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Positive inotropic agents _____ myocardial contractility. They are used in disease states where there is _____ ______.
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What are the two main classes of positive inotropic agents?
- 1. cardiac glycosides
- 2. phosphodiesterase inhibitors
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What are two beta-adrenergic stimulators used in heart failure?
- Dobutrex
- Dopamine - Intropin
- -- increase contractility
- -- only continous IV drip
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Which drug has been around a very long time and used to treat "dropsy" ?
Cardiac glycosides
"dropsy"= fluid accumulation or HF
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What are the different types of cardiac glycosides?
- Deslanoside- Cedilanid-D
- Digitoxin- Crystodigin
- Digoxin-Lanoxin
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What is the most common form of cardiac glycosides?
Digoxin- Lanoxin
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Cardiac glycosides are naturally occuring compounds coming from ____
- leaves of -
- digitalis purpurea (purple foxglove)
- digitalis lanata (white foxglove)
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Cardiac glycosides act on the heart muscle by effecting the function by....
- 1. + inotropic action
- 2. - chronotropic action
- 3. - dromotropic action
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The side effects of cardiac glycosides include:
- yellow-green halo around lights
- heart block
- bradycardia
- anorexia
- Diarrhea + N&V, HA, arrhythmias, fatigue
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True or False: Cardiac glycosides are very potent in low doses.
true
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these drugs are the classic treatment for heart failure:
cardiac glycosides: digoxin, digitoxin, deslanoside
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How do you screen for toxicity in glycosides?
- Hypokalemia,
- hypercalcemia,
- hypomagnesium
- Renal failure
- elevated digitalis levels
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What are the contraindiactions and precautions associated with cardiac glycosides?
- Bradycardia
- Heart block
- Renal failure
- Liver failure
- Hypothyroidism
- Elderly
- Electrolyte imbalance
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What is the antidote for digitalis glycoside toxicity?
- Digoxin Immune FAB - Digibind
- -- Electrolytes should also be checked and returned to normal
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What time are cardiac glycosides given at SLH?
1800 (6pm)
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What should you do if patients pulse is below 60?
Hold medication and call doctor.
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Nursing considerations:
- Monitor:
- K, BUN, CR
- I&O
- Dig Levels: should be 0.5-2.5
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What is the normal digitalis level?
0.5 - 2.5 ng/ml
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Client teaching when taking cardiac glycosides:
- -taking pulse
- -med same time each day
- -don't make up for missed doses
- -do not change brands
- -digoxin and lanoxin are the same drug
- -take 1-2 hours before meals : diet high in fiber will reduce absorption
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What is the onset of action and duration of digibind?
- onset <1 minute
- duration 15-20 hours
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After administering _____ improvement from digitalis toxicity can be seen in _____.
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