Podcast
Questions and Answers
What is the therapeutic range for digoxin levels?
What is the therapeutic range for digoxin levels?
Which of the following drugs is primarily used to treat arrhythmias?
Which of the following drugs is primarily used to treat arrhythmias?
Which effect is NOT associated with the use of phosphodiesterase inhibitors like Milrinone?
Which effect is NOT associated with the use of phosphodiesterase inhibitors like Milrinone?
Which of the following statements regarding the use of Milrinone is correct?
Which of the following statements regarding the use of Milrinone is correct?
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What is the primary reason for maintaining emergency equipment standby when administering digoxin?
What is the primary reason for maintaining emergency equipment standby when administering digoxin?
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What should be monitored before administering digoxin to a patient?
What should be monitored before administering digoxin to a patient?
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Why should digoxin doses be checked carefully?
Why should digoxin doses be checked carefully?
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Which of the following medications should not be taken concurrently with digoxin?
Which of the following medications should not be taken concurrently with digoxin?
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What is an important nursing consideration when administering digoxin intravenously?
What is an important nursing consideration when administering digoxin intravenously?
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What pulse rate indicates that digoxin should be withheld for an adult?
What pulse rate indicates that digoxin should be withheld for an adult?
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Which population is more likely to develop digoxin toxicity?
Which population is more likely to develop digoxin toxicity?
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What should a nurse do if a patient’s pulse rate is low before administering digoxin?
What should a nurse do if a patient’s pulse rate is low before administering digoxin?
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Why is it important to administer digoxin at the same time daily?
Why is it important to administer digoxin at the same time daily?
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Which of the following is an inherited disorder affecting blood coagulation?
Which of the following is an inherited disorder affecting blood coagulation?
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What is the primary action of antiplatelet agents?
What is the primary action of antiplatelet agents?
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Which of the following disorders is categorized as a hemorrhagic disorder?
Which of the following disorders is categorized as a hemorrhagic disorder?
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Which nursing consideration is most relevant for a patient on anticoagulants?
Which nursing consideration is most relevant for a patient on anticoagulants?
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What is the role of thrombolytic agents in blood coagulation?
What is the role of thrombolytic agents in blood coagulation?
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Which of the following is true regarding hemorrhagic disorders?
Which of the following is true regarding hemorrhagic disorders?
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Which medication is classified as an anticoagulant?
Which medication is classified as an anticoagulant?
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Which statement best describes the management of patients receiving drugs affecting coagulation?
Which statement best describes the management of patients receiving drugs affecting coagulation?
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What is a contraindication for the use of phosphodiesterase inhibitors like Milrinone?
What is a contraindication for the use of phosphodiesterase inhibitors like Milrinone?
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Which of the following is an adverse effect of phosphodiesterase inhibitors?
Which of the following is an adverse effect of phosphodiesterase inhibitors?
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What issue may arise if Milrinone is combined with Furosemide in a solution?
What issue may arise if Milrinone is combined with Furosemide in a solution?
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What nursing consideration is important for the administration of phosphodiesterase inhibitors?
What nursing consideration is important for the administration of phosphodiesterase inhibitors?
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Which condition must be monitored frequently during the administration of phosphodiesterase inhibitors?
Which condition must be monitored frequently during the administration of phosphodiesterase inhibitors?
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What is the primary function of the sinoatrial (SA) node in heart physiology?
What is the primary function of the sinoatrial (SA) node in heart physiology?
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How do normal cardiac functions relate to oxygen and nutrients?
How do normal cardiac functions relate to oxygen and nutrients?
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What effect can occur at the infusion site when administering phosphodiesterase inhibitors?
What effect can occur at the infusion site when administering phosphodiesterase inhibitors?
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What is a primary effect of the non-dihydropyridine calcium channel blockers Verapamil and Diltiazem?
What is a primary effect of the non-dihydropyridine calcium channel blockers Verapamil and Diltiazem?
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Which condition is a contraindication for the use of Class IV antiarrhythmic agents?
Which condition is a contraindication for the use of Class IV antiarrhythmic agents?
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What is one of the adverse effects commonly associated with Verapamil and Diltiazem?
What is one of the adverse effects commonly associated with Verapamil and Diltiazem?
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Which of the following is a therapeutic use of Verapamil and Diltiazem?
Which of the following is a therapeutic use of Verapamil and Diltiazem?
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What is a recommended nursing consideration when administering Class IV antiarrhythmic agents?
What is a recommended nursing consideration when administering Class IV antiarrhythmic agents?
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Which of the following drugs increases the risk of cardiac depression when used with Class IV antiarrhythmics?
Which of the following drugs increases the risk of cardiac depression when used with Class IV antiarrhythmics?
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What pharmacokinetic property is true for Verapamil and Diltiazem?
What pharmacokinetic property is true for Verapamil and Diltiazem?
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Which of the following is a potential drug-to-drug interaction with Class IV antiarrhythmic agents?
Which of the following is a potential drug-to-drug interaction with Class IV antiarrhythmic agents?
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Verapamil and Diltiazem are avoided in heart failure due to their negative inotropic effects. What does this mean?
Verapamil and Diltiazem are avoided in heart failure due to their negative inotropic effects. What does this mean?
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What mechanism do Class IV antiarrhythmic agents primarily use to influence heart rhythm?
What mechanism do Class IV antiarrhythmic agents primarily use to influence heart rhythm?
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Study Notes
Cardiotonic (Inotropic) Agents
- Digoxin is administered as a loading dose to achieve therapeutic effects quickly.
- Monitor apical pulse rate and rhythm, and report heart rate less than 60 bpm for adults, 70 bpm for children, and 90 bpm for infants.
- Low pulse rate is a sign of digoxin toxicity.
- Double-check pediatric digoxin doses due to the higher chance of toxicity in children.
- Avoid administering oral digoxin with food or antacids to prevent absorption delays.
- Emergency equipment (potassium salts, lidocaine, phenytoin, atropine, cardiac monitor) should be readily available in case of digoxin toxicity.
- Therapeutic digoxin levels range from 0.5 to 2 ng/mL.
Milrinone
- Milrinone is a second-class cardiotonic agent that blocks the enzyme phosphodiesterase.
- Milrinone acts as a vasodilator, increasing oxygen consumption and potentially causing arrhythmias.
- It is indicated for short-term treatment of heart failure unresponsive to digoxin, diuretics, and vasodilators.
- Administered intravenously only, and widely distributed after injection.
- Contraindicated in patients with allergies, severe aortic or pulmonary valvular disease, acute myocardial infarction, fluid volume deficit, ventricular arrhythmia, as well as older adults and pregnant women.
- Potential adverse effects include ventricular arrhythmias, hypotension, chest pain, GI effects, thrombocytopenia, hypersensitivity reactions, and burning sensation at the IV site.
- Milrinone should be kept away from light to prevent degradation.
- Regularly monitor pulse, blood pressure, input and output, and platelet counts during milrinone therapy.
Class IV Antiarrhythmic Agents
- Verapamil and Diltiazem are Class IV antiarrhythmic agents that block calcium channels.
- They delay Phase 1 and 2 of the action potential, slowing automaticity, conductivity, AV conduction, and ventricular rate.
- They are also used as antihypertensive and anti-anginal agents.
- Administered orally or intravenously, well absorbed, highly protein-bound, metabolized in the liver, and excreted in the urine.
- Contraindicated in patients with allergies, sick sinus syndrome, heart block, severe heart failure, hypotension, pregnancy, lactation, idiopathic hypertrophic subaortic stenosis, and impaired renal or liver functions.
- Potential adverse effects include CNS effects, GI upset, hypotension, heart failure, shock, arrhythmias, AV block, and edema.
- Interactions with other drugs can increase the risk of cardiac depression, AV slowing, and toxicity.
- Beta-blockers, digoxin, carbamazepine, prazosin, and quinidine can elevate serum levels and toxicity.
- Atracurium, pancuronium, and vecuronium can increase respiratory depression.
- Rifampin and calcium products decrease therapeutic effects.
- Concomitant use of other antihypertensive drugs may increase the risk of hypotension, bradycardia, and heart block.
Disorders Affecting Blood Coagulation
- Thromboembolic disorders arise from atherosclerotic cardiovascular disease, infection, trauma, or inherited disorders such as Factor V Leiden condition or antiphospholipid syndrome.
- Hemorrhagic disorders are less common and often result from excessive bleeding due to conditions like hemophilia, liver diseases, or thrombocytopenia.
Drugs Affecting Clot Formation and Resolution
- Antiplatelet agents disrupt platelet aggregation and plug formation.
- Anticoagulants interfere with the clotting cascade and thrombin formation.
- Thrombolytic agents break down thrombi by stimulating the plasmin system.
Nursing Considerations for Antiplatelet Agents
- Provide small, frequent meals to relieve GI discomfort.
- Offer comfort measures and analgesia for headache.
- Implement safety measures such as using an electric razor and avoiding contact sports to minimize bleeding risk.
- Monitor platelet count regularly to detect thrombocytopenia.
- Increase precautions against bleeding during invasive procedures by using pressure dressings and ice.
- Clearly mark the chart of patients receiving these medications to alert medical staff of the potential for bleeding.
- Provide comprehensive patient education.
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Description
Explore the key concepts related to cardiotonic (inotropic) agents, including digoxin and milrinone. Learn about their administration, monitoring parameters, potential toxicities, and therapeutic levels. This quiz enhances your understanding of managing heart failure therapies.
