Heart Failure Medications

Question 1

Medication Options for Heart Failure Include

Answer 1

1. Digoxin
2. Adrenergic Agonists

Question 2

Common Uses of Digoxin

Answer 2

-heart failure
-atrial fibrillation

Question 3

What is one Mechanism of Action of Digoxin

Answer 3

Digoxin works by stimulating the vagus nerve, causing it to release more acetylcholine. This effect helps clients with atrial fibrillation.

Question 4

What is another Mechanism of Action of Digoxin

Answer 4

digoxin inhibits an enzyme (sodium, potassium-ATPase) found in cardiac cells. This causes an increase of calcium in these cells, which causes the heart to contract with more force. Potassium levels must be in normal range for this to work.

Question 5

Digoxin High Yield Concepts

Answer 5

1. Has narrow therapeutic index
2. Causes GI disturbances (1st sign of toxicity)
3. May cause Visual Disturbances as toxicity worsens
4. May Cause Bradydysrhtmias

Question 6

what is therapeutic index for digoxin?

Answer 6

-for HF: 0.5 - 1.0 ng/mL.
-for atrial fibrillation: 1.0 - 2.0. ng/mL
-Levels should never go above 2.0

Question 7

What do Visual Disturbances caused by digoxin toxicity include?

Answer 7

-blurred or yellow vision
-halos around object

Question 8

GI disturbances caused by digoxin toxicity include

Answer 8

anorexia, nausea, vomiting

Question 9

Why is bradydysrhythmias the most feared side effect of digoxin toxicity?

Answer 9

because it can cause dizziness, fainting (syncope), and even death

Question 10

what is digoxin toxicity antidote?

Answer 10

digoxin immune Fab

Question 11

what is side effect of digoxin immune FAB?

Answer 11

hypokalemia

Question 12

What are the 4 Adrenergic Agonists you should know?

Answer 12

1. epinephrine
2. Dopamine
3. Dobutamine
4. Norepinephrine

Question 13

Adrenergic Agonists Common Uses

Answer 13

used in medical emergency situations

Question 14

Epinephrine common uses

Answer 14

• for severe allergic reactions (anaphylaxis)
  -for cardiac arrest
  -inhaled version (racemic epinephrine) that treats upper airway restriction
  -can be added to local anesthetics to decrease blood flow to region

Question 15

Dopamine Common Uses

Answer 15

-for clients with extremely low blood pressure (shock)
-low doses given to help increase blood flow to the kidneys (renal perfusion)

Question 16

Dobutamine Common Uses

Answer 16

-used as short-term treatment of HF
-increases cardiac output by strengthening the force of contractions

Question 17

Norepinephrine Common Uses

Answer 17

-for severe hypotension or shock

Question 18

Adrenergic Agonists Mechanism of action

Answer 18

activates alpha 1, beta 1, and beta 2 receptors, Dopamine Receptor activation

Question 19

Alpha 1 activation (arteries)

Answer 19

Causes vasoconstriction, which increases blood pressure. It also causes pupil dilation (mydriasis).

Question 20

Beta 1 activation (heart)

Answer 20

Causes the heart to beat faster and stronger.

Question 21

Beta 2 activation

Answer 21

Causes the airways to open up (bronchodilation).

Question 22

Dopamine activation

Answer 22

Dopamine also stimulates dopamine receptors in the kidneys. At lower doses, this can help increase blood flow to the kidneys, which is a good thing. At higher doses, however, dopamine will restrict blood flow to the kidneys.

Question 23

Adrenergic Agonists High Yield Concepts

Answer 23

1.) Cardiac Complications (including tachycardia, a hypertensive crisis, and even a heart attack.)
2.) Necrosis (bc powerful vasoconstrictor, if drug leaks out to surrounding tissue a.ka. infiltrates)

Question 24

How to avoid infiltration with adrenergic agonists

Answer 24

the medications are given through a central line

Question 25

High doses of adrenergic agonist even when through proper route can cause

Answer 25

so much vasoconstriction that fingers, toes, and even a patient’s nose can lose too much blood flow and die (necrose)