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47 Cards in this Set
- Front
- Back
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What is the general therapeutic goal with drugs in HF?
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-improve contractility (inotropic)
-improve kidney function -all to improve tissue perfusion |
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What is inotropic?
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increases force of myocardial contraction
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What is chronotropic?
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increases HR
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What is dromotropic?
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increases conduction velocity
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What do glycosides do to the heart?
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mainly increases inotrope (squeeze)
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What HF is most common?
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left HF
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What are the forward effects & backward effects of left HF?
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forward: low CO
backwards: pulmonary pooling |
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What are the indications for glycosides?
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-HF**
-Atrial Fibrillation -Supra-Ventricular Dysrhythmias |
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What is HF?
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syndrome where the heart is unable to pup sufficient blood to meet the metabolic needs of tissues
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What are some physiological adaptations the heart makes with HF?
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-cardiac dilation: increased venous pressure (larger heart/larger CO)
-activated SNS: stimulated by baroreceptors (increase inotrope & chronotrope) -water retention: less urine to increase CO -activation of RAAS |
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What type of drugs improve inotropic (squeeze)?
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-ACEI
-ARB's -cardiac glycosides |
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What are the major underlying causes of HF?
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-chronic HTN
-MI |
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What type of drugs reduce preload?
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diuretics
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What type of drugs reduce afterload?
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vasodilators
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What type of drug allows for rate control and ventricular restructuring?
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beta-blockers
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What is the prototype for cardiac glycosides?
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digoxin (Lanoxin)
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How does digoxin (Lanoxin) work on the heart?
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-increase inotrope (inhibits plasma membrane's Na & K pump)
-decrease chronotrope (increase response of SA node to Ach) -decrease dromotrope (alters the electrical properties of the heart) |
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How is digoxin first dose given?
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Digitalization: higher first dose to reach therapeutic concentrations then normal doses to continue therapeutic range
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What are SE of digoxin?
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bradycardia
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What do we check before giving digoxin?
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apical pulse
-if below 45 hold drug. call physician |
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What is a pulse deficit?
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difference between apical & radial pulse
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What does digoxin toxicity look like (signs & symptoms)?
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early
-n/v -vision changes late -fast dysrhythmias -halos around lights |
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What drugs can increase the likelihood of digoxin toxicity?
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-drugs that depress cardiac function (BB & CCB)
-hypokalemia (most common cause of dig OD: diuretic) -antacids, laxatives & cholesterol-lowering agents (ACE & ARB) |
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What do we use to reverse digoxin toxicity?
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-stop doses
-immune fab (Digibind) binds with molecule and excretes it through kidneys. -hasten elimination by binding (charcoal, cholestyramine) |
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What is considered to be a toxic serum level of digoxin?
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2.2ng/mL
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Does digoxin have an extremely narrow therapeutic range?
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yes VERY narrow.
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What do you need to watch with a pt taking digoxin?
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-HR
-dysrhythmias -hypokalemia (increases risk of toxicity) -hyperkalemia (may produce dysrhythmias) -renal insufficiency pt -pt on diuretics -take apical pulse for 1 minute |
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What is digoxin's half life?
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36 hours
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Why are cardiac glycosides (digoxin) dangerous?
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because at therapeutic doses it can cause dysrhythmias.
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What is angina?
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type of myocardial ischemia, secondary to atherosclerosis of the coronary arteries. angina is a symptoms not a disease.
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What is chronic stable angina typically triggered by?
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physical activity
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What is the underlying cause of chronic stable angina?
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CAD (coronary artery disease)
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What is acute angina?
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-medical emergency
-results from severe CAD complicated by vasospasm, platelet aggregation, and/or thrombi |
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What are treatments for acute angina?
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-sublingual nitroglycerin
-BB -supplemental O2 -morphine -ACEI -ASA -Heparin |
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What causes the angina pain?
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imbalance between oxygen supply and oxygen demand.
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What are the three drugs used to treat chronic stable angina?
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-organic nitrate vasodilators
-BB (short term prophylactic only) -CCB (prophylactic use) |
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What are the goals of treatment with chronic stable angina?
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-relieve pain
-bring balance to MvO2, supply and demand -prevention of MI |
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What is MvO2?
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myocardial oxygen
|
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What is the organic nitrate vasodilator prototype?
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nitroglycerin (NTG)
|
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How does nitroglycerin work?
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-vasodilation of peripheral arteries
-dilates coronary arteries |
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How do we give nitroglycerin (NTG)?
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-typically seen in dissolvable tablets and acts in minutes
-nasal spray -ointments (messy & wear GLOVES) -IV for emergent use following an MI |
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Can you give nitroglycerin PO?
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you could but pt gets nothing after first pass effect
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What are the most common SE of nitroglycerin?
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-HA
-hypotension -reflex tachycardia |
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How does pt take nitroglycerin at home if experiencing angina?
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-take SL tablet
-wait 5 minutes -if pain continues repeat with 2nd dose -if pain persists after 2nd call 911 & take 3rd. |
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What should pt feel under their tongue with nitroglycerin?
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tingling. if not tingling then medication has lost potency.
|
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How long is nitroglycerine good for?
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6 months after opened
|
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How is nitroglycerin stored?
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-in airtight light resistant (brown) glass bottles
-cannot store in pill boxes |
