Pharmacology Exam 3 - Chapt 28

Front 1

What can precipitate digitalis toxicity?

Back 1

Hypokalemia

Front 2

Digoxin improves symptoms of heart failure by?

Back 2

Increasing the force of contraction & slowing down the heartbeat.

Hint 2

Helps the heart to fill & empty more completely, improving circulation & perfusion through the kidneys, reducing edema.

Front 3

What is the antidote given for digoxin toxicity and what does it do?

Back 3

Digibind acts by binding w/ digoxin, preventing it to bind at the site of action. This formed fragment-digoxin complex accumulates in the blood & secreted by the kidneys.

Hint 3

Improvement is seen within 30 minutes.

Front 4

Milrinone & furosemide cannot:

Back 4

Be mixed or infused together; they are chemically incompatible & form a precipitate.

Front 5

Nitopress is given:

Back 5

ONLY Intravenously!

Front 6

Inamrinone cannot be diluted with?

Back 6

A dextrose solution. It can be injected into a running dextrose solution either directly or via a Y connector.

Front 7

What is the expected effect of administering a vasodilator for acute heart failure?

Back 7

It Decreases vascular resistance & the volume of blood returned to the heart (decreasing pulm cong). This also increases perfusion to vital organs & muscle

Front 8

Milrinone has been known to cause thrombcytopenia. What lab value should be monitored?

Back 8

Platelet levels

Front 9

Milrinone is given for short-term management of heart failure. How does it work?

Back 9

Increases HR (force of cardiac contraction & velocity), as well as vasodilating the blood vessels. These actions reduce preload & afterload.

Front 10

Nesiritide would be used on a patient with?

Back 10

Severe heart failure accompanied by dyspnea at rest.

Front 11

Nesiritide is a?

Back 11

Hormone secreted by the ventricles in response to fluid & pressure overload. It reduces preload/afterload, increases excretion of sodium/water, suppresses the renin-angiotensin-aldosterone system, & decreases the secretion of norepinephrine.

Front 12

Systolic Dysfunction:

Back 12

Left, right, or both ventricles lose the ability to pump enough blood to meet the body's circulatory needs. It is the common pathway for several causes of heart failure.

Hint 12

a.k.a, contracting dysfunction

Front 13

Diastolic Dysfunction:

Back 13

Causes heart failure due to the left ventricle becoming stiff & failing to relax enough between contractions to allow adequate filling before the next contraction.

Hint 13

a.k.a, filling dysfunction

Front 14

Systolic heart failure occurs when the heart lacks:

Back 14

the required force needed to pump all the blood (decreased CO) to meet the body's O2 demands(decreased tissue perfusion).

Front 15

Sx of diastolic dysfunction are:

Back 15

Pulmonary congestion & edema.

Front 16

Early clinical Sx of systolic dysfunction are:

Back 16

Decreased activity/exercise tolerance & poor perfusion of peripheral tissues.

Front 17

Inotropic agents:

Back 17

Boost CO by stimulating the heart to increase force of contractions.

Front 18

Digitalis toxicity Sx:

Back 18

1. Increased renal output.
2. Anorexia, N/V.
3. Blurred vision.
4. Increased potassium level;hyperkalemia.
5. Peripheral edema, pulse deficit, leg cramps (nocturnal).

Front 19

Positive inotropy:

Back 19

Increased force of contraction on the heart.

Front 20

Negative Chronotropy:

Back 20

Slowing of the heart rate by reducing conduction velocity & prolonging the refractory period at the AV node.

Front 21

Digoxin glycosides have two primary actions on the heart:

Back 21

Positive inotropy & negative chronotropy.

Front 22

Digitalization:

Back 22

The administration of digoxin in a larger dose over a 24h period of time; loading dose.

Front 23

What is the premedication assessment for digitalizing a pt?

Back 23

1. Check AP - < 60 or > 100 hold.
2. Check relevant baseline data.
3. After initializing therapy monitor for digoxin toxicity, hypocalemia, hypomagnesemia, or unusual increase/decrease in baseline pulse.

Front 24

What is the initiating dosage process for digitalization in adults?

Back 24

**PO: 0.25mg - 0.50mg to start, then 0.125mg q6h until adequate digitalization is achieved. Maintenance: 0.125mg - 0.25mg qd.
**IV: 0.25mg - 0.5mg to start, then 0.125mg q6h until adequate digitalization is achieved. Maintenance: Same as PO. Administer at a rate of 0.5 to 1ml per minute.

Hint 24

Adult therapeutic blood levels are 0.5 to 1.8 ng/mL.

Front 25

Treatment of digoxin toxicity:

Back 25

Stop therapy, including any potassium-depleting diuretics, check potassium levels/administer if needed, & administer an antidysrhythmic drug such as lidocaine or phenytoin.

Front 26

Digoxin is not used to treat?

Back 26

Diastolic heart failure. It can make it worse.

Front 27

What is the goal of treatment using digoxin (Lanoxin)?

Back 27

Achieving optimal cardiac effects; Increased CO, pulse rate slowed, & vasoconstriction is decreased. Thus, minimizing Sx of heart failure: dyspnea, orthopnea, edema.

Front 28

What are the actions of ACE inhibitors on heart failure:

Back 28

Reduce afterload by blocking angiotensin II-mediated peripheral vasoconstriction & help reduce circulating blood flow (preload) by inhibiting secretion of aldosterone.

Hint 28

Reduce BP
Preserve CO
Increase renal blood flow

Front 29

What are the actions of Beta-adrenergic blocking agents:

Back 29

Inhibit cardiac response to sympathetic nerve stimulation by blocking beta receptors. CO, BP, & HR are reduced. Also inhibit release of renin.

Front 30

What are the actions of natriuretic peptides (nesiritide/Natrecor)?

Back 30

It is a hormone secreted by the ventricles that responds to fluid and pressure overload. It helps the heart recover from deteriorating cardiac function by reducing preload and afterload pressures.

Hint 30

Vasodilator given to pts w/dyspnea upon rest or minimal activity.

Front 31

What actions occur if the sympathetic nervous system is activated during heart failure?

Back 31

Increased heart rate, contractility, and peripheral vascular resistance.

Front 32

Inamrinone (Inocor) should be mixed for IV administration with:

Back 32

0.9% saline

Front 33

Digitalis toxicity symptoms:

Back 33

anorexia, nausea, vomiting, blurred vision.

Front 34

You are monitoring a pt receiving treatment for acute heart failure. What is most likely to occur with the intravenous administration of niroprusside (IV nitroglycerin)?

Back 34

Hypotension.

Hint 34

Vasodilator.

Front 35

Pts w/ heart failure need medications that?

Back 35

Reduce preload.