Chapter 41

CARDIAC GLYCOSIDES, ANTIANGINALS, AND ANTIDYSRHYTHMICS

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Cardiac Conduction System

SinoAtrial Node Atrioventricular Node Bachmans Bundle

His Bundle

Left Posterior Bundle

Right Posterior Bundle Purkinje Fibers

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Cardiac Glycosides

Heart failure
Pathophysiology Right-sided Left-sided

Nonpharmacologic measures to treat heart failure Laboratory tests: atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP)

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ACC/AHA Stages of Heart Failure

Stages Characteristics

1
2

High risk for HF without symptoms or structural disease

Some levels of cardiac changes (e.g., decrease ejection fraction without symptoms of heart failure) Structural heart disease with symptoms of HF (e.g., fatigue, SOB, edema, and decreased physical activity)

Severe structural heart disease and marked symptoms of HF at rest

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Cardiac Glycosides

Functions

Positive inotropic action Negative chronotropic action Negative dromotropic action Increase stroke volume

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Cardiac Glycosides (contd)

Digoxin

Drug interactions Diuretics Glucocorticoids Antacids Herbal interactions

Digitalis toxicity Antidote for digitalis toxicity Inotropic agents

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Other Agents Used to Treat Heart Failure

Angiotensin-concerting enzyme (ACE) inhibitors Angiotensin II receptor blockers (ARBs) Diuretics Certain beta blockers Vasodilators

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Nursing Process: Digoxin

Assessment Nursing diagnoses Planning Nursing interventions

Client teaching

Evaluation

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Antianginal Drugs

Types of anginal pectoris with treatment

Suggested steps for treating classic and variant angina pectoris.

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Antianginal Drugs (contd)

Nonpharmacologic measures Types of antianginals

Nitrates Side effects: headache, hypotension, dizziness,

reflex tachycardia

Beta-adrenergic blockers Nonselective and selective beta-blockers Calcium channel blockers Side effects/adverse reactions

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Antianginal Drugs (contd)

Beta blockers

Heart rate and myocardial contractility are decreased, reducing oxygen need and anginal pain Drugs include atenolol (Tenormin), metoprolol (Lopressor), nadolol (Corgard), propranolol HCl (Inderal)

Side effects/adverse reactions

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Antianginal Drugs (contd)

Calcium channel blockers

Amlodipine (Norvasc), bepridil HCl (Vascor), diltiazem HCl (Cardizem), felodipine (Plendil), isradipine (DynaCirc), nicardipine HCl (Cardene), nifedipine (Procardia), nisoldipine (Sular), verapamil HCl (Calan, Isoptin)

Side effects/adverse reactions

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Antidysrhythmic Drugs

Dysrhythmia vs. arrhythmia Cardiac action potentials

Phase 0 to phase 4

Cardiac action potential.

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Antidysrhythmic Drugs (contd)

Mechanism of drug action Class I

Sodium channel blockers 1A: slow conduction and prolongs repolarization 1B: slow conduction and shortens repolarization 1C: prolong conduction with little/no effects on
repolarization

Class II

Beta-adrenergic blockers

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Antidysrhythmic Drugs (contd)

Class III

Prolong repolarization Calcium channel blockers Phenytoin, digoxin, ibutilide fumarate

Class IV

Others

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Practice Question #1
ST has angina pectoris. His BP is 100/60. Nitroglycerin 0.4 mg sublingual (SL) tablet is prescribed when ST has anginal pain. Because of STs health history, nitroglycerin could:
increase his BP. decrease his BP. have no effect on his BP. D. decrease anginal pain without any significant side effects.
A. B. C.

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Practice Question #1 (contd)

Answer: B

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Practice Question #2
Nitroglycerin can dilate veins and arteries. For client ST, nitroglycerin will:
A. B. C. D. reduce myocardial oxygen demand. increase vasoconstriction of vessels. increase myocardial oxygen needs. increase oxygen uses by the heart.

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Practice Question #2 (contd)

Answer: A

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