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46 Cards in this Set
- Front
- Back
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what are the inotropic drugs
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digoxin (lanoxin)
Inamrinone dobutamine dopamine |
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what are the ACE inhibitors
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captopril
enalapril |
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angiotensin II receptor inhibitors
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losartan
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B-blockers
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Bisprolol
carvedilol metaprolol |
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digitalis antibody
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digoxin immune fab
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what are the sources of Digitalis (cardiac glycosides)
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foxglove or digitalis plants
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what is the mech of action for digoxin
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inhibits the Na+/K+ ATPase pump
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what are the mechanical effects of digoxin
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positive inotropic effects
inc contractility dec in HR Inc CO |
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what is the structure of digoxin/glycosides
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aglycone (genin)
3 sugar rings: tri-digitoxose |
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what does the inhibition of the Na+/K+ pump by digoxin do to the intracellular conditions
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Inc Na+ conc
dec K+ conc Inc Ca++ concentration via retention inc actin/myosin interactions inc contractility |
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how do K+ and digoxin interact with each other
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the are competitive inhibitors of each other
they both compete for the Na+/K+ ATPase |
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what increases the effect of digoxin and should never be added to the body while taking digoxin
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Ca++
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what dec digoxin toxicity
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Mg++
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how does digoxin reduce the HR in a normal heart
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parasympathtic like effects by
-stimulation of vagal nuclei -inc SA sensitivity to Ach also, Inc baroreceptor sensitivity causing vasoconstriction. which is why CO is not inc in pts with normal hearts |
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how does digoxin reduce the heart rate in a failing heart
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the inc in contractility causes a dec in baroreceptor response in an already massively vasoconstrictive periphery. the dec baroreceptor reflex causes vasodilation and vagal stimulation which slows the HR
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what are the renal effects of digoxin
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inc diuresis (because of hemodynamic improvement
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what type of effects does digoxin have on the GI tract
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direct irritation: anorexia, diarrhea
stimulation of a chemoreceptor zone: vomiting mesenteric arteriolar constriction: abdominal pain |
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what are the pharmokinetic properties of digoxin
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good oral absorption
40 hr half life >80% renal elimination* |
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why do all digitalis drugs have a narrow margin of safety
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because the Theraputic dose is 50% - 60% of the Toxic dose
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howmany pts have to discontinue digoxin due to the toxic side effects
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5-25%
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what are the earliest signs of digoxin toxicity
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GI sympt
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what are the most common and most dangerous effects of digoxin toxicity
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cardiac toxicity
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what are the effects of cardiac toxicity by digioxin
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bradycardia
ectopic ventricular beats AV block bigeminy |
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what are the CNS side effects of digoxin
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headache, fatigue, malaise, drowsiness, trigeminal neuralgia
disorientation and hallucinations color and visual disturbances occur occasionally in the elderly |
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how do you treat digitalis toxicity
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discontinue
give K+* digitalis immune fab* lidocaine, phenytoin, propranolol* |
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what are the effects of the interaction between digoxin and quinidine
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quinidine displaces digoxin from its tissue binding sites and dec renal clearance.
thus inc plasma conc and inc digoxins toxicity |
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digoxin + dirrhea or diuretics =
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hypokalemia
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digoxin+ B-antagonists +
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dec SA and AV nodeactivity
bradycardia |
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digoxin + erythromycin =
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inc absorption
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digoxin + catecholamines (NE releasing agents) =
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arrhythmias
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what reduces digoxin absorption and toxicity*
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cholestryamine
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what type of arrhythmia is digoxin contraindicated with
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wolf-parkinson-white
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what are the phosphodiesterase inhibitors
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inamrinone
Milrinone |
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what are inamrinonoe and milrinone reffered to as?
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inodilators
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what is the mode of action for inamrinonoe and milrinone
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the inhibit cAMP PDE
this improves diastoic fxn and contractility |
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when should you use inamrinonoe and milrinone
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as a last ditch effort in patients that you can monitor closely
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what is a major side effect of this drug
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doesnt consistently relieve sympt and actually results in a higher mortality and hospitalization rate
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what are the sympathetomimetic drugs
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dobutamine
dopamine |
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effects of dopamine
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increases CO and renal blood flow in severe refractory CHF
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dobutamine=
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B1 selective agonist
inc contractility c less tachy inc O2 demand IV |
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nesiritide=
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BNP mimic (recombinant)
vasodilator effect used in decompensated CHF to reduce PCWP (norm= 8-10mmHg) body does not develop a tolerance to it like it does with NTG Poss hypotension (must monitor pt) |
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what is the fxn of ACE linhibitors
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to block the conversion of angiotensin I to angiotensin II
Angiotensin Converting Enzyme |
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B-blockers and heart disease
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Dangerous in sever heart disease
useful in cardiomyopathies or diastolic dysfxn (w/out severe CHF) redeced HR and arrhythmias reduced mortality |
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effect of sodium nitroprusside
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arterial and venus vasodilator
adverse: hypotension |
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effect of NTG and isosorbid dinitrate
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venodilation more than arteriodilation
tolerance develops quickly |
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effect of hydralazine
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peripherial, arteriolar vasodilation
ANS response: inc HR, CO, EF slow development of tolerance |
