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Positive inotropic agents _____ myocardial contractility. They are used in disease states where there is _____ ______.
What are the two main classes of positive inotropic agents?
- 1. cardiac glycosides
- 2. phosphodiesterase inhibitors
What are two beta-adrenergic stimulators used in heart failure?
- Dopamine - Intropin
- -- increase contractility
- -- only continous IV drip
Which drug has been around a very long time and used to treat "dropsy" ?
"dropsy"= fluid accumulation or HF
What are the different types of cardiac glycosides?
- Deslanoside- Cedilanid-D
- Digitoxin- Crystodigin
What is the most common form of cardiac glycosides?
Cardiac glycosides are naturally occuring compounds coming from ____
- leaves of -
- digitalis purpurea (purple foxglove)
- digitalis lanata (white foxglove)
Cardiac glycosides act on the heart muscle by effecting the function by....
- 1. + inotropic action
- 2. - chronotropic action
- 3. - dromotropic action
The side effects of cardiac glycosides include:
- yellow-green halo around lights
- heart block
- Diarrhea + N&V, HA, arrhythmias, fatigue
True or False: Cardiac glycosides are very potent in low doses.
these drugs are the classic treatment for heart failure:
cardiac glycosides: digoxin, digitoxin, deslanoside
How do you screen for toxicity in glycosides?
- Renal failure
- elevated digitalis levels
What are the contraindiactions and precautions associated with cardiac glycosides?
- Heart block
- Renal failure
- Liver failure
- Electrolyte imbalance
What is the antidote for digitalis glycoside toxicity?
- Digoxin Immune FAB - Digibind
- -- Electrolytes should also be checked and returned to normal
What time are cardiac glycosides given at SLH?
What should you do if patients pulse is below 60?
Hold medication and call doctor.
- K, BUN, CR
- Dig Levels: should be 0.5-2.5
What is the normal digitalis level?
0.5 - 2.5 ng/ml
Client teaching when taking cardiac glycosides:
- -taking pulse
- -med same time each day
- -don't make up for missed doses
- -do not change brands
- -digoxin and lanoxin are the same drug
- -take 1-2 hours before meals : diet high in fiber will reduce absorption
What is the onset of action and duration of digibind?
- onset <1 minute
- duration 15-20 hours
After administering _____ improvement from digitalis toxicity can be seen in _____.