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3312 #3
Cardiovascular Drugs- Cardiotonic/Inotropic
| Question | Answer |
|---|---|
| Two causes of heart failure or congestive heart failure | - coronary artery disease - hypertension |
| failure of the heart as a pump is known as | heart failure or congestive heart failure |
| Four effect of heart failure or congestive heart failure are: | 1. ventricular dysfunction 2. reduced cardiac output 3. inadequate tissue perfusion 4. fluid overload |
| Heart Failure causes the body to respond to the general threat of inadequate oxygen supply causing: | 1. cardiac stimulation 2. kidneys to retain fluid |
| drugs that improve pumping action of the heart | cardiotonic-inotropic |
| Therapeutic goal of these drugs are to improve cardiac output (amount of blood pumped by the ventricle in 1 minute) | Cardiotonic-inotropic |
| Therapuetic goal of these drugs are to maintain normal sinus rhythm (normal electrical conduction) | cardiotonic-inotropic |
| Actions of Cardiotonic/Inotropics are classified as which four effects | positive inotropic effect negative chronotropic effect negative dromotropic effect net effects |
| the action of cardiotonic/inotropics that cause an increase force of myocardial contraction is considered a | postive inotropic effect |
| the action of cardiotonic/inotropics that cause a decrease in heart rate is considered | negative chronotropic effect |
| the action of cardiotonic/inotropics that cause a decreased rate of impulse conduction through the heart is considered a | negative dromotropic effect |
| the action of cardiotonic/inoropics that cause a decreased heart rate and an increased strength of contraction is considered | net effects of the drug |
| drugs used to treat CHF or HF and for the treatment of some dysrhthmias (same as arthmias) | cardiotronic/inotropics |
| anything out side of the normal 60-100 BPM is considered a | dysrhythmia (ie tachycardia, bradycardia) |
| an abnormal cardiac rate or rhythm | dysrhythmia |
| The following are side effects of which classification of cardiovascular drugs cardiac -- bradycardia, other dysthmias GI -- anorexia, n/v CNS-- confusion, visual disturbances (specifically caused by Digoxin) | cardiotonics/inotropics |
| medications that increase the strength of the muscle contractions that pump blood from the heart | cardiotonic/inotropic drugs |
| What are the five classfication of drugs used to treat heart failure | 1. cardiac glycosides 2. phosphodiesterase inhibitors 3. ACE inhbitors 4. human natriuretic peptide B-type 5. endothelin receptor antagonists |
| This drug icreases influx of Ca into myocardial cells which increases activation of actin & myosin, thereby increasing myocardial contractility (positive inotropic effect), slows SA firing and AV conduction What is the class and prototype | Digitalis--Digoxin(Lanoxin) |
| What are unique features of digoxin | - hypokalemia (low potassium) increase risk of digitalis toxicity - half life 36hrs-takes longer time to leave the body - digitalizing and maintenance dosing - contraindicated with heart block |
| digoxin can be given which two ways | PO or IV pt, if meds given IV, should be monitored in ICU setting |
| T or F digoxin (Lanoxin) improves symptoms, but does not improve mortality | True |
| Symptoms of hypokalemia include: | - dsyrythmias - muscle weakness/flacid - confused -fatigue |
| Symptoms of digitalis toxicity | - bradycardia - anorexia - nausea - visual disturbances - yellow glare to everything |
| contraindication for digitalis drugs | heart block |
| T or F As a rule if pt has a HR of 60, you cannot give digitalis drugs without checking with physician | False- as a rule you can give digitalis with a HR of 60 without checking with physician |
| What should you tell a patient who has been prescribed digoxin (Lanoxin) | - get meds from same pharmacists - tablets/capsules not interchangable - take HR before taking med - now S & S of toxicity - different brands are not interchangable |
| as a nurse you should asses what on a pt taking digoxin I(Lanoxin) | - for S & S of hypokalemia - apical pulse X 1 min - peripheral edema - activity intolerance - crackles |
| amrinone(Inocor) is classified as | phosphodiesterase inhibitor |
| This drug increases myocardial contractility by increasing cAMP in myocardial cells and is also a peripheral vasodilator | phosphdiesterase inhibitors--amrinone(Inocor) |
| Unique features of phosphodiesterase inhibitors--amrinone(Inocor) | short-term tx of acute, severe CHF that does not respond to digitalis, diuretics , or vasodilators |
| how is inamrinone (Inocor) given | IV- in cardiac monitor setting |
| Adverse effects of inamrinone (Inocor) are | - deceased B/P - decreased platelets - hepatoxicity |
| These drugs inhibit renin-angiotensin-aldosterone system | ACE (Angiotensin-Converting Enzyme) inhibitors |
| an enzyme that is produced in the kidneys in response to impaired blood flow and tissue perfusion; stimulates conversion of angiotensin I to angiotensin II: 1. vasoconstricts 2. stimulates aldosterone release ( Na and water retention, K secretion | renin |
| T or F ACE inhibitors do no improve life span | False- they do improve life span |
| the amount of blood in the ventricles at the end of diastole, before the next contraction; relates to amount of "stretch" and amount of contractility | preload |
| the peripheral resistance against which the left ventricle must pump | afterload |
| ACE inhibitors improve ___ | perfusion |
| inhibits renin-angiotensin aldosterone system resuling in peripheral vasodilation and also decreases cardiac workload What is the class and prototype | ACE inhibitors--captopril |
| Unique Features of ACE inhibitors--captopril | - first line tx along with diuretics for CHF - monitor serum potassium and creatine - can cause chronic cough |
| Actions of ACE inhibitors--captopril | - peripheral vasodilation - decreased preload and afterload - decreased cardiac workload - improve perfusion |
| ACE inhibitors--captopril reduces ___ flow | renal blood |
| This drug classification causes diuresis; suppresses renin-angiotensin-aldosterone system; decreases norepinephrine and endothelin | Human natriuretic peptide B-type--nesiritide |
| Unique features of Human natriuretic peptide B-type--nesiritide include: | - incompatible with most other drugs in IV inifusion - can cause hypotension, v. tach, bradycardia, n/v, anxiety -used at last resort -increases mortality (die faster) |
| What lab test should be ordered for a pt on Human Natriuretic Peptide B-type | BNP level measures endogenous level (0-100 normal) - if level is high, indicates HF (body is releasing high amounts of BNP to compensate) |
| Adverse Effects of Human Natriuretic Peptide B-type | - hypotension - ventricular tachycardia - bradycardia - n/v - anxiety |
| This medication can be given for moderate to severe HF | spironolactone (aldosterone antagonist) |
| T or F Weight gain of 3lbs in two days is okay for a person on cardiotonics/inotropics | False- it is too much, notify prescriber |
| Which type of drugs should not be used acutely with HF | beta blockers |
| strong scientific evidence supports this type of non-allopathic drug | Hawthorn |
| conflicting scientific evidence for these types of non-allopathic drugs | - coenzyme Q10 - Oleander- contains glycoside chemicals, early studies abandoned due to GI problems and toxicity |
| This type of non-allopathic agent blocks effects of spironolactone | natural licorice |
| This type of non-allopathic agent increases risk of digoxin toxicity | genseng |
| These types of non-allopathic agents are diuretics | dandelion root and juniper berries |
Created by:
Black88cat
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