Positive Inotropic Agents & Heart Failure Drug – Flashcards
Unlock all answers in this set
Unlock answersquestion
We use these meds to treat stable heart failure:
answer
Beta Blockers, ACE inhibitors
question
We use these meds to treat unstable heart failure:
answer
Digoxin, Diuretics
question
symptoms of congestive heart failure
answer
- Pulmonary Edema - Weight Gain - Edema - Shortness of Breath
question
What types of drugs are used on a patient with congestive heart failure?
answer
Lasix (furosemide), a diuretic or positive inotropic drugs
question
What is the action of positive inotropic drugs?
answer
they help to improve contractility and restore cardiac output
question
Why should beta blockers NOT be used in a patient with acute congestive heart failure?
answer
as they have a negative inotropic effect and will dramatically reduce cardiac output
question
62-year-old male with a history of heart failure secondary to longstanding HTN and previous MI. He is admitted to Telemetry with shortness of breath,tachycardia, and diffuse crackles in all lung fields. What type of heart failure does this patient have and why?
answer
Congestive heart failure. Shortness of breath and crackles in all lung fields AND TACHYCARDIA
question
Does tachycardia tell you that the patient is in heart failure?
answer
Tachycardia can occur even without congestive symptoms. Usually tachycardia is an early sign of heart failure, not a late one.
question
62-year-old male with a history of heart failure secondary to longstanding HTN and previous MI. He is admitted to Telemetry with shortness of breath,tachycardia, and diffuse crackles in all lung fields. What kind of drugs would you give this patient?
answer
For congestive symptoms, he would most likely get a diuretic and digoxin. We may also see an ACE inhibitor given, but beta blockers would probably be held until he was back to his baseline.
question
How does the ATPase pump NORMALLY work?
answer
by breaking down ATP and pumping out Na and calcium, and pumping back in potassium (K)
question
How does Digoxin help the heart regain contractility?
answer
simply inhibiting the sodium/potassium ATPase pump. Therefore, sodium and calcium are left inside the cell, and potassium is left outside the cell. Contractility increases because the intracellular calcium content is increased. More calcium in a cell = more contractility.
question
Effects of Digoxin:
answer
o Negative dromotrope and chronotrope o Positive inotrope. Works on both the contractility and the conduction system; therefore, we can use it for both problems - poor contractility and cardiac dysrhythmia
question
Uses for Digoxin
answer
o Congestive heart failure o Rapid heart rates
question
Effects of herbs on patients taking Digoxin.
answer
Digoxin has a very narrow therapeutic index, so it is imperative to understand what the patient can and can not take with it. Ginseng can increase digoxin levels by up to 75%. Black licorice can quadruple the digoxin level! However, St. John's Wort can actually decrease digoxin levels
question
When digoxin is given orally, how long will it take to see a reaction?
answer
up to 6 hours
question
When digoxin is given intravenously, how long will it take to see a reaction?
answer
15 minutes.
question
Why must digoxin be pushed very slowly in an IV?
answer
least over 5 minutes, if not longer. Because of the potential for bradycardia and hypotension, the patient should be on a cardiac monitor when pushing digoxin. It is not prudent to push digoxin without having some way to monitor the patient's cardiac rhythm!!!
question
How long is Digoxins half life?
answer
Up to two days
question
What must we do to ensure that the patients kidneys are sufficient while on Digoxin?
answer
We must monitor the BUN and creatinine (indicators of renal function) when patients are ordered to have digoxin. If the creatinine is very elevated, the digoxin dose may need to be reduced or given every other day instead of every day. Deterioration in renal function can lead to digoxin toxicity!!!!!
question
What is foods affect on Digoxin?
answer
It decreases the bioavailability. Digoxin should be given on an empty stomach.
question
Drugs that are also used to treat heart failure:
answer
ACE inhibitors, beta blockers, alpha-beta blockers, and diuretic. They decrease symptoms and increase QUANTITY of life
question
Used only in stable heart failure:
answer
Alpha beta and beta blockers
question
Ace inhibitors can be used for:
answer
both chronic heart failure and acute congestive heart failure. They work by reducing both preload and afterload. When these are reduced, the heart does not have to work as hard
question
Why are Beta blockers (metoprolol) and alpha-beta bockers (carvedilol) are not used in acute congestive heart failure?
answer
Because they can decrease contractility.
