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Pharmacology > Positive Inotropic Drugs In Heart Failure (51) > Flashcards

Positive Inotropic Drugs In Heart Failure (51) Flashcards

1
Q

Heart failure

A

Heart is unable to pump enough blood to meet the body’s metabolic needs

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2
Q

Symptoms of heart failure depend on

A

Cardiac area affected
-left ventricular failure (edema)
-right ventricular failure (coughing up blood)

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3
Q

Inotropic drugs

A

Increase the force of myocardial contraction
-used in treatment of heart failure

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4
Q

Three types of inotropic drugs

A

-cardiac glycosides
-sympathomimetic drugs
-phosphodiesterase inhibitors

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5
Q

Cardiac glycosides example

A

Digoxin

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6
Q

Sympathomimetic drugs example

A

-dobutamine
-dopamine

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7
Q

What other types of drugs are used in heart failure

A

-diuretics (K losing drugs)
-b adreoceptor antagonists
-RAAS drugs (ace inhibitors, arbs, aldosterone antagonists)
-vasodilators
-organic nitrates

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8
Q

Causes of heart failure

A

-cardiac muscle defect
-supraventricular dysrhythmias
-other

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9
Q

Causes of heart failure: cardiac muscle defect

A

-MI
-congenital

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10
Q

Causes of heart failure: supraventricular dysrhythmias

A

Atrial fibrillation and atrial flutter

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11
Q

Causes of heart failure: other defects beyond cardiac muscle

A

-CAD
-hypertension/pulmonary hypertension
-valve deficiency
-diabetes mellitus

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12
Q

Outcomes of heart failure

A

-structural changes in cardiac muscle or connective tissue in ventricular wall

-functional changes in the ability of the ventricle pump blood

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13
Q

Symptoms of heart failure

A

-reflex tachycardia
-edema
-elevated venous pressure
-dyspnea
-weakness
-enlarged heart

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14
Q

Drug effects on cardiac muscle: inotropic

A

Force of muscular contractions
-positive or negative

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15
Q

Drug effects on cardiac muscle: chronotropic

A

Rate of the heartbeat
-positive or negative

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16
Q

Drug effects on cardiac muscle: dromotropic

A

Conduction speed of electrical impulses
-positive or negative

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17
Q

Digoxin is originally obtained from

A

Digitalis plant
-foxglove

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18
Q

Digoxin mechanism of action

A

Induces an increase in intracellular sodium that will drive an influx of calcium in the heart and cause an increase in contractility

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19
Q

Digoxin inhibits

A

The Na/K ATPase enzyme
-increasing sodium

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20
Q

Three Ss of digoxin action

A

-strengthens
-slows
-slows

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21
Q

Three Ss of digoxin action: strengthens

A

Positive inotropic effect
-inc force of myocardial contraction

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22
Q

Three Ss of digoxin action: slows 1

A

Negative chronotropic effect
-reduced heart rate at SA node

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23
Q

Three Ss of digoxin action: slows 2

A

Negative dromotropic effect
-decreases AV nodal conduction and other effects

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24
Q

Digoxin effects: increases

A

-stroke volume (cardiac output)
-coronary circulation
-diuresis due to improved kidney perfusion

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25
Q

Digoxin effects: decreases

A

-venous BP
-vein engorgement

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26
Q

Digoxin effects: relieves symptoms of

A

-paroxysmal/nocturnal dyspnea
-cough
-cyanosis

***DOES NOT SOLVE JUST RELIEVE

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27
Q

Indications of digoxin

A

-heart failure
-supraventricular dysrhythmias (a fib/a flutter)

28
Q

Different mg a tablet of digoxin

A

0.25, 0.125, 0.0625mg

29
Q

Supraventricular dysrhythmias are a problem located

A

Above the ventricle

30
Q

AE of digoxin:

A

-narrow therapeutic window
-low potassium levels increase toxicity
-general malaise
-GI
-coloured vision
-cardiovascular

31
Q

AE of digoxin: narrow therapeutic window

A

-toxicity slightly above therapeutic plasma level
-drug levels must be monitored

32
Q

AE of digoxin: low potassium levels increase toxicity

A

-low Mg also increases toxicity
-electrolyte levels must be monitored

33
Q

AE of digoxin: generalized malaise

A

“Just dont feel right”
-fatigue, weakness, confusion

34
Q

AE of digoxin: GI

A

Anorexia, nausea, vomiting, diarrhea
-earlier signs of AE

35
Q

AE of digoxin: coloured vision

A

Seeing yellow, green, purple, halo vision, flickering lights

36
Q

AE of digoxin: cardiovascular

A

Dysrhythmias including bradycardia
-or tachycardia

37
Q

Because of cardiovascular AE, what must be done before administering digoxin

A

Must take apical pulse, minimum of 60 b/m
-if lower hold, recheck, notify prescriber

38
Q

Digoxin toxicity

A

Quite common medication problem
-accidental, or intention overdose

39
Q

Symptoms of digoxin toxicity

A

-change in renal function = decreased
-episode of diarrhea

40
Q

How dangerous is digoxin toxicity

A

It is life threatening

41
Q

How do you treat digoxin toxicity

A

Digoxin immune Fab therapy

42
Q

Digoxin immune fab therapy

A

Used as antidote to rapidly reduce toxicity
-binds to digoxin

43
Q

Binding to digoxin can cause

A

Life threatening cardiac dysrhytmias

44
Q

Factors increasing risk of digoxin toxicity

A

-low K
-renal dysfunction
-herbal products
-hypokalemia
-increase absorption of digoxin
-decreases renal clearance of digoxin

45
Q

Factors increasing risk of digoxin toxicity: low K

A

Loop diuretic furosemide
-high ca, low magnesium

46
Q

Factors increasing risk of digoxin toxicity: renal dysfunction

A

Elderly, hypothyroid

47
Q

Factors increasing risk of digoxin toxicity: herbal products

A

Ginkgo, St. John’s Wort

48
Q

Factors increasing risk of digoxin toxicity: hypokalemia

A

Lead to hypokalemia then to toxicity
-amphotericin B, furosemide, thiazides, laxatives, steroids

49
Q

Factors increasing risk of digoxin toxicity: increase absorption of digoxin

A

Anticholinergics

50
Q

Factors increasing risk of digoxin toxicity: decreases renal clearance of digoxin

A

Plasma x2
-quinidine, verapamil

51
Q

Upon giving digoxin, clinical parameters need to be asses….

A

-apical pulse
-serum labs

52
Q

Upon giving digoxin, clinical parameters need to be asses: apical pulse

A

NOT RADIAL
-for one full minute

53
Q

Upon giving digoxin, clinical parameters need to be asses: serum labs

A

Potassium, sodium, magnesium, calcium, renal, liver function studies

54
Q

Apical pulse should be

A

<60 or >120 betas/min
0r less than 90 in an infant

55
Q

What do you do if pulse is <60 or >120

A

-hold dose, recheck in one hour
-notify prescriber, a slow rate could be sign of toxicity

56
Q

Hold digoxin dose and notify prescriber IF

A

Client experiences signs/symptoms of toxicity
-anorexia, nausea, vomiting, diarrhea, visual disturbances

57
Q

Sympathomimetic drugs are administered

A

IV infusion only
-due to rapid metabolism

58
Q

Sympathomimetic drugs activate

A

Cardiac B1 adrenoceptors
-increase cardiac contractility
-only in severe and acute HF

59
Q

Two types of sympathomimetic drugs

A

-dobutamine
-dopamine

60
Q

Phosphodiesterase inhibitors

A

Inhibit enzyme phosphodiesterase

61
Q

Phosphodiesterase inhibitors create

A

Positive inotropic response
-positive lusitropic effects

62
Q

Phosphodiesterase inhibitors two agents

A

Milrinone

63
Q

Indications of Phosphodiesterase inhibitors

A

Short term management of heart failure

64
Q

Phosphodiesterase inhibitors are given when client has

A

Not responses to treatment with digoxin, diuretics, and or vasodilators

65
Q

Phosphodiesterase inhibitors are often given as

A

Weekly six hour IV infusions
-improve QOL
-decreased readmissions for heart failure episodes

66
Q

Monitor for therapeutic effects of Phosphodiesterase inhibitors

A

-inc urinary output
-dec edema, SOB, fatigue, rales (crackles)
-resolving of paroxysmal nocturnal dyspnea
-improved peripheral pulses, skin color, temperature

Pharmacology (23 decks)

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