Term
| Positive Inotrope: classes |
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Definition
| Digoxin, Dobutamine, Inamrinone, Milrinone |
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Term
| Molecular effects of digoxin |
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Definition
| membrane potential less negative, slows recovery of sodium channels, increases effective refractory period, slows conduction of the AP, predisposes to re-entry->cardiac arrythmias |
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Term
| Molecular effects of Hypoxic cardiac tissue |
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Definition
| Hypoxic cells make less ATP than normal, Na/K ATPase pump is less active, membrane potential is less negative, Na channels inactivate more slowly, longer ERP, slows the AP conduction, predisposes to re-entry |
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Term
|
Definition
| vagus mediates digoxins effects on the SA node, atrial muscle, and AV node->slows AV conduction, lowers ventricular rate during atrial tachycardia |
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Term
|
Definition
| Ca overload-->DADs, shortened atrial refractory period (reentry arrhythmias), excessive AV block |
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Term
|
Definition
|
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Term
|
Definition
| increased contractility, slowed AV node conduction (indirect, vagal) |
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Term
|
Definition
| cardiac arrhythmias (hypokalemia due to diuretics, renal disease, CHF, quinidine decreases renal clearance), nausea, vomiting, visual abberations, vasoconstriction, diarrhea, AV block |
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Term
|
Definition
| renal clearance, narrow therapeutic window |
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Term
|
Definition
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Term
| When sympathetic and RAAS tone are normal, digoxin: |
|
Definition
Increases cardiac contractility, increases afterload, Decreases HR
-->Little net change in CO and hemodynamics |
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|
Term
| When SANS and RAAS tone is high (CHF), digoxin |
|
Definition
| increases contractility--> SANS and RAAS tone decrease, afterload decrease (improve CO), improved RBF (diuresis)--> relieves congestion and decreases heart size. HR slows, decreasing O2 demand |
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Term
| Dobutamine: pharm effects |
|
Definition
|
|
Term
| Dobutamine: adverse effects |
|
Definition
| increased HR, lowers BP, arrythmias |
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Term
|
Definition
| IV, tachyphylaxis (only use in acute setting or receptor downreg occurs) |
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Term
|
Definition
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|
Term
| Inamrinone, milrinone: target |
|
Definition
|
|
Term
| Inamrinone, milrinone: pharm effects |
|
Definition
| increased contractility, arteriolar vasodilation |
|
|
Term
| Inamrinone, mirinone: adverse effects |
|
Definition
| increased HR, cardiac arrhythmias, INCREASED mortality |
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Term
| Inamrinone, milrinone: PK |
|
Definition
|
|
Term
| Inamrinone, milrinone: uses |
|
Definition
| acute CHF (not really used anymore), contraindicated for chronic CHF |
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|
Term
|
Definition
| decreased CO, elevated filling pressure |
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|
Term
| Clinical manifestations of vasoconstriction |
|
Definition
| cool, pale skin; low urine output |
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Term
| Inotrope or vasodilator to increase CO |
|
Definition
| vasodilator: does not increase O2 consumption |
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|
Term
| Drugs to decrease chronic CHF remodelling |
|
Definition
| ACE inhibitors, aldosterone inhibitors, b-blockers |
|
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Term
|
Definition
| fatigue, exercise intolerance, cool extremeties, low urine output |
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|
Term
| Pulmonary edema symptoms: |
|
Definition
| SOB, rales, peripheral edema |
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Term
|
Definition
| observe, optimize preload (slow progression) |
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Term
|
Definition
| High ventricular filling pressures-->Pulm edema; Reduce preload-diuretic (furosemide), venodilator (nitroglycerine, nitrate). Inotropes NOT indicated. |
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Term
|
Definition
| Decrease pulm edema and increase CO: Nitroprusside (balanced vasodilation), inotrope if necessary |
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Term
|
Definition
| if HR is low->atropine or pacing; if HR is high->expand volume |
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|
Term
| conditions associated with progressive CHF |
|
Definition
|
|
Term
| Drugs to inhibit CHF remodeling |
|
Definition
| diuretic (reduces mortality), digoxin, ACE-I, b-blocker, Angiotensin RB |
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