Heart Failure Drugs Flashcards
Digoxin (Lanoxin)
Chemical Classification
Digoxin preparation
Digoxin (Lanoxin)
Functional Classification
Cardiac glycoside, inotropic, antidysrhythmic
Digoxin (Lanoxin)
Mechanism of Action
Inhibits the sodium-potassium ATPase pump, which makes more calcium available for contractile proteins, thereby resulting in increased cardiac output (positive inotropic effect); increases force of contractions; decreases heart rate (negative chronotropic effect); decreases AV conduction speed
Digoxin (Lanoxin)
Uses
Heart failure, atrial fibrillation, atrial flutter, atrial tachycardia, cardiogenic shock, paroxysmal atrial tachycardia, rapid digitalization in these disorders
Digoxin (Lanoxin)
Contraindications
Hypersensitivity to digoxin, ventricular fibrillation, ventricular tachycardia, carotid sinus syndrome, 2nd- or 3rd-degree heart block
Digoxin (Lanoxin)
Side Effects
CNS: Headache, drowsiness, apathy, confusion, disorientation, fatigue, depression, hallucinations
CV: DYSRHYTHMIAS, Hypotension, bradycardia, AV BLOCK
EENT: blurred vision, yellow-green halos, photophobia, diplopia
GI: nausea, vomiting, anorexia, abdominal pain, diarrhea
Digoxin (Lanoxin)
Nursing Considerations
ASSESS:
- Apical pulse for 1 min before giving product; if pulse <60 in adult, call prescriber; note rate, rhythm, character; monitor ECG continuously during parenteral loading dose
- Electrolytes: K , Na, Cl, Mg, Ca; renal function studies: BUN, creatinine; blood studies: ALT, AST, bilirubin, Hct, Hgb before initiating treatment and periodically therafter
- I&O ratio, daily weights; monitor turgor, lung sounds, edema
- Monitor product levels: therapeutic level 0.5-2ng/ml
- Cardiac status: apical pulse, character, rate, rhythm
Digoxin (Lanoxin)
Overdose Treatment
Discontinue product; give potassium; monitor ECG; give adrenergic-blocking agent, digoxin immune FAB
Dobutamine
Functional Classification
Adrenergic direct-acting Beta1-agonist, cardiac stimulant
Dobutamine
Chemical Classification
Catecholamine
Dobutamine
Mechanism of Action
Causes increased contractility, increased cardiac output without marked increased in heart rate by acting on Beta1-receptors in heart; minor alpha and beta2 effects
Dobutamine
Uses
Cardiac decompensation due to organic heart disease or cardiac surgery
Dobutamine
Contraindications
Hypersensitivity, idiopathic hypertrophic subaortic stenosis
Dobutamine
Side Effects
CNS: Anxiety, headache, dizziness, fatigue
CV: palpitations, tachycardia, hyper/hypotension, PVCs, angina
ENDO: hypokalemia
GI: heartburn, nausea, vomiting
MS: muscle cramps (leg)
RESP: dyspnea
Dobutamine
Nursing Considerations
ASSESS:
- HYPOVOLEMIA; if present, correct first; administer cardiac glycoside before DOBUTamine
- OXYGENATION/PERFUSION DEFICIT: check BP, chest pain, dizziness, loss of consciousness
- HEART FAILURE: S3 gallop, dyspnea, neck venous distention, bibasilar crackles in patients with CHF, cardiomyopathy, palpate peripheral pulses; report if extremities become cold or mottled or if peripheral pulses decrease
- ECG during administration continuously; if BP increases, product is decreased; CVP or PCWP, cardiac output during inf; report changes
- Serum electrolytes, urine output
- SULFITE SENSITIVITY, which may be life threatening
Dobutamine
Overdose Treatment
Administer a Beta1-adrenergic blocker; reduce IV or discontinue, ensure oxygenation/ventilation; for severe tachydysrhythmias (ventricular), give lidocaine or propranolol
Lisinopril
Functional Classification
Antihypertensive, Angiotensin-Converting Enzyme 1 (ACE) inhibitor
Lisinopril
Chemical Classification
Enalaprilat lysine analog