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45 Cards in this Set

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Digitalis preparations have come to be known for their effectiveness in treatiing
Heart failure
When the heart muscle (myocardium) weakens and enlarges, it loses it's ability to pump blood through the heart and into systemic circulation. This is called
heart failure,pump failure
When the compensatory mechanisms fail and the peripheral and lung tissues are congested . This is called
CHF
The causes of heart failure include:
Chronic hypertension, MI, CAD, valvular heart disease, congenital heart disease, and the aging heart
Left sided HF
When the left ventricle does not contract sufficiently to pump the blood returned from the lungs and left atrium out through the aorta into peripheral circulation; this causes excessive amounts of blood to back up into the lung tissue.
Clinical signs of CHF, (What the patient presents with)
Usually the patient will have shortness of breath
Righ sided HF
Occurs when the when the heart does not sufficiently pump the blood returned into the right atrium from the systemic circulation .
What the patient will present with in right sided hF?
peripheral edema Blood and its constituents are backed up into peripheral tissues. EX. arms and legs
One type of heart failure can lead to another
True
In HF there is an increase in
preload and afterload
What causes the increase in preload?
results from an increase in blood in the ventricle at the end of diastole. (The resting phase of the heart). This occurs b/c of a pathological increase in the elasticity of the ventricular walls associated with a weakend heart.
What causes the increase in afterload?
There is an increased pressure or force in the ventricular wall caused by increased resistance in the aorta which must be overcome to open the aortic valve so blood can be injected into circulation.
Found in a number of plants, including digitalis and they are a group of drugs that inhibit the sodium -potassium pump. Also used to correct a-fib and a-flutter.
Cardiac glycosides
An increase in intracellular sodium leads to
an influx of Calcium, causing the cardiac muscle fibers to contract more efficiently.
Digitalis preparations like digoxin have three effects on the heart muscle:
1. a positve inotropic action ( increases myocardial contraction stroke volume)
2. a negative chronotropic action ( decreases heart rate).
3. negative dromotropic (decreases conduction of the heart cells).
The increase in myocardial contractility increases:
cardiac, peripheral,and kidney function by increasing cardiac output, decreasing preload, improving blood flow the the periphery and kidneys, decreasing edema, and increasing fluid excreation.
As a result of the above:
fluid retention in the lung and extremites are decreased.
Acts by increasing the force and velocity of the myocardial systolic (working phase) contraction.
Digoxin
First and Second line of drugs used to treat Acute heart failure:
First line- Inotropic agents:
DOPAMINE &DOBUTAMINE
PHOSPHOESTERASE
INHIBITORS- Amrione and primacor.
Second line- Digoxin
Other drugs prescribed for HF:
diuretics, beta-blockers, ACE-Inhibitors, ARB'S, CCB, AND vasodialators.
a-fib and a-flutter is controlled by cardiac glycosides by:
negative chronotropic and negative dromotropic effects
true
digoxin does not convert afib to norma heat rhythm.
Management of afib:
CCB AND COUMADIN
Labs used to diagnose Heart failure:
Atrial natriretic hormone or peptide
BNP
ANH or ANP
ANH is secreted from the atria of the heart and acts as an antagonists to renin and aldosterone. It is released during the expansion of the atrium, produces vasodialtion, and increases GFR.
Dig toxicity: What will the patient present with?
Anorexia(loss of appetite), diarrhea, nause, vomitting, bradycardia, PVC's, cardiac dysrhythmias, headaches, malaise, blurred vision, visual illusions (white, green, yellow halos around objects),confusion, and delrium.
What population of people are more suseptible to dig. toxicity?
Elderly adults
A patient that is dig toxic should be place on:
A telemetry monitor b/c ventricular dysryhtmias may result.
Three cardica altered functions can contribute to dig-induced ventricular dysrhythmias:
1. Suppression of A-V conduction
2. increased automaticity
3. decreased refractory period in ventricular muscle.
Drugs used for treating dig-induced ventricular dysrhymias:
PHENYTOIN AND LIDOCAINE.
Antidote for Cardiac glycosides
digoxin immune( digibind, ovine). excreated in the urine, signs and symptoms should be reported to the Dr.
Dig toxicity may result in:
First, Second and Complete heart block. Serum dig levels should be monitored
Drug interactions with dig can cause dig toxicity
1. Lasix, HCTZ- promote the loss of potassium from the body. The result is hypokalemia increases the effect of dig at its myocardial cell siteof action, resulting in dig toxicity.
2. Cortisone-promote Na retention and K excretion.
patient teaching should include for the above:
1. Consume foods rich in K or take K supplements to avoid Low K and dig toxicity.
Antacids
can decrease dig absorption if taken at the same time .
HERBAL ALERT :
ginseng, St. John's wort, Metamucil, Hawthorn, Licorice, Aloe, Ma-hung, and Goldenseal will effect dig mechanism of action
GINSENG
MAY FALSELY ELEVAT DIG LEVELS
ST. JOHNS WORT
DECREASES THE ABSORPTION OF DIG AND THUS DECREASES SERUM DIG LEVELS
METAMUCIL
MAY DECREASE DIG ABSORPTION
HAWTHORN
MAY INCREASE THE EFFECTS OF DIGOXIN
LICORICE
CAN POTENTIATE THE EFFECT OF DIG. IT PROMOTES LOW K, WHICH INCREASES THE EFFECTS OF DIG.
ALOE
MAY INCREASE THE RISK OF DIGITALIS . INCREASES K LOSS
MA-HUNG OR EPHEDRA
INCREASES THE RISK OF DIG TOXICITY
GOLDENSEAL
DECREASE THE EFFECTS OF CARDIAC GLYCOSIDES AND INCREASE THE EFFECTS OF ANTIDYSRYHMICS,.
PHOSPHODIESTERASE INHIBITORS
Primacor, Inocor
These drugs increase SV and CO and promote vasodialtion. Administered IV and Should not be used longer than 48 to 72 hours . Severe cardiac dysrhythmias might result from use of these drugs . So the patient EKG and cardiac status should be monitored closely.