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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