CARDIOVASCULAR & RENAL SYS Etiology of Heart failure Positive Inotropic Agents,
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| Positive Inotropic Agents treats ______ failure. | Congestive heart failure
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| What is heart failure? | Heart failure is a cluster of signs & symptoms that occur when the L, R, or both ventricles lose the ability to pump enough blood to meet the body’s circulatory needs.
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| What is heart failure treated with? | Combination of:
1. vasodilator,
2. inotropic,
3. diuretic therapy
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| Vasodilators reduce___ so that the high volume of blood returning to the heart is _____ .This decreases pulmonary ____ & allows the patient to breathe. | preload;decreased; congestion;
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| Positive Inotropic agents stimulate the heart to _____the force of contractions, thus boosting ______. They also help reduce pulmonary congestion & improve _____ perfusion. | increase ; cardiac output; tissue
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| Negative inotropic agents____the force of contraction (beta blockers, calcium channel blockers). | decrease
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| Diuretics help____ blood volume & water retention; they reduce the _____and central venous pressures, which are the filling pressures of the ventricles. | decrease; preload ;
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| Inotropic drugs influence the ____of muscular_____ | force ; contractions
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| Chronotropic drugs influence the _____of the heartbeat | rate
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| Dromotropic drugs influence the ______ of _____impulses | conduction ;electrical
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| Ejection Fraction reflects heart _____ | contractility
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| What are two Positive inotropic drug classes? | 1. Cardiac glycosides
2. Phosphodiesterase inhibitors
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| Lanoxin (digoxin) is a ____ | Cardiac Glycosides
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| Lanoxin (digoxin) ____force of contraction (pos. inotropy) | Increases
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| Lanoxin (digoxin) ____the HR (neg. chronotropy) | Slows
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| Lanoxin (digoxin) _____ electrical conduction in heart (neg. dromotropy) | Reduces
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| What are the side effects of Lanoxin ( digoxin)? | 1. N/V,
2. Restlessness/Irritability,
3. Confusion,
4. Disorientation,
5. Blurred vision,
6. Halos around objects,
7. Dysrhythmias (toxicity)
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| Therapeutic drug level of Digoxin = _____ to____ ng/mL | 0.5 – 2.0
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| S/S Digoxin toxicity: is induced ____hyperkalemia (level >5 mEq/L), ventricular ______ or fibrillation | arrhythmias, tachycardia
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| When does hypokalemia occur? | Hypokalemia occurs when patient has anorexia, nausea, vomiting, diarrhea or heavy diuresis; predisposes pt. to digitalis toxicity.
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| Antidoate for digoxin toxicity is___ | Digoxin Immune FAB (Digibind)
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| What are the drug interactions of Digoxin are | Potassium sparing diuretics & Beta-Adrenergic Blockers
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| Nursing Considerations for digoxin are ? | 1. Check HR
60 bpm - 120 bpm
Note: IF Less than 60 or greater than 120, DO NOT GIVE MEDICATION
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| You must take ____ pulse for one full minute when digoxin is administered | apical
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| When administering digoxin you should monitor: | 1. Monitor Digoxin level
2. Monitor serum potassium level
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| Bran in large amounts may ____absorption of _____ drugs (do not take oral digoxin at same time as eating bran fiber) | decrease ; oral digitalis
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| Phosphodiesterase Inhibitors _____ the ____ & velocity of myocardial contractions | Increase; force
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| Phosphodiesterase Inhibitors Relax _____muscle to cause _____, reducing preload & afterload | vascular smooth/ vasodilation,
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| Phosphodiesterase Inhibitors are used for ____-term management of systolic dysfunction heart failure in patients who have not responded to digitalis, diuretics, or vasodilator therapy | short
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| What are two examples of Phosphdiesterase? | 1. Inocor (inamrinone)
2. Primacor (milrinone)
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| What are the three adverse effects of Phosphodiesterase Inhibitors? | Thrombocytopenia (inamrinone)
Dysrhythmias (milrinone)
Hypotension secondary to vasodilation (both)
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| What are the 5 cardiac properties? | Conductivity, Automaticity, Irritablity, Contractility, Excitability
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