Pharmacology Ch. 44 Agents treating Arrhythmias

Adverse effects of Angiotensin Receptor Neprilysin Inhibitor (Entresto)

-hypotension, hyperkalemia, cough, dizziness, renal impairment -Monitor patients for signs of low BP and angioedema

The first sign of toxicity in infants and children is ________ or any other cardiac arrhythmia.

sinus bradycardia

Chronotropic

timing -HR (apical pulse)

Digoxin (Lanoxin) is excreted in the: urine. feces. bile. sweat.

urine

Which is a sign that fluid is present in the lungs? Dyspnea Orthopnea Rales Coughing

Rales

Indication of Angiotensin Receptor Neprilysin Inhibitor (Entresto)

Reduce risk of CV death and hospitalization in adults with chronic HF by 30% -Treatment of symptomatic HF with systemic left ventricular systolic dysfunction in pediatric patients over 1 year of age

Indications for Phosphodiesterase Inhibitors (Milrinone)

Short-term treatment of HF that has not responded to digoxin or diuretics alone or has poor response to digoxin, diuretics, and vasodilators. -Use is limited to severe situations

How does digoxin work? It opens the coronary arteries. It works on the peripheral vascular system. It improves cardiac contractility. It increases the heart rate.

It improves cardiac contractility.

Which medication is the antidote for digoxin? Vitamin K Protamine sulfate Digoxin immune fab Calcium gluconate

Digoxin immune fab -Digibind is used when digoxin toxicity is above a 6 -Normal toxicity is between 0.5-2 ng/mL

What is digoxin used to treat? Hypertension Heart failure Hypothyroidism Heart block

Heart failure

Indication for cardiac glycosides (Digoxin)

Treatment of HF, atrial fibrillation

Inotropic

muscle strength -BP

Which is a sign of digoxin toxicity? Constipation Shallow breathing Anorexia Anxiety

Anorexia

A nurse is administering a beta blocker to a patient who has heart failure. Which statement may be part of the nurse's patient education? "This medication will help your heart beat faster." "This medication will help your symptoms only." "This medication will improve your survival and symptoms of heart failure." "This medication helps get rid of the extra fluid in your body."

"This medication will improve your survival and symptoms of heart failure."

Adverse effects for cardiac glycosides (Digoxin)

Headache, weakness, drowsiness, and vision changes -GI upset and anorexia -Arrhythmia development

Which is a phosphodiesterase inhibitor? Digoxin Ivabradine Milrinone Sacubitril/valsartan

Milrinone

Adverse effects of Phosphodiesterase Inhibitors (Milrinone)

arrhythmias, hypotension, chest pain -GI effects -Thrombocytopenia -Hypersensitivity reactions -Burning at IV injection site

Heart Failure- Congestive Heart Failure (CHF)

Condition in which the heart fails to effectively pump blood throughout the body -heart pump is weak causing poor tissue perfusion Primary treatment: Allows the heart muscle to contract more efficiently in an effort to bring the system back into balance

Digoxin is a ____ inotropic medication, meaning that it increases myocardial contractility.

positive

MOA of cardiac glycosides (Digoxin)

Increases intracellular calcium, allows more calcium to enter the myocardial cell during depolarization, causing: - Increased force of myocardial contraction -Increased cardiac output, renal perfusion -Slowed heart rate -Decreased conduction velocity -The overall effect is increased cardiac output

MOA of Phosphodiesterase Inhibitors (Milrinone)

Blocks the enzyme phosphodiesterase, leading to increase in cAMP, which increases the calcium level in the cell, causing a stronger contraction and prolonging effects of sympathetic stimulation

MOA of Angiotensin Receptor Neprilysin Inhibitor (Entresto)

Combination of valsartan and sacubitril - Blocks breakdown of natriuretic peptides -Inhibits effects of RAAS -This leads to decreased cardiac workload, lower vascular volume, lower blood pressure, improved HF symptoms

Dromotropic

rate of electrical conduction -ECG (action potential graph)

How does the nurse assess the heart rate prior to administering digoxin? 30 seconds, radially 30 seconds, apically 60 seconds, radially 60 seconds, apically

60 seconds, apically

Which serum lab value can assist in diagnosing heart failure? Brain natriuretic peptide (BNP) Blood urea nitrogen (BUN) Blood pressure Cardiac catheterization

Brain natriuretic peptide (BNP)

Which is not a common cause of heart failure? Coronary artery disease (CAD) Myocardial infarction (MI) Hypertension Hypothyroidism

Hypothyroidism

Which is a common complaint of patients with left-sided heart failure? Increased difficulty breathing when lying down Slowed respirations Pitting edema in the legs Increased urine outpu

Increased difficulty breathing when lying down

A pt's heartbeat is 59 beats per minute and you are told to administer digoxin, would you administer digoxin to this pt?

NO! Hold digoxin if -notify the prescriber right away! - the pulse is less than 60 beats/min in an adult, less than 70 beats/min in children, or less than 90 beats/min in an infant; retake the pulse in 1 hour (auscultate for 60 seconds apically). -MI or heart block is present

A patient has an ejection fraction (EF) of 35%. What does this indicate? The patient has an optimally functioning heart. The patient is in diastolic heart failure. The patient is in systolic heart failure. The patient is at risk for developing heart failure.

The patient is in systolic heart failure. -An EF less than 40% indicates decreased cardiac output and pump failure, which means they have systolic heart failure. EF is preserved in diastolic heart failure. The heart is not optimally functioning, and the patient has already developed heart failure.

Upon assessment, the nurse notes a patient has crackles and dyspnea. What does this indicate? The patient's right side of the heart is affected. The patient's left side of the heart is affected. The patient has systolic heart failure. The patient has diastolic heart failure.

The patient's left side of the heart is affected.

Drug-Drug Interactions for cardiac glycosides (Digoxin)

Verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, or cyclosporine, Potassium losing diuretics, Cholestyramine, charcoal, colestipol, bleomycin, cyclophosphamide, or methotrexate.

Which are key findings of digoxin toxicity? Visual halos and nausea Hypertension and constipation Fatigue and bounding pulse Hyperglycemia and diarrhea

Visual halos and nausea

Causes of CHF

involves dysfunction of the cardiac muscle, of which the sarcomere is the basic unit. HF can occur with any of the disorders that damage or overwork the heart muscle: - Coronary Artery Disease (CAD) -Cardiomyopathy -Hypertension -Valvular Heart Disease