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6 Cards in this Set
- Front
- Back
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CARDIAC GLYCOSIDE
digoxin |
Indications: treatment of CHF, atrial fibrillation
Actions: increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization; this causes a positive inotropic effect (increased force of contraction), increased renal perfusion with a diuretic effect and decrease in renin release, negative chronotropic effect (slower HR), and slowed conduction through the AV node Excreted unchanged in the urine Adverse effects: headache, weakness, drowsiness, visual disturbances, arrhythmias, GI upset Contraindicated/Caution: allergy, V tach or fib, heart block or sick sinus syndrome, idiopathic hypertrophic subaortic stenosis, acute MI, renal insufficiency, and electrolyte abnormalities Drug to drug: likeliness of toxic effects increase with verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, and cyclosporine, may be less effective if it taken with cholestyramine, charcoal, bleomycin, methotrexate, cyclophosphamide. may be less effective if combined with thyroid hormones, metoclopramide, or penicillin. do not take with st. johns wort, psyllium, decrease effectiveness; increased dig toxicity if combined with ginseng, hawthorn and licorice |
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PHOSPHODIESTERASE INHIBITORS
inamrinone milrinone |
INDICATIONS: short term treatment of CHF in patients who have not responded to digitalis, diuretics, or vasodilators
ACTIONS: blocks the enzyme phophodiesterase, which leads to an increase in myocardial cell cAMP, which increases calcium levels in the cell, causing a stronger contraction and prolonged response to sympathetic stimulation; directly relaxes vascular smooth muscle Excreted in urine and feces CONTRAINDICATIONS: allergy to drug or bisulfites, severe aortic or pulmonic valvular disease, acute MI, fluid volume deficit, ventricular arrhythmias. Use cautiously in elderly and pregnant/lactating women DRUG/DRUG: precipitates form when given with solution containing furosemide ADVERSE: arrhythmias, hypotension, nausea, vomiting, thrombocytopenia, pericarditis, pleuritis, fever, chest pain, burning at injection site |
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CLASS III ANTIARRHYTHMICS
bretylium amiodarone sotalol |
INDICATIONS: treatment of life threatening ventricular arrhythmias (amiodarone, bretylium, and sotalol), for the conversion of recent onset A-fib or flutter, to normal sinus rhythm, and maintenance of sinus rhythm after conversion
ACTIONS: blocks K+ channels and slows the outward movement of K+ during phase 3 of the action potential. This prolongs the action potential (repolarization) and slows the rate and conduction of the heart CONTRAINDICATIONS: no contraindications since they are only used in life threatening situations. Caution should be used with all of these drugs in the presence of shock, hypotension, respiratory depression, hepatic and renal disease, or prolonged QTc interval DRUG/DRUG: do not combine with digoxin or quinidine because of serious toxic effects ADVERSE: related to changes in action potentials; N/V/D, GI distress, weakness, dizziness, hypotension, CHF, and arrhythmias are common; amiodarone is associated with fatal liver toxicity, ocular abnormalities and the development of very serious arrhythmias |
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CLASS I ANTIARRHYTHMICS
quinidine procainamide lidocaine flecainide |
INDICATIONS: management of acute ventricular arrhythmias during cardiac surgery or MI
ACTIONS: block the Na+ channels in the cell membrane during an action potential. They are used as local anesthetics or membrane stabalizing agents. Decreases depolarization, decreasing automaticity of the ventricular cells; increases ventricular fibrillation threshold CONTRAINDICATIONS: allergy, bradycardia or heart block (unless pacemaker is present), CHF, hypotension, shock, and lactation and electrolyte disturbances. Caution with renal/hepatic dysfunction, and pregnancy DRUG/DRUG: with quinidine avoid foods that alkalinize the urine (requires slightly acidic urine-normal urine) like citrus juices, vegetables, antacids, and milk products, which could lead to increased quinidine levels and toxicity. Grapefruit juice interferes with the metabolism of quinidine also leading to increased serum levels and toxic effect. ADVERSE: associated with their membrane stabilizing effects; dizziness, drowsiness, fatigue, twitching, mouth numbness, slurred speech, vision changes, tremors, convulsions, changes in taste, N/V, development of aarhythmias, hypotension, vasodilation and cardiac arrest, respiratory depression/arrest, rash, hypersensitivity, loss of hair, and bone marrow depression |
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CLASS II ANTIARRHYTHMICS
propranolol |
INDICATIONS: treatment of cardiac arrhythmias, especially supraventricular tachycardia, treatment of V-tach induced by digitalis or catecholamines
ACTIONS: Competitively blocks beta-adrenergic receptors in the heart and kidney, thereby decreasing HR, cardiac excitability, and cardiac output; slowing conduction through the AV node; and decreasing the release of renin. These effects stabilize excitable cardiac tissue and decrease BP, which decreases the heart workload and further stabilizes hypoxic cardiac tissue. It has a membrane stabilizing effect and decreases the influence of the SNS CONTRAINDICATIONS: sinus bradycardia and AV block, cardigenic shock, CHF, asthma, respiratory depression, pregnancy and lactation. caution with diabetes and thyroid dysfunction, and renal/hepatic dysfunction DRUG/DRUG: risk increases when taken with verapamil; increased hypoglycemia if combined with insulin. ADVERSE: bradycardia, CHF, cardiac arrhythmias, heart blocks, CVA, pulmonary edema, gastric pain, flatulence, N/V/D, impotence, decreased exercise tolerance, antinuclear antibody development |
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CLASS IV ANTIARRHYTHMICS
diltiazem verapamil |
INDICATIONS: treatment of supraventricular tachycardia and to control the ventricular to rapid atrial rates
ACTIONS: block the movement of calcium ions across the cell membrane, depressing the generation of action potentials, delaying phases 1 and 2 of repolarization and slowing conduction through the AV node. *diltiazem: inhibits the movement of calcium ions across the membranes of myocardialand arterial muscle cell contraction, which depresses myocardial contractility; slows cardiac impulse formation in the conductive tissues, and relaxes and dilates arteries, causing a fall in blood pressure and a decrease in venous return; decreases the workload of the heart and myocardial oxygen consumption and, in Prinzmetal's angina, also relieves the vasospasm of the coronary artery, increasing blood flow to the muscle cells CONTRAINDICATIONS: allergy to calcium channel blocker; sick sinus syndrome or heart block; pregnancy and lactation; and with CHF or hypotension; use caution with idiopathic hypertrophic subaortic stenosis; and renal/hepatic function DRUG/DRUG: increased risk with beta blockers (causes cardiac depression); additive AV slowing with digoxin, increased serum levels and toxicity with digoxin, carbamazepine, prazosin, and quinidine; increased respiratory depression with atracurium, gallamine, pancuronium, tubocurarine, and vecuronium; and decreased effects when combined with rifampin and calcium products; can increase cyclosporine levels and toxicity. ADVERSE: dizziness, headache, asthenia, peripheral edema, bradycardia, AV block, flushing, nausea, hepatic injury |
