Cardiotonic-Inotropic Drugs
TERMS
□ digoxin (Lanoxin, Lanoxicaps)
□ inamrinone lactate (Inocor)
□ nesiritide (Natrecor)
QUICK LOOK AT THE CHAPTER AHEAD
Cardiotonic-inotropic drugs, digitalis cardiac glycosides, and phosphodiesterase inhibitors, are used frequently to treat congestive heart failure (CHF). Recombinant Human type B natriuretic peptide is the newest class of medication used to treat heart failure. Cardiotonic-inotropic drugs also include adrenergic drugs.
Digitalis is derived from the foxglove plant and was initially used hundreds of years ago as an herbal remedy for fluid accumulation. It is one of the most commonly prescribed drugs in the world. Digoxin (Lanoxin, Lanoxicaps) is the most commonly prescribed digitalis glycoside.
Table 39-1 Cardiotonic-Inotropic Drugs | |||||||||||||||
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CARDIOTONIC-INOTROPIC DRUGS CLIENT TEACHING
Take radial pulse before taking medication.
Contact health care provider if pulse is below 60 beats per minute or greater than 120 beats per minute in an adult, below 90 beats per minute in infants, and below 70 beats per minute in children through adolescence.
Contact health care provider if experiencing visual changes, anorexia, nausea, vomiting, or if pulse is irregular.
Take medication the same time daily and exactly as prescribed and do not abruptly stop taking.
Avoid concurrent use of OTC drugs and herbal remedies without consulting health care provider.
Carry or wear medical alert identification.
Report signs and symptoms of digitalis toxicity immediately to health care provider.
Weigh self daily.
Notify health care provider if there is a weight gain of 1 to 2 pounds or more a day.
If eating dairy products or taking antacids, take medication 2 hours before or after consuming.
Take radial pulse before taking medication.
Contact health care provider if pulse is below 60 beats per minute or greater than 120 beats per minute in an adult, below 90 beats per minute in infants, and below 70 beats per minute in children through adolescence.
Contact health care provider if experiencing visual changes, anorexia, nausea, vomiting, or if pulse is irregular.
ACTIONCardiac Glycosides
Digoxin (Lanoxin, Lanoxicaps)
Positive inotropic effect, which increases the force of myocardial contraction; negative chronotropic effect, which slows the heart rate; and negative dromotropic effect, which decreases conduction through the sinoatrial and atrioventricular (AV) nodes, with a prolonged refractory period through the AV node
Cardiac Glycosides Antidote
Digoxin Immune FAB (Digibind)
Believed to work by binding to free digoxin or digitoxin, which blocks or reverses the drug effects and symptoms of toxicity
It is an antibody produced in sheep.
Phosphodiesterase Inhibitors (PDIs)
Inamrinone Lactate (Inocor) and Milrinone (Primacor)
Inhibit the enzyme phosphodiesterase, which produces a positive inotropic response and vasodilatation
Inhibit phosphodiesterase, resulting in an increase in intracellular cyclic adenosine monophosphate
Recombinant Human Type-B Natriuretic Peptide
Nesiritide (Natrecor)
Produced by recombinant DNA technology, and is identical to the hormone human type-B natriuretic peptide that has vasodilating effects on arteries and veins1
USE
