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29 Cards in this Set

  • Front
  • Back
- Heart Rate

+ chronotropic increases HR
- chronotropic decreases HR
- Conduction

+ dromotropic increases cond.
- dromotropic decreases cond.
- Force of Contraction

+ inotropic increase force
- inotropic decrease force
Angiotensin Converting Enzyme Inhibitors

(ACE inhibitors)
1. Captopril
- DOC for HF
- reduce peripheral vascular resistance via blockage of the angiotensin converting enzyme
Angiotensin Receptor Blockers (ARB's)
1. Losartan
2. Valsartan
- block the binding of angiotensin II to the AT1 receptor
- used when ct can't tolerate ACE inhibitors

Beta - Blockers
- supress activation of SNS
- used long term to shrink heart back to normal size
- used to treat acute & chronic HF
Aldosterone Antagonist
1. Spironolcatone
- reduces aldosterone induced retention of Na and H2O
1. Nitrates: venous dilators decrease preload
2. Hydralazine: arterial dilators decrease afterload

- can be combined to decrease pre and after load
Inotropic Agent:

Glycosides Digoxin (Lanoxin)
- inhibit Na pump (na and Ca increase leading to enhanced contraction)
- increase vagal tone: increased diastolic filing
- increase refractory period: allow Na and K levels to be reached b4 depolorization
Glycosides con't
+ inotropic effect
- dromotropic effect
- chronotropic effect
Glycoside Indications
- HF
- Dysrythmias
- Atrial Fibrilation
- prevent V -tachy
Drugs that increase the effect of digoxin
- cholinergic blockers
- antidysrythmics
- andregenics
Digoxin Contraindications
- severe myocarditis
- bradycardia
- current v- tach
Tx of Digoxin Toxicity
- low therapeutic window
- non specific s/ anorexia, nausea, confusion
- antidote: Digibine (digoxin binding antedote)
Administration & Digitalization of Digoxin
- orally or IV
- IM not recommended (d/t pain and muscle necrosis)
- low thereputic window
Nursing Assessment/Implementation
- Assess for HF risk factors
- heart / breath sounds
- hypokalemia can precipitate toxicity
Cardiac Dysrythmia
- abnormalities in HR or rhythm
Antidysrythmic Drug Uses
- atrial fib, or flutter
- maintain NSR
Vaughn Williams Classification
drugs are assigned to classes i to iv according to their effects on the heart's action potential
- each class acts on a different phase
Class I: Sodium Channel Blockers
-block the flow of Na into the cell in initial phase of the action potential.
- slows switching of K and Na through the channel (conduction delay)
Class Ia
- moderately block the na channel

- Quinidine
Class Ib
- minimal blocking of Na channel

- Lidocaine
Class Ic
- major blocking effect - used in ER

- Propatenone
Class II: Beta Blockers
block SNS stimulation in heart
Class II categories (3)
1. noncardiac specific: Propranolol (Inderal)
2. cardiac specific: Atenolol
3. Combo Alpha & Beta blockers
Class III: Potassium Channel Blockers
block the movement of K during the third phase - prolong the refractory period

- Amidarone
Class IV: Calcium Channel Blockers
inhibit movement of Ca through the Ca channels of SA and AV nodes during 2nd phase

- Diltiazem
Nursing Implications
- Apical & Radial pulse b4 each dose
- observe for thereputic & adverse effects