Cardiac glycosides
Cardiac glycosides
Affect Calcium level in heart leading to increased contractility
Class 1 antiarrythmic Prototype
Lidocaine
Action
Improve blood delivery to heart by
Dilating Blood vessels - increasing oxygen supply
Decreasing work of the heart - decreasing demand for oxygen
Prototype
Metoprolol
Prototype
Digoxin
Interacts with Potassium sparing diuretics (furosemide)
Propranolol
Nitrates prototype
Nitroglycerin
Do not combine with sildenafil
Metoprolol AE
Dizziness
Vertigo
HF
Arrhythmias
Gastric Pain
Flatulence
Vomiting
Diarrhea
Impotence
Decreased exercise tolerance
AE
Digoxin toxicity
Risk increases when potassium is low
Class 3 antiarrhythmic
Amiodarone
For life threatening ventricular arrhytmias
Potential fatal hepatotoxicity & Lung fibrosis
Nitrates (nitroglycerin) AE
Headache
Flushing
Sweating
Ortho hypo
Reflex tachycardia
Tolerance
Prototype calcium channel blocker
Diltiazem
Digoxin toxicity S/S
GI symptoms, Fatigue, visual disturbances, yellow, blurred vision
Class 4 antiarrhythmic
Diltiazem
Angina, HTN
Nitroglycerin teaching
Rapid onset
Prophylactic use
Keep in OG bottle in cool dark place
Take 3 tabs no more
Diltiazem AE
Dizziness, Headache, light head, asthenia, peripheral edema, bradycardia, atrioventricular block
Considerationns
Monitor potassium lvls (eat high potassium food)
Daily weight
Serum Digoxin 0.8-2
Monitor apical oulse for full minute
Adminn at same time each day
Do not double when dose is missed or stop abruptly
ST. Johns wort psyllium decrease effectiveness
Ginseng hawthorn licorice increase effectiveness
Prevention of toxicity = Digoxin Immunne Fab
Other arrhythmia drugs
Digoxin
Adennosine
used to convert supra tachycardia rhythm
Nitrate Considerations
Treat acute attack or as prophylaxis
Use ASA or acetaminophen for headache
Slow position change
Long acting preparation should be off 12H daily
Avoid alcohol, sildenafil
Keep diary