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HLSC 220 Pharmacotherapeutics for Health Professionals 💊 > Positive Inotropic Drugs in Heart Failure - Ch. 51 > Flashcards

Positive Inotropic Drugs in Heart Failure - Ch. 51 Flashcards

1
Q

What is Heart failure?

A

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

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2
Q

What do heart failure symptoms depend on?

A

Cardiac area affected
- left ventricular failure
-Right ventricular failure

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3
Q

What are Inotropic drugs?

A

Drugs that increase the force of myocardiac contraction

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4
Q

What are inotropic drugs used for?

A

Treatment of heart failure

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5
Q

What are the kinds of Inotropic drugs?

A

Cardiac glycosides
Sympathomimetic drugs
Phosphodiesterase inhibitors

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6
Q

Example of cardiac glycoside?

A

Digoxin

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7
Q

Examples of Sympathomimetic drugs?

A

Dobutamine
Dopamine

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8
Q

What are some other drugs used in heart failure?

A

Diuretics (K losing)
Beta-adrenoceptor antagonists
RAAS drugs (ACEIS, ARBs, Aldosterone antagonists)
Vasodilators (hrydralazine)
Organic nitrates (isosorbide dinitrate, nitroglycerin)

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9
Q

What causes heart failure to occur?

A

Cardiac muscle defect
Supraventricular dysrhythmias
Other defects beyond cardiac muscle

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10
Q

What cardiac muscle defects cause HF?

A

MI
Congenital

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11
Q

What Supraventricular dysrhythmias cause HF?

A

Atrial fibrillation
Atrial flutter

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12
Q

What other defects beyond cardiac muscle cause HF?

A

Coronary artery disease -ischemia
Hypertension/pulmonary hypertension
valve deficiency
Diabetes mellitus

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13
Q

What are the outcomes of HF?

A

Structural changes in cardiac muscle/connective tissue in ventricular wall

Functional changes in the ability of the ventricle to pump blood

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14
Q

What are symptoms of heart failure?

A

Reflex tachycardia
Edema
Elevated venous pressure
Dyspnea
Weakness
Cardiomegaly

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15
Q

What are inotropic drug effects on cardiac muscle?

A

Positive or negative force of muscualr contractions

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16
Q

What are chronotropic drug effects on cardiac muscle?

A

Positive or negative rate of the heartbeat

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17
Q

What are the dromotropic drug effects on cardiac muscle?

A

Positive or negative conduction speed of electrical impulses

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18
Q

Where were cardiac glycosides (digoxin) originally obtained from?

A

Digitalis plant (foxglove)

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19
Q

What are 3 S’s of Digoxin action?

A

Strengthens
Slows
Slows

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20
Q

What is “strengthens” in digoxin action?

A

Positive inotropic effect
-increase in force of myocardiac contraction

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21
Q

What is the 1st “Slows” in digoxin action?

A

Negative chronotropic effect
-reduced heart rate at SA node

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22
Q

What is the 2nd “Slows” in digoxin action?

A

Negative dromotropic effect
-Decreases AV nodal conduction

23
Q

What are the effects of digoxin?

A

↑stroke volume and cardiac output
↓ venous BP and vein engorgment
↑ coronary circulation
Promote diuresis (due to improve kidney perfusion)
Palliation of exertional, paroxysmal and
nocturnal dyspnea, cough, and cyanosis

24
Q

What is digoxin used for?

A

Heart failure
Supraventricular dysrhythmias (Afib and flutter)

25
Q

How is Digoxin supplied?

A

0.25mg, 0.125mg, 0.0625 mg/tablet

26
Q

What adverse effects are associated with Digoxin?

A

Narrow therapeutic window
Low potassium and Mg levels increase toxcity
Generalized malaise
GI disturbances
Colored vision
CV effects

27
Q

What is the narrow therapeutic index of digoxin?

A

Toxicity is slightly above therapeutic plasma level
-drugs leves must be monitored

28
Q

What is generalized malaise?

A

“just don’t feel right”
Fatigue, weakness, confusion

29
Q

What GI disturbanced are caused by digoxin?

A

Anorexia, nausea, vomiting, diarrhea

30
Q

What is colored vision?

A

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

31
Q

What CV adverse effects are caused by digoxin?

A

Dysrythmias including bradycardia

32
Q

What must you take to monitor for CV adverse effects associated with digoxin?

A

Take apical pulse
-Minimum 60bpm

33
Q

What is digoxin toxicity?

A

Common medication problem,can be life threatning
Accidental or intention overdose
Change in renal function (decreased elimination)
Diarrhea episodes

-Reduce or stop dosing

34
Q

What is Digoxin immune Fab (Digibind) therapy

A

Used as an antidote to rapidly reduce digoxin toxcity

35
Q

How does Digoxin immune Fab (Digibind) therapy work?

A

Binds to digoxin to stop life-threatning cardiac dysrythmias

36
Q

What factors increase risk of digoxin toxicity?

A

Low K (e.g, Furosemide loop diuretic)
High Calcium
Low magnesium
Renal dysfunction
Elderly
Hypothyroid
Herbal products
Drugs

37
Q

What herbal products increase risk of digoxin toxicity?

A

Ginkgo
St. Johns Wort

38
Q

What ways do drugs increase risk of digoxin toxicity?

A

Lead to hypokalemia then toxicity
Increase absorption of digoxin
Decreases renal clearance of digoxin (Plasma x2)

39
Q

What drugs lead to hypokalemia then to digoxin toxicity?

A

Amphotericin B, furosemide, thiazides, laxatives,
steroids

40
Q

What drugs Increase absorption of digoxin and cause digoxin toxicity?

A

anticholinergics

41
Q

What drugs decrease renal clearance of digoxin and lead to digoxin toxicity?

A

Quinidine
Verapamil

42
Q

What serum labs need to be assessed for a client on digoxin?

A

Potassium
Sodium
Magnesium
Calsium
Renal and liver function studies

43
Q

What should the apical pulse (not radial) of someone on digoxin be?

A

<60 or >120 bpm
-less than 90 in an infant
-Slow rate= sign of toxicity

44
Q

What signs/symptoms indicate digoxin toxicity? Notify HCP, Hold dose!!!

A

Anorexia
Nausea
Vomitting
Diarrhea
Visual disturbances: Blurred vision, seeing green or yellow halos around bjects

45
Q

What is the only way sympathomimetic drugs are administered?

A

IV infusion only

46
Q

What do sympathomimetic drugs do?

A

Activate Beta1-adrenoceptors
-Increase cardiac contractility

47
Q

What are sympathomimetic drugs used for?

A

Only in severe or acute HF

48
Q

What do Phosphodiesterase Inhibitors do?

A

Inhibit the enzyme Phosphodiesterase and produce a positve inotropic respone amd positive lusitropic effect

49
Q

What are two phosphodiesterase inhibitor agents?

A

Milrinone
amrinone

50
Q

What are Phosphodiesterase Inhibitors used for?

A

Short-term management of HF

51
Q

When are Phosphodiesterase Inhibitors given?

A

When client has not responded to digoxin, diuretics and/or vasodilators

52
Q

How are Phosphodiesterase Inhibitors administered?

A

Weekly 6-hour IV infusions

53
Q

What theraputic effects should be monitored when a client is given a positive inotropic agent?

A

Increased urinary output (adequate fluids important)
Decreased edema, shortness of breath (dyspnea), rales (crackles), and fatigue
Resolvinf of paroxysmal nocturnal dyspnea
Improved peripheral pulses, skin colour and temperature

HLSC 220 Pharmacotherapeutics for Health Professionals 💊 (31 decks)

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