Pharm 2 Positive Inotropic Dgs.

Front 1

Positive Inotropic Agents

Back 1

-Drugs that increase the force of Myocardial contractions
-Used for Heart failure
-Ex. Card. Glucosides (Digoxin)
-Phosphodiesterase inhibitors

Front 2

Myocardial Deficiency and increased Workload: Common Causes..

Back 2

-Myocardial Deficiency (MI, CAD, Cardiomyopathy, infection)
-Inadequate filling (A-fib,infection, tamponade, ischemia)
-Increased workload (Hypertension, outflow obstruction)
-Vol Overload (Hypervolemia, Congenital defects, anemia, thyroid disease)

Front 3

Cardiac Glycosides

Back 3

Digoxin, used to contol Afib and heart failure, also Digitoxin

Front 4

Cardiac Glycosides Mech of action

Back 4

-inc. Myocard. Contractility
-Change electrical conduction of heart (decrease rate, and prolong refractory period inbetween SA and AV node)

Front 5

Cardiac Glycosides Drug effects

Back 5

-inotropic positive, increases force or energ of muscle contractions
-Chronotropic Negative decreasing (HR)
-Dromotropic negative (Conduction of electrical impulses is decreased
-inc. SV
-reduction of heart size during diastole
-Decrease Venous BP
-incr. coronary circ.
-promotes diuresis via blood circ.
-palliation, of exertional and parooxysmal nocturnal dyspnea, cough, and cyanosis

Front 6

Cardiac Glycosides Indications..

Back 6

-Heart Failure
-SV dysrhythmias

Front 7

Digoxin (Lanoxin)

Back 7

-narrow therapeutic window
-monitor drug level and electrolytes
-low K+ increases its toxicity

Front 8

Cardiac Glycosides Digoxin side effects..

Back 8

-CV: Dysrhythmias (Brady and Tachy
-CNS: Headache, fatigue,Malaise, confusion, convulsions
- Eye: Colored vision, halo visio
-GI: nausea, anorexia,Vom Diarrhea

Front 9

Digoxin toxicity:

Back 9

Digoxin immune FAB (Digibind) therapy: Hyperkalemia (>5 mEq/L)
-Life threat dysphyth.
-overdoes

Front 10

Phosphodiesterase Inhibitors..

Back 10

-Do what as their name indicates.
-result in positive inotropic response, Vaso dilation (positive) lusitropic effect)
-Amrinone and Milrinone

Front 11

Phosphodiesterase Inhibitors indications..

Back 11

-Short term heart failure
-when digoxin not effective
-given weekly in 6 hr infusions

Front 12

Phosphodiesterase Inhibitors,Amrinone and Milrinone side effects..

Back 12

-Amrinone, Thrombocytopenia Dis Rhyth., nausea, hypotension
-Milrinone Disrhyth (Ventrical), Hypotension, angina, Hypo K+, tremor, and thrombocytopenia

Front 13

Nursing implications

Back 13

--Assess Health Hx, KDA, contraindic.
-BP, Ap. Pulse, Heart Sounds, Breath S., Weight, I&O, ECG, Serum Labs, K, Na, Mg, Ca, and renal and liver function studies
-Pulse <60 or >120 hold dose, tell Dr.
-Report any indication of toxicity
-Don't give with High Fiber foods
-report weight gain of 2 lb/day or 5/week
Use infusion pump with Amrinone and Milrinone,

Front 14

IV amrinone

Back 14

Do not mix with dextrose, it is yellow

Front 15

Monitor Therapeutic effects..

Back 15

incr. urine out
-decreased edema, shortness of breath, dyspnea, rales and fatigue
-resolves paroxysmal nocternal dyspnea
-better periferal pulses, skin color, and temp