Studied by 16 people
based off brain boost
What is midodrine
a hypotensive agent
what is the action of midodrine?
activates alpha1- adrenergic receptor (agonist) → leading to peripheral vasoconstriction and an increase in vascular tone and blood pressure
what are the indications of midodrine?
treatment of orthostatic hypotension
midodrine can cause ___?
serious supine hypertension
what should you monitor in midodrine?
BP in the standing, sitting, and supine position
What are vasopressors?
used to lower BP
what are some examples of vasopressors?
norepinephrine, epinephrine, dopamine, phenylephrine
Where are infusions of vasopressors taken place?
intensive care unit (ICU) with frequent BP monitoring
What is heart failure?
a condition in which the heart fails to effectively pump blood throughout the body
What are the 2 contractile proteins in cardiac muscle?
Actin and myosin
what keeps actin and myosin apart?
troponin
what is the first goal in heart failure treatment?
decrease the workload of the heart
angiotensin receptor inhibitor (ARNI)
used in treatment of HF
ACE inhibitor, or ARB inhibitor (blocks RAAS)
beta blockers
used to treat HF
metroprolol, bisoprolol
reduce sympathetic stimulation
diuretics
used to treat HF
loop, potassium-sparing
vasodilators
used to treat HF
hydralazine
isosorbide dinitrate
used to treat HF
What is a cardiac glycoside?
digoxin (lanoxin)- available PO or IV
digoxin actions
increases myocardial intracellular calcium → causing increased force of contraction (positive inotrope)
increased Cardiac output (CO)
decreased renin relase → decreased RAAS activation
decreased HR ( negative chronotropic effect)
decreased conduction velocity though the atrioventricular (AV) node
digoxin indications
mild to moderate HF
a fib., atrial flutter, and paroxysmal atrial tachycardia
digoxin pharmacokinetics
therapeutic range: 0.8-2.0 ng/mL
excreted thru kidneys
digoxin adverse effects
vision changes (blurred vision, yellow halo around objects)
bradycardia
dysrhythmias (with low K+ levels)
digoxin toxicity: when levels are too high (> 2.4ng/mL ) can be life threatening
early warning signs: anorexia, N/V → can progress to heart block; monitor K+ levels
_____ increases the risk of digoxin toxicity
hypokalemia
what is the reversal agent for digoxin?
digoxin immune fab (DigiBind)
what does digoxin immune fab do ?
binds to digoxin facilitating its elimination
what is ivabradine (Corlanor)?
a hyperpolarization- activated cyclic nucleotide- gated channel blocker
when is ivabradine used?
when beta blcoker therapy isnt working
must be in a normal, sinus rhythm with a HR of ≥ 70)
what is adverse effects of ivabradine?
bradycradia, atrial fibrillation, hypertension, luminous phenomena (visual changes)
What is dobutamine?
positive inotrope/sympathomimetric used in sever HF
is dobutamine a continuous infusion?
Yes: mcg/kg/min
what is a phosphodiesterase inhibitor?
milrinone (primacor)
what is milirinone used for ?
severe HF
what is the infusion for milirinone?
continous, mcg/kg/min
must be renally dosed
what are antirrhythmic agents?
drugs used to treat dysrhythmias
has 4 classes
class I antirhythmic action
action: blocks the Na+ channels in the cell membrane →phase 0 when Na+ rushes into the cell and results in depolarization
what is an example of a class I antirhythmic
Lidocaine, quinidine, procainamide
what are Class I antirhythmic agents used in?
treatments of life-threatening ventricular dysrhythmias, prevention of atrial tachycardia( flecainide), and prevention of paroxysmal atrial tachycardia (propafenone)
what should be avoided with those taking quinidine?
grapefruit → can interfere with metabolism and lead to toxic levels
lidocaine can cause____
hypotension, dysrhythmias, and CNS effects
what are class II antirhythmic
beta blockers (-olol)
what do class II antirhythmic agents do?
block beta-receptors, causing depression of phase 4 of the action potenial
slow conduction through the AV node and decrease the release of renin (from esmolol IV FORM ONLY)
what is the caution of propanolol (inderal)
caution with asthma → bronchoconstriction can occur with beta-2 receptor blockade
Monitor HR/BP
Class II antirhythmic contraindications
cardiogenic shock, sinus bradycardia, or AV Block
what is a class III antirhythmic?
amiodarone (cordarone): PO or IV
-(arones)
what are class III antirhythmic used for?
block K+ channels and prolong phase 3 of the action potential ( time of rapid repolarization as the Na+ gates closed and K+ flows out of the cell)
what is amiodarone used for ?
treatment of life-threatening ventricular tachycardia and ventricular fibrillation and in maintaining normal sinus rhythm after conversion of dysrhythmias (i.e. a fib, atrial flutter)
What are the adverse effects of amidarone?
GI: N/V, anorexia
hypotension (IV use)
pulmonary toxicity
skin discolaration (blue-grey ) with long term usage
fatigues
HF, cardiac arrhythmias, cardiac arrest
hepatotoxicity
what are class IV antirhythmic?
non-dihydropyridine CBB
verapamil & diltiazem
what is the action of class IV antirhythmic?
block calcium channels in the cell membrane
what should you avoid with class IV antirhythmic?
GRAPEFRUIT
what is adenosine?
used to convert supreventrivcular tachycardia (SVT) to normal sinus rhythm ( short duration action)
Class II antirhymatic
adenosine interrupts the _____?
AV node reentry pathways and slows AV conduction time
what is the dosage of adenosine?
6mg rapid IV push (then elevate the arm) → followed by 12 mg IV q1-2 minutes x2 PRN
what kind of monitoring is necessary with adenosine?
cardiac monitoring done during administration and physician should be at the bedside
Adenosine cautions
caution in clients with asthma → can cause bronchospasm
amiodarone is the drug of choice for treatment of _______
VF or pulseless ventricular tachycardia (VT) in cardiac arrest
Note
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