E1:CardiacGLyCOsides Flashcards
What are the three ways the body tries to make up for congestive heart failure? HOW DO WE STOP THIS FROM HAPPENING???
1.increase HR 2.Increase peripheral resistance 3.increase O2 demand….BLOCK THE Sympathetic NERVOUS system!!!
Congestive Heart Failure ALMOST ALWAYS causes:
Atherosclerotic coronary artery disease
With acute CHF you will likely see?
Acute: shortness of breath
Goals of CHF Tx: ______ heart rate to increase the filling time
SLOW
Goals of CHF Tx: \_\_\_\_\_\_\_ contractile force to improve the ejection fraction (make the heart more efficient)
INCREASE (counterintuitive right?!)
WHAT IS THE DRUG OF CHOICE FOR CHF? whats its duration? Where is it metabolized?
DIG-OX-in..intermediate duration (6 days)…kidney
BIG TOPICDIGOXIN MECH OF ACTION: inhibits the ______ resulting in increased Ca+ inside the cell. This ______ contraction of the heart and causes a _______ INOTRPIC effect.
Na/K PUMP!….INCREASES….POSITIVE
DIGOXIN MECH OF ACTION: Directly suppresses ______ conduction to increase _____ and DECREASE conduction velocity…has a ______ CHRONOTROPIC effect
AV node …ERP…NEGATIVE
DIGOXIN MECH OF ACTION: causes _______ and therefore decreases venous return…decreases filling pressure, decreases heart rate, decreases heart size
DIURESIS
99 Problems and CHF AINT ONE; Increased vagal output = can be blocked by ______ (anticholinergic drug)
Atropine
99 Problems and CHF AINT ONE; Slowing of AV conduction = can slow too much, which allows for ectopic foci = _________*** can arise
uncoordinated arrhythmias
99 Problems and CHF AINT ONE; Low therapeutic index = therapeutic dose is approximately __-__% of the toxic dose
50-60
Digoxin Toxicity: mainly and issue of bradycardia due to an _____ block..Can also cause _______!
AV(between SA and AV)…arrythimias!
Digoxin Toxicity: _______ result from stimulation of chemoreceptor zones and vagal nucleus
GI Effects
OHHHH what was the one where the Pt sees a green/yellow aura!?!?
DIG-OX-IN toxicity!!
How the hell do we treat a Digoxin toxicity???
- Discontinue the drug (no fuckin way) 2.GIVE ANTIDOTE (digiBIND, digiFAB) (you’ll just pee it out!)
More Tx of digoxin toxicity: Administer ________ and anti- arrhythmic medications
potassium chloride
THIS IS ONE OF OUR RED FLAG DRUGS IN DENTISTRY!!!Digoxin can be INCREASED if the patient is also on these 2 drugs….
- Systemic Azole Antifungals 2.Macrolide antibiotics
ALSO caution with Digoxin and _________: they can cause arrythmias!
vasoconstrictors
What are the 3 drugs that work well with Digoxin to Tx CHF??
1.ACE Inhibitors (decrease H2O/NaCl retention) 2.B1 agonists (increase force of contraction) 3.Vasodilators (decrease work of the heart)
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
stress… vasoconstrictors…. vasoconstrictors… recline….General anesthesia… hospital
REMEMBER: decreased intracellular ____ POTENTIATES the effects of DIGITALIS
K+
_________ (like an antidote if toxicity) DECREASES the effects of digitalis!!!
INCREASING K+
INCREASED ______ INSIDE THE CELL INCREASES CONTRACTION OF THE HEART.
Calcium
Digitalis glycosides DECREASE all except which one? Edema, Urine flow, heart size, heart rate, residual diastolic volume.
Urine flow (i think :)
Primary action of Digitalis on cardiac muscle is an INCREASE in ______
force of contraction…it SHORTENS ERP in atria and ventricles
