-Inotropic Drugs

-Increases the Ca levels in the heart muscle- Increases contractility- Increases CO- Increases renal blood flow-Increases renin production- Prevents activation of the reninangiotensin system- Increases urine output- Increases BV- Increases heart's workload.

Cardiotonic Agents:

Cardiac Glycosides

Prototype:_____

Digoxin (Lanoxin) "Dig"

*originally derived from the foxglove plant.

Cardiotonic Agents:

Cardiac Glycosides

Prototype: Digoxin (Lanoxin) "Dig"

Indications (2):

1. HF
2. Atrial fibulation

Cardiotonic Agents:

Cardiac Glycosides

Prototype: Digoxin (Lanoxin) "Dig"

Actions (2):

1. Positive Inotrope, Negative Chronotrope, Negative Dromotrope
2. Diuretic Effect (NOT a diuretic)

Cardiotonic Agents:

Cardiac Glycosides

Prototype: Digoxin (Lanoxin) "Dig"

Adverse Effects (7):

1. Hypotension
2. Bradycardia
3. Weakness & drowsiness
4. Headache
5. Vision changes (yellow halo, blurring, spots/threads)
6. arrhythmias
7. GI Upset

Cardiotonic Agents:

Cardiac Glycosides

Prototype: Digoxin (Lanoxin) "Dig"

Normal therapeutic dose:

0.125mg-0.25mg

*Very close to toxic dose

Cardiotonic Agents:

Cardiac Glycosides

Prototype: Digoxin (Lanoxin) "Dig"

Nursing Interventions (1):

1. Monitor for S/E, PG/Lactation, MI

Cardiotonic Agents:

Cardiac Glycosides

Prototype: Digoxin (Lanoxin) "Dig"

Apical pulse for 1 min, if HR is __, hold, reuptake pulse.

1hr later, if still __, hold & notify physician: Document, as this may be an indicator of "dig" toxicity.

Cardiotonic Agents:

Digoxin Antidote

Prototype: ___

Cardiotonic Agents:

Digoxin Antidote

Prototype: Digoxin Immune Fab (Digibind)

Normal Value Range:

Cardiotonic Agents:

Digoxin Antidote

Prototype: Digoxin Immune Fab (Digibind)

Indications (3): Dig Toxicity:

Dig Toxicity

1. >10 ng/mL & symptomatic
2. K >5 mEq/L
3. Digoxin toxicity s&s: acute- N/V/D & lethargy/ Chronic- S/E of digoxin

Cardiotonic Agents:

Digoxin Antidote

Prototype: Digoxin Immune Fab (Digibind)

Action (1):

1. Binds molecules of digoxin, making them unavailable @ their receptor site. It's an antibody found in sheep.

Cardiotonic Agents:

Digoxin Antidote

Prototype: Digoxin Immune Fab (Digibind)

Adverse Effects (3):

1. Allergic response to drug
2. Reemergence of HF & AFib
3. Hypokalemia

Cardiotonic Agents:

Digoxin Antidote

Prototype: Digoxin Immune Fab (Digibind)

Nursing Implications (5):

1. Get pt off your floor if possible.
2. Continuous heart monitoring
3. No telemetry
4. Crash cart by door.
5. DONT look at labwork after giving as the serum level will remain high.

Cardiotonic Agents:

Phosphodiesterase Inhibitors

Prototype:____

Cardiotonic Agents:

Phosphodiesterase Inhibitors

Prototype: Inamrinone (Inocor)

Indications (2):

1. End stage HF pts who aren't responding to Dig, diuretics, or vasodilators.
2. Given while admitted or schedule out pt clinic- Short term Tx.

Cardiotonic Agents:

Phosphodiesterase Inhibitors

Prototype: Inamrinone (Inocor)

Action (1):

1. Increases Ca levels in cardiac cell results in stronger contractions, vasodilation

Cardiotonic Agents:

Phosphodiesterase Inhibitors

Prototype: Inamrinone (Inocor)

Adverse Effects (3):

1. Hypotension
2. Arrhythmias
3. Buring @ IV site

Cardiotonic Agents:

Phosphodiesterase Inhibitors

Prototype: Inamrinone (Inocor)

Nursing Implications

1. Telemetry
2. s&s of hypotension must be initiated in CCU/ short stay, etc & then can be monitored on the floor.
3. Gradually increase tapering, frequent VS when starting (q 15mins)