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26 Cards in this Set
- Front
- Back
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How does digoxin help in heart failure?
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What are the implications of digoxon's narrow therapeutic window?
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Short notes on digoxin
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Positive and negative inotropic agents have a role in the management of CV conditions. Describe the actions and uses for one positive and one negative inotropic agent (25)
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state the actions and indications for use of digoxin (10)
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Explain the concept of the narrow therapeutic window as it applies to digoxin (10)
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Outline the process of therapeutic drug monitoring (5)
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Short notes on glyceryl trinitrate
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glyceryl trinitrate
Class=organic nitrate MOA=when metabolised converts to nitric oxide, which relaxes smooth muscle by interfering with Ca2+ uptake Indications=acute angina attack, MI, CCF Contras=hypotension, hypovolemia Interactions=? Side effects=headache, dizziness, tachycardia, facial flushing |
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Side effects of Digoxin?
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Digoxin side effects:
=risk of arrhythmias =risk of heart block =nausea/vomiting =loss of colour vision =abdominal pain |
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Advantages and disadvantages of Digoxin?
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Digoxin
Advantages: =slows, steadies and strengthens heart =used in CCF where other Tx has failed =useful in urgent situations Disadvantages: =Narrow therapeutic window =toxicity >2.6mmol/L =Dysrrhythmia risk =Heart block risk |
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MOA of digoxin?
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Digoxin MOA
Slows, steadies and strengthens 1) increases vagal activity - slows AV conduction 2) inhibits sodium-potassium pump in cardiac muscle - intracellular calcium rises and contraction force increases |
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When is Digoxin indicated?
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Digoxin is indicated in:
-chronic CCF -Atrial fibrillation -heart spasms |
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Contraindications to digoxin?
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Digoxin contraindications:
x heart block x hypokalaemia from diuretics use |
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What does "positively inotropic" mean?
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Positively inotropic means that the agent increases the contractility of heart muscle.
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Name one positively and one negatively inotropic agent used to treat cardiac conditions.
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Positively inotropic=digoxin
Negatively inotropic=? |
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Calcium channel blockers have a __________ inotropic effect.
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Calcium channel blockers are negatively inotropic.
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Name three classes of drugs useful for treating cardiac failure
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Cardiac failure?, use:
-diuretics -ACE inhibitors -Cardiac glycosides |
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Name three classes of drug used to treat ischaemic heart disease.
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Ischaemic heart disease?, use:
-Nitrates -Beta-blockers -Calcium-channel blockers |
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Cardiac failure is...?
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Cardiac failure is a chronic condition in which cardiac output is insufficient to meet the demands of the body.
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Give three causes of cardiac failure.
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Cardiac failure is caused by damage to the myocardium caused by:
1) ischaemic heart disease 2) heart valve damage 3) poorly controlled hypertension |
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Broadly speaking, how does the body respond to reduced cardiac perfusion?
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Reduced cardiac perfusion prompts counter-regulatory mechanisms to restore perfusion (homeostasis).
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Name three regulatory mechanisms that are stimulated by poor cardiac perfusion.
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- Sympathetic nervous system peripheral vasoconstriction & direct heart stimulation.
- The renin-angiontensin-aldosterone system activated to raise BP and blood volume. |
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Why do the body's counter-regulatory mechanisms for cardiac ultimately fail?
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They increase the load on the heart.
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Why use diuretics in cardiac failure?
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Diuretics are useful in cardiac failure because they:
1- reduce fluid retention and blood volume 2- reduce pre- & after-load on heart, via peripheral vasodilation. |
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State the main treatment aims of Tx cardiac failure.
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-to reduce fluid retention
-to reduce pre- and after- load on the heart |
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Name three classes of drugs commonly used to treat cardiac failure. Give an example of each.
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Drugs to treat cardiac failure
=diuretics (Furosemide) =ACE inhibitors (Ramipril) =Inotropic agents (Digoxin) |
