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26 Cards in this Set

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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
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
Side effects of Digoxin?
Digoxin side effects:
=risk of arrhythmias
=risk of heart block
=nausea/vomiting
=loss of colour vision
=abdominal pain
Advantages and disadvantages of Digoxin?
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
MOA of digoxin?
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
When is Digoxin indicated?
Digoxin is indicated in:
-chronic CCF
-Atrial fibrillation
-heart spasms
Contraindications to digoxin?
Digoxin contraindications:
x heart block
x hypokalaemia from diuretics use
What does "positively inotropic" mean?
Positively inotropic means that the agent increases the contractility of heart muscle.
Name one positively and one negatively inotropic agent used to treat cardiac conditions.
Positively inotropic=digoxin
Negatively inotropic=?
Calcium channel blockers have a __________ inotropic effect.
Calcium channel blockers are negatively inotropic.
Name three classes of drugs useful for treating cardiac failure
Cardiac failure?, use:
-diuretics
-ACE inhibitors
-Cardiac glycosides
Name three classes of drug used to treat ischaemic heart disease.
Ischaemic heart disease?, use:
-Nitrates
-Beta-blockers
-Calcium-channel blockers
Cardiac failure is...?
Cardiac failure is a chronic condition in which cardiac output is insufficient to meet the demands of the body.
Give three causes of cardiac failure.
Cardiac failure is caused by damage to the myocardium caused by:
1) ischaemic heart disease
2) heart valve damage
3) poorly controlled hypertension
Broadly speaking, how does the body respond to reduced cardiac perfusion?
Reduced cardiac perfusion prompts counter-regulatory mechanisms to restore perfusion (homeostasis).
Name three regulatory mechanisms that are stimulated by poor cardiac perfusion.
- Sympathetic nervous system peripheral vasoconstriction & direct heart stimulation.
- The renin-angiontensin-aldosterone system activated to raise BP and blood volume.
Why do the body's counter-regulatory mechanisms for cardiac ultimately fail?
They increase the load on the heart.
Why use diuretics in cardiac failure?
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.
State the main treatment aims of Tx cardiac failure.
-to reduce fluid retention
-to reduce pre- and after- load on the heart
Name three classes of drugs commonly used to treat cardiac failure. Give an example of each.
Drugs to treat cardiac failure
=diuretics (Furosemide)
=ACE inhibitors (Ramipril)
=Inotropic agents (Digoxin)