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Mech of axn of Adrenergic blockers. Example?
- decrease cardiac workload by slowing HR (B1) and
- decreasing BP (a1)
- example = carvedilol
Hydralazine acts on ______ to decrease PV resistance, reduce afterload, increase CO.
Mech of axn of cardiac glycosides. Example?
- increase C.O. by increasing force of contraction
- example = digoxin
What type of drug is digoxin?
Mech of axn of Phosphodiesterase inhibitors. Example?
- increase CO by increasing force of contraction
- example = milirinone
How do vasodilators work? Example?
- DECREASE cardiac workload by dilating BV & reducing preload
- example = isosorbide dinitrate with hydrazine
How do ACEI and ARBS work? Example?
- Increase CO by lowering arterial BP (afterload) and BV, dilates veins
- (ACEIs block aldosterone which increases BV & preload)
- example = lisinopril
How do diuretics work? Example?
- Increase CO by reducing FV and BP
- example = furosemide (Lasix)
Drug of choice for HF.
Drug that is effective in preventing HF following an MI.
Adverse effects of ACEIs.
- Dry hacking cough
ACEI cause K+ ______ and loop diuretics cause K+ _______.
ARBS & ACEIs may cause symptomatic _______.
What type of drug is a thiazide? Example?
- HCTZ, HydroDIURIL
Side effects of diuretics.
- Na+, K+, & H20 loss
- NVD, dizziness
_______ can produce a reverse remodeling of the heart, which means?
- decreased dilation & hypertrophy (good for treating HF after MI)
Carvedilol (Coreg) & metoprolol (Toprol) are approved for _____ (outpatient). When should you hold them?
Metoprolol decreases _____ and results in ________.
What do you monitor for in a pt taking metoprolol or carvedilol?
When is metoprolol contraindicated?
Pts with 2nd or 3rd degree AV block WITHOUT a pacemaker
Use caution with BB in patients with?
- diabetes (masks signs of hypoglycemia),
- hepatic impairment
What is carvedilol used for? Contraindicated?
- to treat HF (adrenergic blocker)
- pts with 2nd or 3rd degree heart block without pacemaker
Isosorbide works on _____ and reduces _____ by directly dilating them.
Adverse effect of hydralazine.
orthostatic hypotension (dilation of arterioles)
Adverse effect of isosorbide.
peripheral edema (dilation of veins)
Metoprolol decreases HR and results in _____, where Carvedilol decreases HR, _____ and _______ and causes ______.
- reduced myocardial O2 consumption
- afterload, contractility (B1 receptors), vasodilation
NESIRITIDE is identical to what?
human beta-type natriuretic peptide
In therapeutic doses, nesiritide (Natrecor) causes _____.
vasodilaction, reducing preload.
Nesiritide (Natrecor) is administered _____.
- IV with continuous monitoring
- (risk for severe hypotension)
What is nesiritide (Natrecor) indicated for?
ACUTELY decompensated HF
What is extremely important to monitor in a pt receiving nesiritide (Natrecor)?
- Monitor BP every 10-15 min due to risk of severe hypotension (usually first 15-60 min of infusion).
- Can cut off drug if needed (very short half-life)
How is digoxin administered?
IV or PO only - never IM or SubQ
How are dobutamine & dopamine administered?
Mech of axn for digoxin.
- inhibits Na+ K+ pump
- increases intracellular Ca++
- increases contractility & force
- decreases AV conduction velocity
Do not administer digoxin with a HR below?
What is important to do prior to administering digoxin?
Take apical pulse for one FULL minute
Digoxin must be given over a minimum of _______.
FIVE minutes (can dilute 4-5mL)
Digoxin is highly protein bound. What does this mean?
Low albumin would mean more free digoxin
1/2 life of digoxin.
Adverse effects of digoxin.
- ventricular dysrhythmias including sudden cardiac death
- *most common cause is diuretic K+ depletion*
Normal serum digoxin levels & when they are drawn.
- .5 - 1.5 mg/mL
- 6-12 hrs after last dose
Earliest sign of digoxin toxicity.
Digoxin toxicity is often unrecognized & may present with the same manifestations as what?
Why is digoxin contraindicated in a pt with MI?
it increases O2 demand & squeeze
How does digoxin interact with diuretics?
diuretics can cause hypokalemia, which makes the heart more sensitive to digoxin and pt can exhibit toxicity at "normal" serum levels of digoxin
Digoxin reversal agent.
digoxin immune Fab (Digibind)
Teaching points with Digoxin.
- Take same time each day
- Don't skip or double dose
- Do not switch brands
- Do not breast feed
Two most common AEs with Beta-adrenergic agonists.
Sympathomimetic (beta agonists) IV drug of choice and why.
- Dobutamine (Dobutrex)
- causes minimal changes to HR or BP
Dopamine is used in patients with _____ and particularly _______.
A low _____ level increases the risk of digoxin toxicity.
The primary problem associated with HF is _______, therefore ______ is the drug of choice. (#8, 187, Rationales)
- decreased contractility
- (positive inotrope
________ is used for sinus bradycardia. (#8, p.187, Rationales)
Propolanol is a _______ and is used for ______ and _______. (#8, p.187, Rationales)
- hypertension & angina
Verapamil is a ________ and is used for what? (#8, p.187, Rationales)
- (negative inotrope)
CCB can cause ______ if taken in excessive doses. (#8, p.187, Rationales)