Quiz 6
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| Group of drugs composed of digitalis, a substance which occurs naturally in the foxglove plant. Have narrow therapeutic range. Widespread use for 200 years. | Cardiac Glycosides
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| Cardiac Glycosides are also known as | Inotropes
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| Digoxin is what type of drug? | Cardiac Glycosides (Inotropes)
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| Absorption of this drug varies widely between manufacturers. Once absorbed or given IV, takes 8 hr to reach tissue binding sites. Have long half-lives; several days for therapeutic effect. May receive loading dose. | Cardiac Glycosides (Inotropes) = DIGOXIN
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| Positive inotropic, and negative inotropic and dromotropic effects. Stimulates PNS, slows heart rate, and slows conduction through AV node. | Cardiac Glycosides (Inotropes) = DIGOXIN
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| Used to treat CHF, A-fib, atrial flutter, and paroxysmal atrial tachycardia. May improve cardiac hemodynamics when used with diuretics and vasodilators in mild to moderate HF. | Cardiac Glycosides (Inotropes) = DIGOXIN
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| `Will increase myocardial O2 demand, so benefits must outweigh risk before prescribing in post MI for supraventricular arrhythmias. | Cardiac Glycosides (Inotropes) = DIGOXIN
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| Quinidine may double serum levels by reducing this drug's rate of elimination. Verapamil enhances effects of this drug. | Cardiac Glycosides (Inotropes) = DIGOXIN
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| Antacids decrease absorption of this drug if taken at the same time, so doses should be staggered. | Cardiac Glycosides (Inotropes) = DIGOXIN
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| Therapeutic range of Digoxin is _______ng/dL | 0.5-2.0
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| Hypokalemia may predispose patients to toxicity. Signs include N/V, diarrhea, restlessness, irritability, cardiac arrhythmias (bradycardia, atrial, and ventricular). | Cardiac Glycosides (Inotropes) = Digoxon
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| Cariotonic-inotropic agents used in the short-term management of HF not controlled by digoxin, diuretics, and vasodilators. | Phosphodiesterase Inhibitors
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| Drugs relax vascular smooth muscle to produce vasodilation, decrease preload and afterload. Given by continuous IV infusion. | Phosphodiesterase Inhibitors
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| What type of drug is Amrinone? | Phosphodiesterase Inhibitors
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| What type of drug is Milrinone? | Phosphodiesterase Inhibitors
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| Group of drugs that may be used in severe HF to provide circulatory support. Strengthen myocardial contraction. | Adrenergic Agents
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| Use of minimal effective dose of this group of drugs is recommended, because tachycardia and HTN can cause increased cardiac workload and increased myocardial O2 consumption. | Adrenergic Agents
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| Dopamine is what type of drug? | Adrenergic Agents
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| Dobutamine is what type of drug? | Adrenergic Agents
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| Drugs of 1st choice in treating all four NY Heart Association classifications. Act to block the conversion of Angiotensin I to Angiotensin II, thus producing dilation of both veins and arteries, and decreased retention of Na and H2O. | Angiotensin-converting Enzyme (ACE) Inhibitors
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| This group of drugs results in decreased preload and afterload, decreases cardiac workload, and increases perfusion of body organs and tissues. Can be given with or without digoxin. | Angiotensin-converting Enzyme (ACE) Inhibitors
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| What type of drug is Captopril? | Angiotensin-converting Enzyme (ACE) Inhibitors
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| What type of drug is Lisinopril? | Angiotensin-converting Enzyme (ACE) Inhibitors
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| What type of drug is Quinapril? | Angiotensin-converting Enzyme (ACE) Inhibitors
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| What type of drug is Enalapril? | Angiotensin-converting Enzyme (ACE) Inhibitors
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| Used in treatment of chronic HF to suppress activation of SNS and excessive catacholamine response that eventually damages myocardial cells. | Beta-adrenergic Blocking Agents
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| Over time, use of this group of drugs results in the heart returning to normal shape and function (reverse remodeling), and cardiac output increases. | Beta-adrenergic Blocking Agents
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| This group of drugs is not used in acute HF because of initial decrease in myocardial contractility. May be started once acute symptoms relieved. | Beta-adrenergic Blocking Agents
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| This group of drugs usually starts in low doses, then dosage increased over 2 weeks. Used with ACE inhibitor. | Beta-adrenergic Blocking Agents
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| What type of drug is Bisoprolol? | Beta-adrenergic Blocking Agents
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| What type of drug is Carvedilol? | Beta-adrenergic Blocking Agents
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| What type of drug is Metaprolol? | Beta-adrenergic Blocking Agents
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| Group of drugs used to relieve edema by decreasing extracellular fluid volume and increasing excretion of Na and H2O, thus decreasing preload. | Diuretics
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| This group of drugs may be given PO or IV. Initial treatment in acute failure. Relieved symptoms of HF but does not improve left ventricular function. | Diuretics
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| Group of drugs includes ACE inhibitors, angiotensin receptor antagonists, nitrates (venous dilators), and arterial vasodilators (such as Hydralazoine). | Vasodilators
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| Group of drugs acts to decrease preload and afterload depending on the agent used. May combine isosorbide (a nitrate) with hydralazine to decrease both preload and afterload. | Vasodilators
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| Group of drugs may be taken PO for clients with chronic HF, or IV for those in severe HF. | Vasodilators
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| This specific drug is a combination of hydralazine and isosorbide, which received approval in 2005 for treating HF, especially in African-Americans. | BiDil
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| Group of drugs produced by recombinant DNA technology; it is identical to endogenous human BNP, which is secreted by the ventricles in response to fluid and pressure overload. | Human B-Type Natriuretic Peptide (BNP)
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| Group of drugs compensates for deteriorating cardiac function by reducing preload and afterload, increases diuresis, and suppresses the renin-angiotensin-aldesterone mechanism. | Human B-Type Natriuretic Peptide (BNP)
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| Nesteritide is the first drug in this class to be used in the treatment of HF | Human B-Type Natriuretic Peptide (BNP)
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| What type of drug is Nesteritide? | Human B-Type Natriuretic Peptide (BNP)
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| Group of drug relaxes blood vessels and improves blood flow by targeting the neurohormone endothelin-1 that is produced in excess in HF. Other drugs in this class are being studied (additional data beeded to support use in HF). | Endothelin Receptor Antagonists
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| What type of drug is Bosentan? (Note additional info on answer side!) | Endothelin Receptor Antagonists (Note: This drug is approved by the FDA for treatment of pulmonary HTN)
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| Upon evaluation of the patient with HF, what therapeutic effects may we see with use of HF drugs? | Breath easier, decreased edema, improved activity tolerance
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| What should we assess the pt for with HF? | Symptoms of HF, breath sounds, edema, dyspnea, HTN, confusion, fatigue
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| What considerations should be made in implementation of drug administration for HF? | Assess baseline apical HR and rhythm prior to each dose, hold for apical rate <60 and call MD, monitor serum digoxin levels, monitor for signs of dig toxicity.
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| What should we teach client who is taking meds for HF? | Take own pulse (call MD with pulse <60 and do not take med), take at same time every day and don't double missed doses, take same brand (DO NOT substitute), report s/s HF, report s/s dig toxicity.
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