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Core Concepts in Pharmacology Ch 15


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pressure to overcome for the ventricles to eject blood from the heart
chronotropic effect
change in the heart rate
strength of contraction of the heart

similar to rubber band
dromotropic effect
change in the speed of electrical conduction through the heart
abnormal cardiac rhythm
Frank-Starling Law
the greater the stretch on myocardial fibers, the greater the force by which they contract
heart failure (HF)
heart muscle can't contract with enough force to meet the body's metabolic needs
inotropic effect
change in the strength or contractility of the heart

primary characteristic of cardiac glycosides (class of drugs)
peripheral edema
swelling in the limbs due to an accumulation of interstitial fluid

particularly the feet and ankles
enzyme in muscle cells that cleaves phosphodiester bonds

its inhibition increases myocardial contractility
degree to which heart fibers are stretched just prior to contraction
refractory period
time during which the myocardial cells rest and are not able to contract

occurs between heart beats
The three primary characterisitcs of heart function are . . .
1. force of contraction

2. heart rate

3. speed of impulse conduction
_____ have 1.5 to 2 times the incidence of HF as whites.
HF is twice as frequent in 1_____ pts and five times as frequent in persons who have experienced a 2_____ 2_____.
1 hypertensive
2 heart attack
What are the treatment goals for HF?
prevent, treat, or remove underlying causes (whenever possible)
HF on the left side of the heart can cause:


1. the wall of left ventricle to hypertrophy

2. blood to "back up" into the lungs (congestive HF)
Although 1_____ HF is more common, the 2_____ side can fail as well (both sides simultaneously or one side only). In 3_____ HF, the blood "backs up" into the peripheral veins resulting in peripheral 4 _____ and engorgement of 5_____.
1 left
2 right
3 right
4 edema
5 organs
AKA: Lanoxin
CLASS: cardiac glycoside
ACTION: positive inotropic effect - ↑ force & velocity of myocardium - ↑ cardiac output = ↑ urine production - ↓ blood volume - affects impulse conduction in heart
A/E: dysrhythmias - effects on digestive system - increased salivation - blurred vision

* monitor drug/drug interaction carefully
AKA: Prinivil - Zestril
CLASS: Angiotensin Converting Enzyme (ACE) Inhibitor
ACTION: lowers peripheral resistance - reduces blood volume via increasing excretion of sodium & water - dilates veins returning blood to heart - increases cardiac output - decreases preload
A/E: high K+ levels - cough - taste disturbances - hypotension
isosorbide dinitrate
AKA: Isordil - Sorbitrate - Dilatrate
CLASS: vasodilator
ACTION: acts directly on vascular smooth muscle - reduces cardiac workload - an organic nitrate
A/E: headache - hypotension - reflex tachycardia - contraindicated if taking Viagra
AKA: Lasix
CLASS: diuretic
ACTION: increase urine flow - reduce blood volume & cardiac workload
A/E: electrolyte imbalance - hypokalemia - dehydration - hypotension

* monitor carefully when used w/digoxin
AKA: Primacor
CLASS: Phosphodiesterase inhibitor
ACTION: block enzyme phosphodiesterase in cardiac & smooth muscle - increases calcium available for myocardial contracction - positive inotropic response - vasodilation
A/E: ventricular dysrhythmia (occurs in more than 1:10)
AKA: Coreg
CLASS: beta-adrenergic blocker
ACTION: reduces heart rate and bp - reduces cardiac afterload - negative inotropic effect
The pulse should be checked before giving 1_____. If the rate is 2_____ bpm, it should not be given.
1 digoxin
2 <60
Blood electrolyte levels are critical to safe digoxin therapy. Which of the following will significantly reduce the effectiveness of digoxin?
a. hypokalemia
b. hyperkalemia
c. hypocalcemia
d. hypercalcemia
a. hypokalemia
The primary action of digoxin (Lanoxin) that makes it very effective at treating heart failure is its ability to:
a. dilate the coronary arteries
b. increase impulse conduction across the myocardium
c. decrease blood pressure
d. incre
d. increase cardiac contractility/output
Cardiac glycosides help the heart to beat more forcefully and:
a. with a faster heart rate
b. with a slower heart rate
c. do not affect cardiac output
d. with a diminished cardiac output
b. with a slower heart rate
A client with heart failure is prescribed digoxin (Lanoxin) 0.3 mg. It is available as digoxin 500 mcg/2 ml. How many ml's will the nurse administer?
a. 1 ml
b. 1.1 ml
c. 1.2 ml
d. 1.3 ml
c. 1.2 ml
The physician orders enalapril (Vasotec) 15 mg. It is available as 10 mg/ 5 ml. How many ml's will the nurse administer?
a. 6 ml
b. 6.5 ml
c. 7.5 ml
d. 8 ml
c. 7.5 ml
T.N., age 64, receives hydralazine (Apresoline) 50 mg. It is available as hydralazine 25 mg/ tablet. How many tablets are needed to administer this dose?
a. 2 tabs
b. 3 tabs
c. 4 tabs
d. 5 tabs
a. 2 tabs
A client takes isosorbide dinitrate (Isordil) 8.75 mg. It is available as isorsobide dinitrate 2.5 mg/tablet. How many tablets woudl the nurse need to administer this dose?
a. 2.5 tabs
b. 3 tabs
c. 3.5 tabs
d. 4 tabs
c. 3.5 tabs
The physician orders a client to receieve a stat dose of bemetanide (Bumex) 10 mg and it is mixed in 50 ml of D5W. It is to be administered in 15 minutes. In ml/hr, how does the nurse set the IV pump?
a. 25 ml/hr
b. 100 ml/hr
c. 150 ml/
d. 200 ml/hr

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