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31 Cards in this Set
- Front
- Back
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Positive inotrope |
Drugs that increase force of myocardial contraction |
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Negative inotropes |
Drugs that decrease force of myocardial contraction e.g. Beta blockers |
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Positive chronotropes |
Drugs that increase rate at which heart beats e.g. Adrenaline |
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Negative chronotropes |
Drugs that decrease rate at which the heart beats e.g. Digoxin |
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Cardiac glycosides |
Digoxin currently only drug used in this category |
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Indications for digoxin |
-Tx of HF (inotrope) -Tx arrhythmia |
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Digoxin MOA |
-Inhibits activity of the sodium-potassium pump. This increases intracellular calcium and sodium. This increases cardiac contraction. -slows HR by decreased conduction through SA and AV nodes -reduce cardiac workload and increase cardiac output |
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Digoxin has a ______________ therapeutic index |
Narrow |
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Digoxin ADRs |
-Anorexia and other GI disturbance -CNS effects - visual disturbance, confusion, fatigue -arrhythmia |
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Digoxin toxicity signs |
Decreased appetite N+V Diarrhoea Tiredness Bradycardia Visual disturbance Drowsiness Confusion |
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Digoxin antidote |
Digoxin immune antigen-binding fragment (fab, digibind) |
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Digibind therapeutic effects |
Binding and subsequent removal of digoxin, preventing toxic effects in overdose |
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Digoxin nursing responsibilities |
-take apical pulse one full minute before giving -listen for irregular HR -monitor pts also taking diuretics or corticosteroids; digoxin and K+ compete for receptor and so digoxin effects can be increased in hypokalaemia |
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What are vasodilator drugs used for |
Manage and prevent ischaemia |
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What drugs are used to treat angina symptoms |
Nitrates Beta blockers Calcium channel blockers |
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Preload |
The blood volume in the ventricles at the end of diastole, when the ventricles are full |
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Afterload |
The force against which a ventricle contracts |
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Nitrate MOA |
-bind to nitrate receptors in vascular smooth muscle causing relaxation -cause vasodilation in peripheral veins so decreased venous return to heart (decreased preload) and o2 demand -cause arterial vasodilation (decreased BP and afterload) -coronary artery vasodilation improving oxygenation to myocardium |
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GTN (glyceryl trinitrate) |
-short acting (20-30 minute duration) |
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Why is GTN give sublingual or topicak |
Avoid first pass effect or wouldn't have any effect |
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Isosorbide mononitrate |
Long acting For prophylaxis if b-blockers or CCBS contraindicated
Modified release formulations available e.g. Corangin, diuride |
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Nitrate ADRs |
- due to vasodilation - headache, dizziness, fainting and postural hypotension - reflex tachycardia - nausea and vomiting - ankle oedema |
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Nitrate tolerance |
-Tolerance develops over time to longer acting nitrates -loss of normal drug response -managed by ensuring the pt has a nitrate free period each day |
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Examples of calcium channel blockers |
Verapamil Diltiazem Nifedipine |
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CCB indications |
Angina HTN Arrhythmias |
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CCB MOA |
- inhibit calcium entry into myocardial and arterial muscle -therefore: decreased contractility, HR, and increased arterial vasodilation |
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Two main classes of CCB |
Dihydropyridines and non-dihydropyridines |
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CCB ADRs |
-headache -dizziness -blurred vision -HF -pulmonary oedema |
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CCB contraindications |
Hypotension LV Dysfunction - decreased force of myocardial contraction will worsen dysfunction |
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ACE inhibitor examples |
Captopril Enalapril Cilazapril Quinalapril Benazepril |
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ACE MOA |
-competitively block ACE responsible for conversion of ANG 1 to ANG II |
