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hrt failure

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Cardiac Glycosides   Admin: apical pulse 1min @ least 60 bpm narrow theraputic range 0.8- 2ng/ml Preg Cat A monitor geri/pedi due to inadequate renal & hepatic metabolic enzymes  
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Cardiac Glycosides /Digoxin side/contraindictions   Side: dysrhythmias hypokalemia n&v fatigue anorexia vision issues halos ylw-grn tinge blurring Con: no w pt that have AV block or ventricular dysrhythmias unrelated to HF pts w renal issues get lower doses use caution MI hypothyroidism core pulmonale  
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Cardiac Glycosides/ Digoxin   teach: take pulse before dose reports any signs of toxicity (yellow halos) heart rate monitor- check their HR with steth apical for 1 min  
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lifespan for digoxin   pediac safe-dose by age, safe in newborns and children not recom for breastfeed older adults- more senstive- excretes thru kidneys, liver- report n/v and halos  
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inotropic effect   a change in contractility of the heart  
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preload   the degree to which the myocardial fibers are stretched just prior to contraction increased preload will increase cardiac output  
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afterload   the defree of pressure in the aorta that must be overcome for blood to be ejected from the l. ventricle affects cardiac output lower BP makes less afterload; less workload for heart  
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hrt failure   the in ability of the ventricles to pump enough blood for body's needs weakening of hrt muscle due to aging or disease  
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cardiovascular disease   coronary artery disease (CAD) Mitral stenosis Myocardial infarction (MI) chronic hypertension (HTN) Diabetes mellitus (DM) hyperthyroidism/ hypothyroidism  
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function of the l. side of heart   bld fill in l. ventricle l. ventricle thickens/ enlarges (hypertrophy) cardiac remolding- changes of the myocardial cells (myocytes) cough/SOB result  
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function of the r. side of heart   bld backs up into veins peripheral edema & organ engorgement less common than l. sided HF  
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pharmacologic mechanisms   slows hrt rate increase contractility reducing myocardial workload  
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tx for hrt failure pt 1   ace inhibitors- lisinopril (drug of choice) excretion of sodium and water, lowers peripheral resistance, increase cardiac output ARBs- for those unable to tolerate ace inhibitors  
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tx for hrt failure pt 2   diuretics-given with other drugs increased urine reduce bld volume edema pulmonary congestion & cardiac workload beta blockers- metoprolol (reduce sx of HF & slow progression of disease) Slows heart rate reduce BP reduced workload of hrt inotropic effect  
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tx for hrt failure pt 3   Cardiac glycosides- digoxin (increase contractility or strength of contraction) increase course of heartbeat slows heart rate improved cardiac output. Use in combination with other drugs  
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tx for hrt failure pt 4   phosphodiesterase Inhibitors- milrinone (short-term therapy hrt failure) cause positive inotropic response & vasodilation increase contractility & decrease afterload, increasing myocardial contraction force and cardiac output.  
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Digoxin/ lanoxin   cardiac glycoside- Reduces heart rate with forceful contractions improving cardiac output by inhibiting Na+ K+ ATPase exchanging sodium ions for potassium ions. Sodium accumulates and calcium ions are released action: HF  
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Cardiac Glycosides/ Digoxin interactions- drug/food herbal pt 1   Inter: given w diuretics/ Ca+ IV increase risk of dysrhythmia/hypokalemia. Ace/spironolactone/K+ supp- hyperkalemia & reduce action of digoxin. Other positive and on-topic drug increase of facts on heart contractility. Beta blockers result in brady  
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Cardiac Glycosides/ Digoxin interactions- drug/food herbal pt 2   Verapamil alprazolam quinidine decrease distribution and excretion of digoxin ^ risk of digoxon toxicity food- ginseng ^ the digoxin toxicity Ma huang and ephedra induce dysrhythmias.  
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