NU 578 Units 3
Treatment of CHF - answerDigoxin (increases cardiac contractility), diuretics (increases
NA and H2O excretion), ACEI (decreases BP and BV), Vasodilators (decreases BP),
dobutamine and dopamine and PDE inhibitors (increase ventricular contractility)
Digoxin - answerclass: cardiac glycoside
increases myocardial contractile force and increases cardiac output
has a positive inotropic effect by inhibiting sodium potassium tump (this increases
Calcium into cell).
decreases HR
decreases AV nodal conduction
* USED FOR HF AND DYSRHYTHMIAS*
Digoxin toxicity - answerwarn patients about dig induced dysrhythmias and instruct to
take meds exactly as prescribed. toxicity symptoms are altered hr or rhythm, visual or gi
disturbances (nausea, anorexia, vomitting, fatigue, blurred vision, yellow tinge to vision).
toxicity is made much worse by hypokalemia or anything that decreases digoxin
clearance.
Treatment: d/c digoxin, correct potassium, administer digibind
Digoxin pharmacokinetics - answergood PO absorption but capsules are better than
tablets. don't switch forms once prescribed. dosage is based on lean body weight and is
really excreted. therapeutic levels are 0.5-0.8ng/ml.
half life is 1.5 days. 6 days required to reach plateau and 6 days to eliminate.
Digoxin drug interactions - answerAntacids: decease absorption
diuretics: cause hypokalemia and increase toxicity
quinidine: displaces dig from tissues and decreases excretion
amiodarone: increases concentration of dig
verapamil: increase plasma levels of dig
sympathomimetics: increases chance of arrthymias
How do ACEI work in CHF? - answerinhibitor of ACE decreases angiotensin II,
decreases total peripheral resistance, and decreases blood volume. decreased
aldosterone decreases TPR and BV.
Block the production of angiotensin II, decrease the release of aldosterone, and
suppress degradation of kinins. arteriolar dilation improves blood flow in kidneys,
venous dilation reduces venous pressure, edema, preload, and suppression of
aldosterone release enhances excretion of sodium and water . contribute to cardiac
remodeling!!! prolong life. not in acute decompensated HF. excreted by kidneys
, FIRST LINE TREATMENT IN CHF!!!!
ACEI side effects - answercough, increased potassium, dizziness, angioedema,
hypotension. can cause renal failure in patients with bilateral renal artery stenosis. use
with caution in patients taking potassium supplements or k sparing diuretics,
neutropenia
DDI: diuretics can intensify hypotension, antihypertensive agents can increase powered
bp, risk of hyperkalemia with k sparing diuretics and k supplements, NSaids and Lithium
decrease effects of ACEI
BBW: can cause fetal injury in pregnancy.
Lisinopril - answerACE inhibitor that is given in active form
decreases TPR, Na and H2O load by inhibiting ACE.
block angiotensin II, decreases BO and salt and water retention.
longer 1/2 life. q day dosing. causes first dose syncope, dizziness, GI SE
approved for MI, HTN, heart failure.
Angiotensin 2 receptor blockers - answerapproved for hypertension, heart failure,
diabetic nephropathhy, MI, prevention of MI and stroke
They block the action of angiotensin 2. cause dilation of the arterioles, prevent cardiac
structure change, increase renal excretion of sodium and water. DO NOT INHIBIT
KINASE II and do not increase levels of bradykinin in the lungs. have lower risk for
cough.
Used for HF, HTN, diabetic neuropathy, MI, stroke prevention, prevention of MI, diabetic
retinopathy
ARBS AE - answerangioedema, renal failure.
BBW for fetal harm
Calcium Channel Blockers - answerprint calcium ions from entering cells. used for
dysrhythmias, htn, angina pectoris.
Reduces force of contraction, slow heart rate, and suppress conduction through the AV
node.
Diuretics in CHF - answerreduces blood volume and decreases venous pressure,
arterial pressure (after load), pulmonary edema, peripheral edema, cardiac dilation.
Thiazide diuretics: used for long term therapy of HF. watch for hypokalemia
Loop Diuretics: preferred for severe HF
K Sparing Diuretics: scant diuresis.
Treatment of CHF - answerDigoxin (increases cardiac contractility), diuretics (increases
NA and H2O excretion), ACEI (decreases BP and BV), Vasodilators (decreases BP),
dobutamine and dopamine and PDE inhibitors (increase ventricular contractility)
Digoxin - answerclass: cardiac glycoside
increases myocardial contractile force and increases cardiac output
has a positive inotropic effect by inhibiting sodium potassium tump (this increases
Calcium into cell).
decreases HR
decreases AV nodal conduction
* USED FOR HF AND DYSRHYTHMIAS*
Digoxin toxicity - answerwarn patients about dig induced dysrhythmias and instruct to
take meds exactly as prescribed. toxicity symptoms are altered hr or rhythm, visual or gi
disturbances (nausea, anorexia, vomitting, fatigue, blurred vision, yellow tinge to vision).
toxicity is made much worse by hypokalemia or anything that decreases digoxin
clearance.
Treatment: d/c digoxin, correct potassium, administer digibind
Digoxin pharmacokinetics - answergood PO absorption but capsules are better than
tablets. don't switch forms once prescribed. dosage is based on lean body weight and is
really excreted. therapeutic levels are 0.5-0.8ng/ml.
half life is 1.5 days. 6 days required to reach plateau and 6 days to eliminate.
Digoxin drug interactions - answerAntacids: decease absorption
diuretics: cause hypokalemia and increase toxicity
quinidine: displaces dig from tissues and decreases excretion
amiodarone: increases concentration of dig
verapamil: increase plasma levels of dig
sympathomimetics: increases chance of arrthymias
How do ACEI work in CHF? - answerinhibitor of ACE decreases angiotensin II,
decreases total peripheral resistance, and decreases blood volume. decreased
aldosterone decreases TPR and BV.
Block the production of angiotensin II, decrease the release of aldosterone, and
suppress degradation of kinins. arteriolar dilation improves blood flow in kidneys,
venous dilation reduces venous pressure, edema, preload, and suppression of
aldosterone release enhances excretion of sodium and water . contribute to cardiac
remodeling!!! prolong life. not in acute decompensated HF. excreted by kidneys
, FIRST LINE TREATMENT IN CHF!!!!
ACEI side effects - answercough, increased potassium, dizziness, angioedema,
hypotension. can cause renal failure in patients with bilateral renal artery stenosis. use
with caution in patients taking potassium supplements or k sparing diuretics,
neutropenia
DDI: diuretics can intensify hypotension, antihypertensive agents can increase powered
bp, risk of hyperkalemia with k sparing diuretics and k supplements, NSaids and Lithium
decrease effects of ACEI
BBW: can cause fetal injury in pregnancy.
Lisinopril - answerACE inhibitor that is given in active form
decreases TPR, Na and H2O load by inhibiting ACE.
block angiotensin II, decreases BO and salt and water retention.
longer 1/2 life. q day dosing. causes first dose syncope, dizziness, GI SE
approved for MI, HTN, heart failure.
Angiotensin 2 receptor blockers - answerapproved for hypertension, heart failure,
diabetic nephropathhy, MI, prevention of MI and stroke
They block the action of angiotensin 2. cause dilation of the arterioles, prevent cardiac
structure change, increase renal excretion of sodium and water. DO NOT INHIBIT
KINASE II and do not increase levels of bradykinin in the lungs. have lower risk for
cough.
Used for HF, HTN, diabetic neuropathy, MI, stroke prevention, prevention of MI, diabetic
retinopathy
ARBS AE - answerangioedema, renal failure.
BBW for fetal harm
Calcium Channel Blockers - answerprint calcium ions from entering cells. used for
dysrhythmias, htn, angina pectoris.
Reduces force of contraction, slow heart rate, and suppress conduction through the AV
node.
Diuretics in CHF - answerreduces blood volume and decreases venous pressure,
arterial pressure (after load), pulmonary edema, peripheral edema, cardiac dilation.
Thiazide diuretics: used for long term therapy of HF. watch for hypokalemia
Loop Diuretics: preferred for severe HF
K Sparing Diuretics: scant diuresis.
