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Cardiotonic drugs

pharm exam 3: drugs affecting cardiac circulation in heart failure

define automacity ability to spontaneously initiate an electrical impulse without external stimuli (self-excitement)
3 properties of the heart automaticity; conductivity; refractoriness
define conductivity ability to transmit action potential from cell to cell
where does conductivity exists in heart muscles and electrical conductions system
define refractoriness people during cardiac cycle during which a stimulus fails to produce an action potential
normal cardiac output volume 4-8 L/minute
What part of the heart does the sympathetic nervous system innervate? all of the heart
What part of the heart does the parasympathetic nervous system innervate? AV node, atria, little in the ventricle
hormones that affect cardiac output epinephrine, norephinephrine, acetylcholine
normal stroke volume 70 mL/beat
3 factors affecting stroke volume preload, contractility, afterload
define preload ventricular filling
define contractility ventricular contraction
define afterload systemic vascular resistance
define Starling's Law degree of stretch = stretching the myocardial fibers during diastole will increase the force of contraction during systole
Starling's Law describes the increase in... preload
inotropic drugs affect what factor in stroke volume? contractility
effects of + inotropic drugs strengthens contractility
effects of - inotropic drugs decreases contractility
chronotropic drugs affect what part of cardiac output? heart rate
effects of + chronotropic drugs increases heart rate by increased impulses from SA node
effects of - chronotropic drugs decreases heart rate by decreased impulses from SA node
dromotropic drugs influence what? conduction
effects of + dromotropic drugs speeds conduction
effects of - dromotropic drugs slows conduction
5 forms of heart problems heart failure; hypertension, arrhythmia, angina, myocardial infarction
define heart failure heart is no longer pumping enough blood for metabolic demands of the body
define hypertension elevated BP
What causes elevated BP in hypertension blood volume is greater compared to space available inside blood vessels
define arrhythmias electrical conduction problems that occur when pathways malfunction
define angina chest pain; way of signaling that some of heart cells are not getting enough oxygen
define myocardial infarction damage to heart muscle due to ischemia (lack of oxygen)
another name for cardiotonics cardiac glycosides
prototype for cardiotonic (cardiac glycosides) digoxin (lanoxin)
other names for digitalis foxglove; cardiotonics; cardiac glycosides
What was digitalis (foxglove) initially prescribed for? dropsy (edema)
primary action of digitalis (foxglove) on the heart; duresis occurs following improved circulation
dynamics of digoxin (Lanoxin) more influx of calcium into cells
How does digoxin increase force of contraction? more complete systolic emptying; heart size decreases; increased kidney perfusion
What happens when force of heart contraction is increased? CO increases; systolic emptying is more complete; heart size decreases
What causes duresis with digoxin? increased kidney perfusion
What property of digoxin allows for increased force of contraction? + ionotropic = increased cardiac output
How does digoxin increase vagal activity? conduction through AV node is decreased and refractory time is prolonged
What properties of digoxin allow for increased vagal activity? - dromotropic; - chrontopic
EKG signal seen with use of digoxin symbolizing increased vagal activity prolonged p-r interval
uses for digoxin congestive heart failure; atrial dysrhythmias
Kinetics of digoxin po - absorption 2 hours IV - 10 minutes
Why can digoxin lead to accumulation widely distributed; bound to albumin in blood
clinical manifestations of heart failure weak, rapid heart rate; less than normal cardiac output; SOB
Why is digoxin used in heart failure? slows the heart and strengthens contraction
Where is digoxin detoxified? in liver; only small amount destroyed and excreted daily (leading to accumulation)
Why is a loading dose required for digoxin? blood protein must be saturated before blood concentration is stabilized
define digitalization use of a loading dose to achieve high plasma levels of digoxin quickly
How long does it take to reach plateau drug levels if no loading dose of digoxin is given? 6 days
Loading dose varies with... age, body size, health problems
describe pediatric dose of digoxin proportionally higher doses according to weight
maintenance of digoxin may take a week to reach state
How does renal impairment affect digoxin levels slows elimination
percentage of patients who have digoxin toxicity 10-25% of patients
describe optimal dose of digoxin close to toxic dose
first symptoms of digoxin toxicity appears where? vision, GI, cardiac
vision symptoms of digoxin toxicity blurred, double vision, yellow or green color changes, halos around objects
GI symptoms of digoxin toxicity anorexia, nausea, vomiting, diarrhea
apical impulse rates in adult digoxin toxicity 60 or less
apical impulse rates in infants digoxin toxicity 100 or less
How long should you measure the apical impulse when digoxin toxicity is suspected? 1 minute
EKG changes seen in digoxin toxicity prolonged p-r interval, shortening QT, T wave inversion, PVCs
predispositions for digoxin toxicity hypokalemia, hypocalcemia, vomiting, gastric suctioning, diuretics
IV predisposition for digoxin toxicity large amount of IV dextrose
Why does a large amount of IV dextrose a predisposition for digoxin toxicity? causes intracellular shift of potassium
age predispositions for digoxin toxicity young and old
health alterations that predispose for digoxin toxicity liver and kidney dysfunction
normal potassium level 3.5-5
normal calcium level 8.5-10
nursing assessment diagnositc of digoxin toxicity appearance (color/edema); tachycardia/bradycardia, dysrhythmia,m pulmonary rales, anorexia, visual distrubances
What to monitor with digoxin toxicity I&O; weight; apical pulse for one full minute
Labs to draw with digoxin toxicity potassium, calcium, kinetics
When do you hold digoxin adult apical impulse below 60; infant apical impulse below 90-110
When do you check calculation on digoxin? prior to administration
Antidote for digoxin digoxin immune FAB (Digibind)
What color is the bottle of digoxin for children? green
Teaching for digoxin use how/when to call doctor; how to measure digoxin with children; daily weight may need increase in potassium rich foods/supplementation
How much weight gain may indicate fluid retention? 1-2 pounds
1 kg = ?? lbs 2.2
Human B-type natiuretic peptide prototype nesiritide (natrecor)
therapeutic use of nesiritide (natrecor) acute heart failure
what does nesiritide (natrecor) do? recombinate DNA - identical to peptide secreted by ventricle with fluid and pressure overload
Action of nesiritide (natrecor) decreases preload/afterload; increases diuresis and secretion of sodium; decrease renin-angiotension-aldosterone and secretion of norephenephrie
nesiritide (natrecor) onset immediate
Nursing considerations for nesiritide (natrecor) give IV, bolus then separate IV; monitor urinary output
Why is nesiritide (natrecor) given in separate IV? not compatible with many drugs
What to do in emergency situation while on neiritide (natrecor) put patient on heart monitor
Created by: 1818554924
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