Pharmacology

Front 1

Chronotropic

Back 1

- Heart Rate

+ chronotropic increases HR
- chronotropic decreases HR

Front 2

Dromotropic

Back 2

- Conduction

+ dromotropic increases cond.
- dromotropic decreases cond.

Front 3

Inotropic

Back 3

- Force of Contraction

+ inotropic increase force
- inotropic decrease force

Front 4

Angiotensin Converting Enzyme Inhibitors

(ACE inhibitors)

Back 4

1. Captopril
- DOC for HF
- reduce peripheral vascular resistance via blockage of the angiotensin converting enzyme

Front 5

Angiotensin Receptor Blockers (ARB's)

Back 5

1. Losartan
2. Valsartan
- block the binding of angiotensin II to the AT1 receptor
- used when ct can't tolerate ACE inhibitors

Front 6

Adrenergics:

Beta - Blockers

Back 6

- supress activation of SNS
- used long term to shrink heart back to normal size

Front 7

Diuretics

Back 7

- used to treat acute & chronic HF

Front 8

Aldosterone Antagonist

Back 8

1. Spironolcatone
- reduces aldosterone induced retention of Na and H2O

Front 9

Vasodilators

Back 9

1. Nitrates: venous dilators decrease preload
2. Hydralazine: arterial dilators decrease afterload

- can be combined to decrease pre and after load

Front 10

Inotropic Agent:

Glycosides Digoxin (Lanoxin)

Back 10

- 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

Front 11

Glycosides con't

Back 11

+ inotropic effect
- dromotropic effect
- chronotropic effect

Front 12

Glycoside Indications

Back 12

- HF
- Dysrythmias
- Atrial Fibrilation
- prevent V -tachy

Front 13

Drugs that increase the effect of digoxin

Back 13

- cholinergic blockers
- antidysrythmics
- andregenics

Front 14

Digoxin Contraindications

Back 14

- severe myocarditis
- bradycardia
- current v- tach

Front 15

Tx of Digoxin Toxicity

Back 15

- low therapeutic window
- non specific s/ anorexia, nausea, confusion
- antidote: Digibine (digoxin binding antedote)

Front 16

Administration & Digitalization of Digoxin

Back 16

- orally or IV
- IM not recommended (d/t pain and muscle necrosis)
- low thereputic window

Front 17

Nursing Assessment/Implementation

Back 17

- Assess for HF risk factors
- APICAL PULSE
- heart / breath sounds
- hypokalemia can precipitate toxicity

Front 18

Cardiac Dysrythmia

Back 18

- abnormalities in HR or rhythm

Front 19

Antidysrythmic Drug Uses

Back 19

- atrial fib, or flutter
- maintain NSR

Front 20

Vaughn Williams Classification

Back 20

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

Front 21

Class I: Sodium Channel Blockers

Back 21

-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)

Front 22

Class Ia

Back 22

- moderately block the na channel

- Quinidine

Front 23

Class Ib

Back 23

- minimal blocking of Na channel

- Lidocaine

Front 24

Class Ic

Back 24

- major blocking effect - used in ER

- Propatenone

Front 25

Class II: Beta Blockers

Back 25

block SNS stimulation in heart

Front 26

Class II categories (3)

Back 26

1. noncardiac specific: Propranolol (Inderal)
2. cardiac specific: Atenolol
3. Combo Alpha & Beta blockers

Front 27

Class III: Potassium Channel Blockers

Back 27

block the movement of K during the third phase - prolong the refractory period

- Amidarone

Front 28

Class IV: Calcium Channel Blockers

Back 28

inhibit movement of Ca through the Ca channels of SA and AV nodes during 2nd phase

- Diltiazem

Front 29

Nursing Implications

Back 29

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