Cardiac Drugs
Positive Inotropic
Digoxin:
Treatment of CHF, tachycardia, atrial fibrillation, atrial flutter, atrial tachycardia
Decrease conduction through the SA and AV node {slows heart rate (negative chronotropic) and increases
cardiac output (positive inotropic)}
CONTRAINDICATIONS:
o AV heart block
CAUTION:
o Hypokalemia
o Hypomagnesemia
o Hypercalcemia
o Diuretic use (may cause hypoK and hypoMg)
o Hypothyroidism
A/E:
o ARRHYTHMIAS
o Fatigue, bradycardia, anorexia, N/V
o Blurred vision, halo, diarrhea, thrombocytopenia
Nursing Implications:
o Monitor apical pulse 1 min before administration (no med and notify MD if < 60bpm adult, <70bpm pedi,
<90bpm infant)
o Monitor EKG through IV administration and 6 hours after each dose
o Therapeutic Level: 0.5 – 2 mg/ml
o First signs of toxicity are abdominal pain, anorexia, vomiting, visual disturbances, bradycardia,
arrhythmias
o Administer over at least 5 minutes
Dopamine
Improve BP, cardiac output, urine output in treatment of shock unresponsive to fluid replacement
Small dose: renal vasodilation
Larger dose: cardiac stimulation and renal vasodilation
Larger dose: may cause renal vasoconstriction
CONTRAINDICATIONS:
o Tachyarrhythmias
o Pheochromocytoma
o Hypersensitivity to bisulfites
CAUTION:
o Hypovolemia
o MI
o Occlusive vascular diseases
Page 1 of 8
, A/E:
o Arrhythmias, hypotension
o H/A, dyspnea, EKG changes, palpitations, vasoconstriction, N/V
Nursing Implications:
o Monitor BP, HR, pulse pressure, EKG, PCWP, cardiac output, CVP, urine output continuously
o HypoTN??? = increase rate to cause constriction
o Correct Hypovolemia with volume expanders BEFORE initiating dopamine therapy
o Administer into large vein to prevent extravasation, necrosis, and sloughing of tissue
o Administer via infusion pump to ensure precise amount delivered
o Rate and concentration are based on patient’s weight
Primocor
Treatment of CHF unresponsive to traditional therapy with digoxin, diuretics and vasodilators
Increase myocardial contractility
Decreases preload and afterload by dilation
Increased cardiac output (inotropic effect)
CONTRAINDICATIONS:
o Severe aortic or pulmonic valve heart disease; hypertrophic subaortic stenosis
CAUTION:
o h/o arrhythmias
o electrolyte abnormalities
o abnormal dig levels
o insertion of vascular catheters
o renal impairment
A/E:
o VENTRICULAR ARRYHTHMIAS
o Angina, chest pain, hypoTN, Supraventricular arrhythmias, H/A, tremors, hypokalemia
Nursing Implications:
o Monitor heart rate and BP continuously
o Monitor I & O and daily weight
o Monitor EKG continuously during infusion (arrhythmias are common and may be life threatening)
o Toxic overdose manifests as hypoTN
o Administer loading dose over 10 minutes
o Continuous infusion rate is based on patient’s weight
o Educate it will not cure but is used to control symptoms of CHF
Inocor
Short-term treatment of CHF unresponsive to traditional therapy with digoxin, diuretics and vasodilators
Increase myocardial contractility
Decreases preload and afterload by dilation
Increased cardiac output (inotropic effect)
CONTRAINDICATIONS:
Page 2 of 8
Positive Inotropic
Digoxin:
Treatment of CHF, tachycardia, atrial fibrillation, atrial flutter, atrial tachycardia
Decrease conduction through the SA and AV node {slows heart rate (negative chronotropic) and increases
cardiac output (positive inotropic)}
CONTRAINDICATIONS:
o AV heart block
CAUTION:
o Hypokalemia
o Hypomagnesemia
o Hypercalcemia
o Diuretic use (may cause hypoK and hypoMg)
o Hypothyroidism
A/E:
o ARRHYTHMIAS
o Fatigue, bradycardia, anorexia, N/V
o Blurred vision, halo, diarrhea, thrombocytopenia
Nursing Implications:
o Monitor apical pulse 1 min before administration (no med and notify MD if < 60bpm adult, <70bpm pedi,
<90bpm infant)
o Monitor EKG through IV administration and 6 hours after each dose
o Therapeutic Level: 0.5 – 2 mg/ml
o First signs of toxicity are abdominal pain, anorexia, vomiting, visual disturbances, bradycardia,
arrhythmias
o Administer over at least 5 minutes
Dopamine
Improve BP, cardiac output, urine output in treatment of shock unresponsive to fluid replacement
Small dose: renal vasodilation
Larger dose: cardiac stimulation and renal vasodilation
Larger dose: may cause renal vasoconstriction
CONTRAINDICATIONS:
o Tachyarrhythmias
o Pheochromocytoma
o Hypersensitivity to bisulfites
CAUTION:
o Hypovolemia
o MI
o Occlusive vascular diseases
Page 1 of 8
, A/E:
o Arrhythmias, hypotension
o H/A, dyspnea, EKG changes, palpitations, vasoconstriction, N/V
Nursing Implications:
o Monitor BP, HR, pulse pressure, EKG, PCWP, cardiac output, CVP, urine output continuously
o HypoTN??? = increase rate to cause constriction
o Correct Hypovolemia with volume expanders BEFORE initiating dopamine therapy
o Administer into large vein to prevent extravasation, necrosis, and sloughing of tissue
o Administer via infusion pump to ensure precise amount delivered
o Rate and concentration are based on patient’s weight
Primocor
Treatment of CHF unresponsive to traditional therapy with digoxin, diuretics and vasodilators
Increase myocardial contractility
Decreases preload and afterload by dilation
Increased cardiac output (inotropic effect)
CONTRAINDICATIONS:
o Severe aortic or pulmonic valve heart disease; hypertrophic subaortic stenosis
CAUTION:
o h/o arrhythmias
o electrolyte abnormalities
o abnormal dig levels
o insertion of vascular catheters
o renal impairment
A/E:
o VENTRICULAR ARRYHTHMIAS
o Angina, chest pain, hypoTN, Supraventricular arrhythmias, H/A, tremors, hypokalemia
Nursing Implications:
o Monitor heart rate and BP continuously
o Monitor I & O and daily weight
o Monitor EKG continuously during infusion (arrhythmias are common and may be life threatening)
o Toxic overdose manifests as hypoTN
o Administer loading dose over 10 minutes
o Continuous infusion rate is based on patient’s weight
o Educate it will not cure but is used to control symptoms of CHF
Inocor
Short-term treatment of CHF unresponsive to traditional therapy with digoxin, diuretics and vasodilators
Increase myocardial contractility
Decreases preload and afterload by dilation
Increased cardiac output (inotropic effect)
CONTRAINDICATIONS:
Page 2 of 8
