CARDIONIC MEDICATION  Because of this, caution should be exercised in the presence of renal

impairment because the drug ma not be excreted and could

 Drugs used to increase the contractility of the heart
accumulate, causing toxicity.
Mechanism of Action
Contraindication
 Inotropic drugs affect the intracellular calcium levels in the heart
 Patient with ventricular tachycardia or fibrillation, which are
muscle, leading to increased contractility
potentially fatal arrythmias and should be treated with other drug
 This increased in contraction strength leads to increased cardiac
 Heart block or sick sinus syndrome, which could be made worse by
output, which caused increased renal blood flow and increased urine
slowing of conduction through the AV node
production
 Renal insufficiency because the drug is excreted through the kidneys
 Increased renal blood flow decreases renin releases interfering with the
and toxic levels could develop
effect of the Renin-Angiotensin-Activation-System (RAAS), and
 Idiopathic hypertrophic subaortic stenosis (IHSS) because the increase
increase urine output leading to decreased blood volume
in the force of contraction could obstruct the outflow tract to the aorta
 The result is a decrease in the heart’s workload and relief of Heart
and cause severe problems
Failure
 Acute Myocardial Infarction (MI) because the increase in force of
1. Cardiac Glycosides
contraction could cause more muscle damage and infarct
 Originally derived from the foxglove or digitalis plant
 Electrolyte abnormalities (increased calcium, decreased potassium,
 These plants were once ground up to make digitalis leaf
decreased magnesium), which could alter the action potential and
 Digoxin (Lanoxin) is the drug most often used to treat heart failure
change the effects of the drug
Actions & Indication
Adverse effects
 Digoxin increases intracellular calcium and allows more calcium to
 Headache, weakness, drowsiness, and vision changes (yellow halo
enter myocardial cells during depolarization
around objects)
o This results to increased force of myocardial contraction
 GI upset, anorexia, arrythmias, ventricular tachycardia, malaise,
(positive inotropic effect) depression
 Increased cardiac output and renal perfusion Antidote
 Slowed heart rate, owing to slowing of the cellular repolarization  Digoxin Immune Fab (Digifab)
(negative chronotropic effect) o Is an antigen binding fragment (fab) derived from specific
 Decreased conduction velocity through the atrioventricular (AV) node
antidigoxin anti bodies. These antibodies bind molecules of
 Indicated for the treatment of Heart failure, atrial flutter, atrial
digoxin, making them unable at their site of action. The
fibrillation and paroxysmal atrial tachycardia
digoxin antibody-antigen complexes accumulate in the blood
 It has a very narrow margin of safety
and are excreted through the kidney. Digoxin immune fab is
Pharmacokinetics
used for the treatment of life-threatening digoxin intoxication
 It can be for oral and parenteral administration
(serum levels >10 ng/mL with serum potassium >5 mEq/L in a
 It has a rapid onset of action and rapid absorption
setting of digoxin intoxication) and potential life-threatening
o 30-120 minutes when taken orally
digoxin overdose
o 5-30 minutes when given intravenously o The amount of digoxin immune fab that is infused
 Primarily excreted unchanged in the urine intravenously is determined by the amount of digoxin ingested

PHARMACOLOGY MIDTERMS
 or by the serum digoxin level if the ingested amount is
unknown. The patient cardiac status should be monitored
continually while the drug is given and for several hours after
the infusion is finished. Because there is a risk of
hypersensitivity reaction to the infused protein, life-support
equipment should be on standby.
o Serum digoxin levels will be very high and unreliable for
about 3 days after the digoxin immune fab infusion because of
the high levels of digoxin in the blood. The patient should not
be redigitalized for several days to 1 week after digoxin
immune fab has been used because of the potential of
remaining fragment in the blood
o

PHARMACOLOGY MIDTERMS