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Cardiotonic and Inotropic Drugs

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32 views16 pages

Cardiotonic and Inotropic Drugs

Uploaded by

Raghad
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Cardiotonic and Inotropic Drugs

CH38

Nadia amro
Cardiotonics are drugs used to increase the
efficiency and improve the contraction of the heart muscle,
which leads to improved blood flow to all tissues of the body.
cardiotonics used to treat heart failure when
ejection fraction less than 40%
Left ventricular dysfunction: leads to pulmonary
symptoms, such as dyspnea and (orthopnia) ,tachypnea .
Right ventricular dysfunction : leads to systemic
congestion neck vein distention, peripheral edema, weight
gain, and hepatic engorgement and Pulmonary artery
hypertension .
• Stimulation of the Beta1-adrenergic
receptors in the heart results in positive
inotropic (increases contractility),
chronotropic (increases heart rate)
• Cardiotonic drugs Used for patients
with persistent symptoms or recurrent
hospitalizations of heart failure or in
conjunction with ACE inhibitors, loop
diuretics, and beta blockers
Cardiotonic drugs
Digoxin (Lanoxin) from digitoxin plant
(Digitalis purpurea and Digitalis lanata). cardiotonics
are cardiac glycosides or digitalis glycosides.
Ivabradine (Corlanor) is a newer cardiotonic replacing
digoxin to treat heart failure.

Milrinone:Another drug with positive


inotropic action is, a nonglycoside, intravenous
(IV) drug used in the short-term, acute
management of heart failure.
Actions of cardiotonics
1) increase cardiac output through positive inotropic activity (an
increase in the force of the contraction).
2) They slow the conduction velocity through the atrioventricular
(AV) node in the heart
3) decrease the heart rate through a negative chronotropic effect.
• So the heart rate slows and allows blood to fill the heart chamber.
• Milrinone = inotropic action , used in the short-term
management of severe heart failure that is not controlled by the
digitalis preparation.
Cardiotonics uses
• Heart failure
• Atrial fibrillation
Atrial fibrillation is a cardiac arrhythmia characterized by rapid
contractions and quivering of the atrial myocardium, resulting in
an irregular and often rapid ventricular rate.
The cardiotonic drugs do not cure heart failure; rather, they
control its signs and symptoms
Adverse reactions
•
Central Nervous System Reactions
• Headache
• Weakness, drowsiness
• Visual disturbances (blurring or yellow halo—digoxin; increased
brightness)
Cardiovascular and Gastrointestinal System Reactions
• Arrhythmias
• Nausea and anorexia
Digoxin, dosage is calculated carefully and adjusted.
• There is a narrow margin of safety between the full therapeutic effects and
the toxic effects of cardiotonic drugs.
• Even normal doses of a cardiotonic drug can cause toxic

Digitalis toxicity (or digitalis intoxication) is used to describe toxic drug


effects that occur when digoxin is administered.
Signs of Digitalis Toxicity
contraindications and precautions
 presence of digitalis toxicity
patients with known hypersensitivity, ventricular failure,
ventricular tachycardia, cardiac tamponade, restrictive
cardiomyopathy, or AV block.
hypokalemia, hyper and hypo calcemia, and hypomagnesemia
thyroid disorders(myxedema =hypothyroidism bradycardia),
severe carditis, heart block, myocardial infarction, pulmonary
hypertension, systemic hypertension ,acute glomerulonephritis,
and impaired renal or hepatic function.
So we give vasodilator to reduce the workload on heart
Digoxin is classified as a pregnancy category C drug
• Atrial fibrillation happens when abnormal
electrical impulses suddenly start firing in
the atria.
• These impulses override the heart's natural
pacemaker, which can no longer control
the rhythm of the heart
Cardiac glycoside interactions
NURSING PROCESS
Patient Receiving a Cardiotonic Drug

• READ page1183

• apical pulse rate for 60 second??WHY


• Electrolytes
• Toxicity

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