Cardiac Glycosides,antianginals, And Antidysrhythmics

Front 1

Digitalis preparations have come to be known for their effectiveness in treatiing

Back 1

Heart failure

Front 2

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

Back 2

heart failure,pump failure

Front 3

When the compensatory mechanisms fail and the peripheral and lung tissues are congested . This is called

Back 3

CHF

Front 4

The causes of heart failure include:

Back 4

Chronic hypertension, MI, CAD, valvular heart disease, congenital heart disease, and the aging heart

Front 5

Left sided HF

Back 5

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.

Front 6

Clinical signs of CHF, (What the patient presents with)

Back 6

Usually the patient will have shortness of breath

Front 7

Righ sided HF

Back 7

Occurs when the when the heart does not sufficiently pump the blood returned into the right atrium from the systemic circulation .

Front 8

What the patient will present with in right sided hF?

Back 8

peripheral edema Blood and its constituents are backed up into peripheral tissues. EX. arms and legs

Front 9

One type of heart failure can lead to another

Back 9

True

Front 10

In HF there is an increase in

Back 10

preload and afterload

Front 11

What causes the increase in preload?

Back 11

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.

Front 12

What causes the increase in afterload?

Back 12

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.

Front 13

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.

Back 13

Cardiac glycosides

Front 14

An increase in intracellular sodium leads to

Back 14

an influx of Calcium, causing the cardiac muscle fibers to contract more efficiently.

Front 15

Digitalis preparations like digoxin have three effects on the heart muscle:

Back 15

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).

Front 16

The increase in myocardial contractility increases:

Back 16

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.

Front 17

As a result of the above:

Back 17

fluid retention in the lung and extremites are decreased.

Front 18

Acts by increasing the force and velocity of the myocardial systolic (working phase) contraction.

Back 18

Digoxin

Front 19

First and Second line of drugs used to treat Acute heart failure:

Back 19

First line- Inotropic agents:
DOPAMINE &DOBUTAMINE
PHOSPHOESTERASE
INHIBITORS- Amrione and primacor.
Second line- Digoxin

Front 20

Other drugs prescribed for HF:

Back 20

diuretics, beta-blockers, ACE-Inhibitors, ARB'S, CCB, AND vasodialators.

Front 21

a-fib and a-flutter is controlled by cardiac glycosides by:

Back 21

negative chronotropic and negative dromotropic effects

Front 22

true

Back 22

digoxin does not convert afib to norma heat rhythm.

Front 23

Management of afib:

Back 23

CCB AND COUMADIN

Front 24

Labs used to diagnose Heart failure:

Back 24

Atrial natriretic hormone or peptide
BNP

Front 25

ANH or ANP

Back 25

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.

Front 26

Dig toxicity: What will the patient present with?

Back 26

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.

Front 27

What population of people are more suseptible to dig. toxicity?

Back 27

Elderly adults

Front 28

A patient that is dig toxic should be place on:

Back 28

A telemetry monitor b/c ventricular dysryhtmias may result.

Front 29

Three cardica altered functions can contribute to dig-induced ventricular dysrhythmias:

Back 29

1. Suppression of A-V conduction
2. increased automaticity
3. decreased refractory period in ventricular muscle.

Front 30

Drugs used for treating dig-induced ventricular dysrhymias:

Back 30

PHENYTOIN AND LIDOCAINE.

Front 31

Antidote for Cardiac glycosides

Back 31

digoxin immune( digibind, ovine). excreated in the urine, signs and symptoms should be reported to the Dr.

Front 32

Dig toxicity may result in:

Back 32

First, Second and Complete heart block. Serum dig levels should be monitored

Front 33

Drug interactions with dig can cause dig toxicity

Back 33

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.

Front 34

patient teaching should include for the above:

Back 34

1. Consume foods rich in K or take K supplements to avoid Low K and dig toxicity.

Front 35

Antacids

Back 35

can decrease dig absorption if taken at the same time .

Front 36

HERBAL ALERT :

Back 36

ginseng, St. John's wort, Metamucil, Hawthorn, Licorice, Aloe, Ma-hung, and Goldenseal will effect dig mechanism of action

Front 37

GINSENG

Back 37

MAY FALSELY ELEVAT DIG LEVELS

Front 38

ST. JOHNS WORT

Back 38

DECREASES THE ABSORPTION OF DIG AND THUS DECREASES SERUM DIG LEVELS

Front 39

METAMUCIL

Back 39

MAY DECREASE DIG ABSORPTION

Front 40

HAWTHORN

Back 40

MAY INCREASE THE EFFECTS OF DIGOXIN

Front 41

LICORICE

Back 41

CAN POTENTIATE THE EFFECT OF DIG. IT PROMOTES LOW K, WHICH INCREASES THE EFFECTS OF DIG.

Front 42

ALOE

Back 42

MAY INCREASE THE RISK OF DIGITALIS . INCREASES K LOSS

Front 43

MA-HUNG OR EPHEDRA

Back 43

INCREASES THE RISK OF DIG TOXICITY

Front 44

GOLDENSEAL

Back 44

DECREASE THE EFFECTS OF CARDIAC GLYCOSIDES AND INCREASE THE EFFECTS OF ANTIDYSRYHMICS,.

Front 45

PHOSPHODIESTERASE INHIBITORS

Back 45

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.