles