Cardiotonic

Increase efficiency and improve contraction of the heart muscle, resulting in improved blood
flow to all tissues of the body. Long been used to treat heart failure.

Increase cardiac output through positive inotropic activity(increase of force of contraction). They
slow the conduction velocity through the AV node in the heart and decrease the heart rate through a
negative chronotropic effect

For pt w/persistent symptoms or recurrent hospitalization or as indicated in conjunction w/ ACE

inhibitors, loop diuretics, beta blockers

PO cardiotonic
Digoxin(Lanoxin)

For older pt maintained on the drug for several years, pt experiencing symptoms
after using the first-choice drugs, some cases of atrial fibrillation

Can cause blurring or yellow halo, less effective in African American patients;
when digoxin/ivabradine is being considered, combination of hydralazine and isosorbide
is more efficacious for African American

Ivabradine(Corlanor)

Newer cardiotonic replacing digoxin to treat HF. Reduces repeated

hospitalizations associated w/CHF when used w/beta blocker

Blocks the I (funny channel) and inhibits the pacing of SA node of the heart,
slowing the heart rate and allowing blood to fill the heart chamber

Can cause increased brightness, do not use if pregnant/lactating

Adverse reactions of cardiotonics

CNS: headache, weakness, drowsiness, visual disturbances

Cardio/GI: arrhythmias, N/A

C/I cardiotonics

Presence of digitalis toxicity, ventricular failure, ventricular tachycardia, cardiac tamponade,

restrictive cardiomyopathy, AV block

Cardiotonics taken w/food slows absorption, but the amount absorbed is the same

High fiber meals w/cardiotonics causes decreased absorption

Miscellaneous cardiotonic information

Cardiotonics taken w/food slows absorption, but the amount absorbed is the same
 High fiber meals w/cardiotonics causes decreased absorption

Apical pulse for 60 seconds before administration, if <60/>100, withhold and notify

Hold if <70 in child. <90 in infant

Hypokalemia, hypomagnesemia, hypercalcemia may increase risk cardiotonic toxicity

Cardiotonic can be give PO, IV, IM

If IV, give slowly over at least 5 minutes

Inotropic
Milrinone

Nonglycoside and IV, for short term management of severe HF that is not controlled by
digitalis