Other Half of the Exam

Question 1

Digoxin

Answer 1

Cardiac Glycoside/Positive Inotropic Drug
Requires Loading Dose (3)

Indicated in:
Heart failure to improve symptoms, quality of life and exercise tolerance
Control ventricular response to Atrial fibrillation or Atrial flutter (fast contraction of atria)
Digoxin and Beta 1 blockers (-olol) help slow down HR

Indirectly creates a vagomimetic effect
Depresses SA node & prolongs conduction to the AV node (negative dromotropic)
Results in slowing of HR; Results in increased CO
Promotes mild diuresis due to improved renal perfusion

Direct effects
Positive inotropic effect: Increases calcium ion movement across myocardial cell membrane which strengthens force of contraction.
Palliation of exertional and paroxysmal nocturnal dyspnea, cough, and cyanosis

Question 2

Digoxin Adverse Effects

Answer 2

***Cardiovascular: Dysrhythmias, including bradycardia or tachycardia
Colored, blurred vision (could be digoxin toxicity)
GI: Anorexia, nausea, vomiting, diarrhea

***Any HR lower then 60, HOLD Administration
Electrolyte levels must be monitored (K+, Mg+, Ca++) for toxicity. Make sure K+ levels are normal
Teach patient how to take their pulse

Question 3

Digoxin Toxicity

Answer 3

With levels >2 ng/mL
Or lower if hypokalemia, hypomagnesemia, or hypothyroidism
S/S dig toxicity: anorexia, N/V/D, confusion, blurred vision, drowsiness

***Digoxin immune Fab (Digibind) therapy

Predisposing Conditions to Digoxin Toxicity: Hypokalemia, Hypomagnesemia, Hypercalcemia

Question 4

Use of Statins

Answer 4

Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol
Lower the rate of cholesterol production

Contraindications
Active liver disease
Unexplained persistently elevated LFTs
Pregnancy (category X)

Adverse Effects
Myopathy (muscle pain)- most common complaint
Elevations in liver enzymes (ALT & AST)
Rare but serious- rhabdomyolysis
Liver disease

Question 5

Adrenergic Receptors

Answer 5

Alpha 1
Vasoconstriction
BP increases

Alpha 2
Receptors within the brain
Decreases Norepinephrine 
Inhibits SNS 
Decreases vasoconstriction & HR 

Beta 1
Increase HR (chronotropic effect)
Increases speed of contraction
Increase cardiac muscle contractility (inotropic effect)

Beta 2
Bronchiole dilation (targeted when treating asthma attacks) & some peripheral dilation

Question 6

Beta Blockers (metoprolol)

Answer 6

Reduce BP by reducing heart rate & contractility through β1-blockade
Long-term use causes reduced peripheral vascular resistance
Cause reduced secretion of renin

Adverse Effects: Bradycardia, hypotension, *wheezing,

Question 7

Beta Blockers (metoprolol)

Answer 7

Reduce BP by reducing heart rate & contractility through β1-blockade
Long-term use causes reduced peripheral vascular resistance
Cause reduced secretion of renin

Adverse Effects: Bradycardia, hypotension, *wheezing Hypoglycemia, hyperthyroidism, Dizziness, fatigue, mental, depression, lethargy, drowsiness, unusual dreams

Question 8

ACE Inhibitors (-pril)

Answer 8

Often used as first-line drugs for HF
and hypertension

Inhibit angiotensin-converting enzyme, which is responsible for converting angiotensin I (through the action of renin) to angiotensin II (Angiotensin II is a potent vasoconstrictor)

Adverse Effects: Possible hyperkalemia: releasing potassium since we’re inhibiting aldosterone
***Dry, nonproductive cough, Angioedema, Neutropenia

Question 9

Potassium Sparing Diuretics: Spiralactone

Answer 9

Spironolactone (Aldactone) Sounds like aldosterone! Inhibits this. Treats hyperaldosteronism

Work in collecting ducts and distal convoluted tubules
Block the resorption of sodium and water usually induced by aldosterone
Promotes retention of potassium & magnesium
Monitor hyperkalemia; make sure they’re not on an ACE inhitor

Adverse Effects: Hyperkalemia, Gynecomastia, amenorrhea, irregular menses, postmenopausal bleeding

Question 10

Calcium Channel Blockers: Verapamil/Diltiazem

Answer 10

Used for paroxysmal supraventricular tachycardia; rate control for atrial fibrillation and flutter

Question 11

Misoprostol

Answer 11

Synthetic prostaglandin analog: cytoprotective activity
Protect gastric mucosa from injury by enhancing local production of mucus or bicarbonate
Promote local cell regeneration
Help to maintain mucosal blood flow
Used for prevention of NSAID-induced gastric ulcers

Most common adverse effects: diarrhea, abdominal pain
Pregnancy category X: causes premature labor

Question 12

Proton Pump Inhibitors: lanzoprazole (Prevacid)

Answer 12

Irreversibly binds to H+/K+ ATPase enzyme system
This bond prevents the movement of hydrogen ions from the parietal cells into the stomach
Result: ALL gastric acid secretion is temporarily blocked

Used for GERD, Esophagitis, Duodenal/Gastric Ulcers/H-Pylori Ulcers

Adverse Effects: Diarrhea, Headache, Pneumonia (aspiration: stomach is no longer acidic, bacteria colonizes)

May increase serum levels of diazepam, phenytoin, and cause increased chance for bleeding with warfarin

PPIs often work best when taken 1 hour before meals

Question 13

Polycarbophil

Answer 13

Bulk Forming Laxative: Use for Acute and chronic constipation, Irritable bowel syndrom, Diverticulosis

Acts similar to fiber
Absorbs water to increase bulk
***Distend bowel to initiate reflex bowel activity

Adverse Effects:
Impaction
Fluid overload? Pt should be taking high fluids with bulk-forming