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Heart Failure Drugs

Ch. 22 Pharm

What is automaticity? Property of specialized excitable tissue that allows self-activiation through the spontaneous dev of an action potential, as in the pacemaker cells of the heart.
What is positive chronotropic? Negative chronotropic? increase of heart rate decr of heart rate
What is + dromotropic? what is - dromotropic? + = accelerate conduction - = deccelerate conduction
What is + inotropic? what is - inotropic? + = incr. force of contraction - = decr. force of contraction
What is left ventricular end-diastolic volume? Also known as? Total amt of blood in vent. immediately before it contracts Preload
what is ejection fraction? what is normal %? proportion of blood that is ejected during ea vent contraction 65%
Systolic dysfunction is inadequate ventricular contraction or refilling? contraction diastolic dysfunction is inadequate vent filling
Name two typical cardiac defects that lead to heart failure Myocardial Infarction and Valve deficiency
Name three defects outside the heart that leads to heart failure diabetes coronoary artery disease pulmonary hypertension
What are supraventricular dysrhythmias? problems in the atria: atrial fibrillation, flutter
heart failure drugs that are most common positive inotropic drugs? phosphodiesterase inhibitors cardiac glycosides B-type natriuretic peptids ACE inhibitors ARB's (angiotensin II receptor blockers) beta blockers
ACE inhibitors do what? convert angiotensin I to II, a vasoconstrictor and induces aldosterone secretion. Prevents Na and H2O resportion by inhibiting aldosterone secretion.
What does aldosterone do? stimulates Na and H2O resportion, can raise BP
What is renin? vasoconstrictor released by kidneys
what is the renin-angiotensin-aldosterone system? process to raise BP by reorption of Na and h20
What is the most common ACE inhibitor? lisinopril (Prinvil, Zestril)
What are three ARB's available? valsartan, candesartan, losartan
What is an adverse effect of lisinopril? dry cough, hyperkalemia
What is the advantage of ARB's over ACE ihnibitors? no cough
What do ARB's ultimately do? vasodilators which decr systemic vascular resistance or afterload
What are B-type natiurectic peptides and name one used in severe life threatening heart failure. vasodilators, incr CO, suppress renin-angiotensin system, diuresis nesiritide (Natrecor)
What do beta blockers block? SNS stimulation to the heart adn heart's conduction system. Prevent catecholamine actions on heart.
What is the most common beta blocker? Metoprolol
catecholamines are what? SNS neurotransmitters: epi, norepi, dopamine
Name 4 adverse effects for B-type natiurectic peptides hypotension, dysrhythmia, headache, abd pain
phosphodiesterase inhibitors (PDI's)inhibit what? What is inodilators? Name two drugs phosphodiesterase inodilators +inotropic,vasodilation inamirone, milirone
phosphodiesterase inhibitors are given when pxt does not respond to what? digoxin, diurectics, &/or vasodilators short term mgmt for heart failure
What are adverse effects of inamrinone? milrinone? thrombocytopenia (dec platelets) dysrhythmia, hypokalemia, hypotension
Cardiac glycosides are oldest cardiac drugs. Obtained from what plant? foxglove
what is prototypical cardiac glycoside? What treatment is it used for? Digoxin systolic heart failure, atrial fibrillation
Digoxin has a + intotropic or - without an increase in what? + or - dromotropic? What does it prolong? + inotropic, w/o incr in O2 consum. - dromotropic refractory period (area b/n SA & AV nodes)
What is result of digoxin? reduced cardiac heart rate and improved cardiac effeciency, reduced heart size, less edema, incr coronary circulation (more blood to heart), help pxt exert and breathe better
A normal ventricle squeezes how much blood out with how much blood left behind? Weak left vent? 60%, 40% 33%, 67%
Heart Failure symptoms SOB, feet swell, no energy, insomnia, abd swell, cough, diuresis, confusion
Dig adverse effects very narrow therapeutic window, can get toxic quickly, drug levels must be .5-2ng/mL Low K incr toxicity electrolyte levels monitored dysrhythmias, headaches, colored vision, anorexia
What is the antidote for dig overdose? Digoxin immune Fab (digibind)
In measure the apical pulse for Dig, what should you look for? Measure apical for 1 min. If <60 or lower, or >100, then withhold dose and notify doctor
What food should not be adm. with Dig? high fiber foods b/c fiber binds and alters absorption adn bioavailability
Therapeutic effects of pos. inotropic drugs incr urinary output decr edema decr dyspnea/crackles decr fatigue resolve paroxysmal noct. dyspnea Impr. peripheral pulses,skin color, temp
What are the parameters for weight gain with heart failure drugs 2+ lbs in day or 5+ in week, report
When adm. inamrinone or milrinone, how should you adm. it? use infusion pump
An IV inamrinone should never be mixed with what? What color is the solution? dextrose yellow
Created by: palmerag



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