Glycosides, Heart Failure, Angina, Antilipemic

What positive inotropic effect does digoxin have?

increases force of myocardial contraction, improving heart pumping efficiency and increasing stroke volume and cardiac output

What negative chronotropic effect does digoxin have?

slows SA node depolarization and impulse conduction, decreasing heart rate and allowing more ventricular filling time

What are some therapeutic uses for digoxin?

treatment of heart failure, dysrhythmias (particularly afib)

What are some key contraindications for digoxin?

ventricular fibrillation or tachycardia, second or third degree heart block; use cautiously in hypokalemia, partial AV block, advanced heart failure, renal impairment

What are some signs of digoxin toxicity?

GI effects (n/v), CNS effects (visual halos), cardiac effects

What are some nursing considerations for digoxin?

check pulse before administration, consistent timing, monitor for toxicity, for IV infuse slowly over at least 5 minutes (10-15 minutes in pulmonary edema), monitor for dysrhythmias

What are some patient education points for digoxin?

monitor and record pulse daily, report irregularities immediately, take exactly as prescribed, do not double next dose if a dose is missed; report vision changes, nausea, vomiting, loss of appetite, fatigue or weakness, signs of hypokalemia

What are the primary uses of epinephrine?

cardiac arrest, anaphylaxis, severe hypotension/shock

What is the mechanism of action of epinephrine?

alpha-1 effect --> vasoconstriction which elevates BP; Beta-1 effect --> increased HR and contractility; Beta-2 effect --> bronchodilation

What are the primary uses for norepinephrine?

severe hypotension/shock

What is mechanism of action for norepinephrine?

alpha-1 effect --> strong vasoconstriction which elevates BP; Beta-1 effect --> increased HR and contractility (less than epinephrine)

What are some nursing considerations for norepinephrine?

monitor BP closely, continuous IV infusion via central line preferred

What effect does low dose dopamine (1-5 mcg/kg/min) have?

What effect does moderate dose (5-10 mcg/kg/min) dopamine have?

What effect does high dose (>10 mcg/kg/min) dopamine have?

What are the primary uses of isoproterenol?

heart block, bradycardia unresponsive to atropine

What is the mechanism of action for isoproterenol?

Beta-1 effect --> increase HR and contractility (less than epinephrine); Beta-2 effect --> vasodilation and bronchodilation

What are some nursing considerations for isoproterenol?

monitor HR, BP, ECG; can cause tachyarrhythmias or hypotension

What receptor doe dobutamine act on?

Beta-1 selective

What is dobutamine used for?

heart failure, cardiogenic shock

What is the key point of dobutamine?

increased cardiac contractility and cardiac output

What is the onset and duration of sublingual/spray nitroglycerin?

rapid onset, short duration

What is the use of sublingual/spray nitroglycerin?

treat acute attack or prophylaxis of acute attack when exertion is anticipated

What is the onset and duration of nitroglycerin transdermal patch?

slow onset, long duration

What is the use of nitroglycerin transdermal patch?

for long-term prophylaxis

What is the onset and duration of sustained-release nitroglycerin?

slow onset, long duration

What is the use for sustained-release nitroglycerin?

for long-term prophylaxis

What are some adverse effects of nitroglycerin?

headache, orthostatic hypotension, reflex tachycardia

What are some contraindications of nitroglycerin?

severe anemia, closed-angle glaucoma, head injury; never combine with ED medications --> dangerously low BP; use cautiously with antihypertensives and alcohol

What is the pharmacological action of ranolazine?

lowers cardiac oxygen demand and thereby improves exercise tolerance and decreases pain; myocardial energy use is more efficient due to the decreased accumulation of sodium and calcium in the myocardial cells

What are the therapeutic uses for ranolazine?

anti-anginal medication used to treat chronic angina

What are some nursing actions for ranolazine?

monitor BP, monitor ECG, do not use in clients who have a prolonged QT or are taking other medications that prolong QT

What does sacubitril/valsartan treat?

severe heart failure

What is the therapeutic use of sacubitril/valsartan?

approved for patients who have class II-IV heart failure and reduced ejection fraction to replace an ACE inhibitor or ARB

What are some nursing administration points for sacubitril/valsartan?

available as an oral tablet, monitor renal function and potassium

What are some safety considerations for statins?

hepatotoxicity risk, myopathy risk, pregnancy category X, take at night for best effect, avoid alcohol, report muscle pain immediately

What is the mechanism of action for bile acid sequestrants?

bind bile acids which leads to increased cholesterol excretion

What are some key points of bile acid sequestrants?

causes constipation, take other meds 1 hour before or 4-6 hour after

What is the mechanism of action for fibrates?

decreased triglycerides and increased HDL

What are some key points for fibrates?

monitor liver enzymes, increased gallstone risk

What is the mechanism of action of ezetimibe?

decreased cholesterol absorption

What are some key points for ezetimibe?

can combine with statins, monitor lier enzymes