Chapter 38: Cardiotonic and Inotropic Drugs

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1. What is Heart -the heart unable to pump enough of 11. RIght ventricular Leads to
Failure blood to meet tissue needs of the body dysfunction -hepatic engorgement
, any condition that impedes the ability -JVD
for the ventricle to pump blood can -peripheral edema (weight gain)
lead to heart failure -venous congestion in HF
2. Most heart failure hypertension 12. Bcuz Both sides of the left side (decreased cardiac
is caused by heart work together and output)
can cause HF but what
3. What happen with left ventricle is overstretched from the
side would be affected
left ventricle that arriving blood from the left atrium
first
causes heart failure leaving to much blood in the left
ventricle causing the contraction to 13. Cardiotonics action are -increase cardiac output w/ pos.
become weaker to inotropic activity
-slow conduction of velocity thru
4. HF can result from -ischemic heart disease
AV node
any number of -hypertension
-lower HR thru negative
cardiac and -hyperthyroidism
chronotropic effect
metabolic
disorders are 14. Milirinone a A drug with inotropic actions
nonglycoside IV drug used in short-term management
5. HF 1st The sympathetic nervous system
of HF.,that is not controlled by
increase the secretion of the
digitalis preparation
catecholamines( epi, nonepi,
neurohormones) which results in 15. Cardiotonic drugs are HF and atrial fibrillation
increased HR & vasodilation mainly use to treat
6. HF 2nd Activation of renn-angiotensin- 16. Atrial Fibrillation a cardiac arrhythmia
aldosterone (RAA) occurs bcuz of characterized by rapid
decreased perfusion to the kidneys. contractions and quivering of the
Ang II and aldosterone levels increases atrial myocardium (digoxin is
the BP, adding to the work load of the used after other drugs fail)
heart
17. Most commonly used Digoxin (Lanoxin)
7. neurohormonal Causes a remolding (restructuring) of cardiotonic drug
activity the cardiac muscle cells, leading to
18. A newer cadiotonic drug Ivabradine ( Corlanor)
hypertrophy of the heart, increased
uses to treat heart when used with beta blocker it
need for o2, and cardia necrosis, which
failure reduces repeated hospitalization
worsens the heart failure
with pt dealing with HF
8. A person with right -JVD
19. Cardiotonic adverse CNS - headache , weakness,
ventricular -peripheral edema
reactions drowsiness
dysfunction what -nocturia (urine at night )
visual disturbances ( yellow ,
common sign
green and white halo around
would the nurse
dark objects or blurry)
assess for
20. Cardiovascular and GI -arrhythmias
9. Cardiotonic drugs increase the efficiency and improve the
adverse reactions of -nausea and anorexia
are used to contraction of the heart muscle
cardiotonic drugs are
10. Left ventricular causing pulmonary symptoms
21. Drug therapy only improves heart function do not
dysfunction
cure HF
-dyspnea
-moist cough (pink frothy blood 22. Only real cure for heart heart transplant because the
sputum) failure and why damage to the heart muscle is
-shortness of breath not reversible
23. Digoxin (Lanoxin) is a cardiac glycoside that works on
heart muscle fiber to increase to
force of contraction and lower
HR and improve cardiac output
24. Cardiotonic drugs are
contraindicated in pt with the
presence of digitalis toxicity
and in pt that are
25. Digoxin use will continue for
26. A pt using cardiotonic drugs
the nurse should you
cautiously with pt who have
27. Digoxin and immune Fab is
classified in pregnancy
28. Digoxin is less effective in
which race
29. Cariotonic Interactions
30. Benzodiazepines interact
with what drug and what is
this drug uses
31. What drug that interacts with
cardiotonic drugs may
decrease the absorption of
digoxin
32. Nurse Process : Assessment
-cardiac tamponade
-restrictive cardiomyopathy
-ventricular failure and
tachycardia
-AV block
-
-older pt who are
maintained on the drug for
years
- after primary drugs fail
-in some cases treat for
atrial fibrillation
electrolyte imbalances (
hypo K, Calcium , Ma)
-thyroid disorder
-severe carditis
-heart block
-myocadial infarction
-pulmonary disease
-acute glomerulonephritis
-impaired renal or hepatic
function
category C should be used
cautiously only when the
potential benefit outweighs
harm to the infant
blk people but they can use
( hydralazine and isosorbide)
-antineoplastics
-benzodiazepines ( increase
plasma digitalis level ,
leading to toxicity ) anxiety
-rifampin
cardiotonic and treat
seizures and anxiety
antacids
- take BP
-auscultate lungs
-examine for edema
-check JVD
-daily weight
-inspect sputum
-shortness of breath,
cyanosis
33. Before the nurse administer
the drug what should the
nurse assess for
34. When should the nurse
withhold the drug if
administering a cadiotonic
drug
35. With toxicity when using
digoxin it may cause
36. Male users of digoxin have
reported what type of
effects
37. If a child is given digoxin it
is held and the PCP is
notified if the HR is
38. Nursing Diagnosis for
Imbalanced Nutrition : Less
than Body Requirements
39. Nursing Diagnosis for
Activity Intolerance
40. If nausea occurs wheg
giving cardiotonic drug
what can the nurse
implement
41. Digitalization may be
accomplished by two
general methods
42. First sign of drug toxicity in
children are
43. Education and pt teaching
-lab levels ( liver - AST/ALT /
kidney - BUN , Creatinine )
-CBC
-apical pulse and HR
for adults if HR is lower than
60 BPM or higher than 100
BPM
low HR less than 60 BPM
resulting into bradycardia
estrogen such as ;
gynecomastia ( enlargement
of breast and tenderness )
less than 60 BPM and for
infant less than 90 BPM
anorexia , nausea, vomiting
weakness and drowsiness
small meals instead of 3 large
meals with snacks in between
-restrict fluid in between
meals or 1 hour before and
after meal
-oral hygiene
rapid and gradual
digitalization (observe every 2
to 4 hr)
atrial dsyrhythimas
-take drug same time each
day
-dont discontinue w/o PCP
approval
-no antacids or cold OTC
meds
-contact PCP if adverse
reactions happen
-carry med card
-do not substitute for other
routes
-taking ivabradine use
effective birth control notify
doctor if you think you are
pregnant
44. The most Left ventricular dysfunction 51. A orally, IV, or intramuscularly (IM).
common SOB with exercise cardiotonic
symptoms Dry, hacking cough or wheezing can be given IV: it is administered slowly (over at least
associated with Orthopnea Restlessness and anxiety Right given 5 minutes), and the administration site is
heart failure ventricular dysfunction assessed for redness or infiltration.
include the Swollen ankles, legs, or abdomen, leading
following: to pitting edema IM injection is not recommended for these
Anorexia drugs yet, it may be given through this route
Nausea when needed urgently and IV access is not a
Nocturia able. When given IM, give the injection deep in
Weakness the muscle and follow with massage to the site.
Weight gain as the result of fluid retention No more than 2 mL should be injected
45. The most Palpitations, fatigue, or pain when
Oral preparations can be given without regard
common performing normal activities
to meals Tablets can be crushed and mixed
symptoms Tachycardia or irregular heart rate
with food or fluids if the patient has difficulty
associated with Dizziness or confusion
swallowing.
heart failure
include the
Do not alternate between the dosage forms
following:
Other 52. If digitalis digoxin immune Fab (Digibind)
symptoms toxicity
include: occurs
treat with
46. When the absorption is slowed, but the amount
cardiotonics absorbed is the same.
are taken with
food,
47. When absorption of the cardiotonics may be
cardiotonics decreased.
are taken with
high-fiber
meals,
48. NURSING levels are monitored closely. Blood for
ALERT Serum serum level measurements should be
digoxin drawn immedately before the next dose or
6 to 8 hours after the last dose regardless
of route. Therapeutic drug levels are
between 0.8 and 2 ng/mL. Serum digoxin
levels greater than 2ng/ml are considered
toxic
49. Ivabradine by women who are pregnant or lactating.
should not be Effective birth control methods must be
used used and this drug should be discontinued
before a woman attempts to conceive a
child.
50. NURSING makes the heart muscle more sensitive to
ALERT digitalis, thereby increasing the possibility
Hypokalemia of developing digitalis toxicity. At frequent
intervals, observe patients who can
become hypokalemic (diuretic therapy)
closely for signs of digitalis toxicity.