CHAPTER 37
Cardiac Glycosides, Antianginals, and
Antidysrhythmics
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HEART FAILURE
• Heart muscle weakens and enlarges
• Loses ability to pump blood adequately
• Lungs and periphery become congested
• Preload
• Afterload
• Contractility
 Right-sided manifestations?
 Left-sided manifestations?
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NONPHARMACOLOGIC MANAGEMENT
• Limit salt and saturated fat intake
• Limit or avoid alcohol intake
• Stop smoking
• Perform mild exercise
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PROTOTYPE: DIGOXIN
Action
• Positive inotrope
• Increases myocardial contractility
• Negative chronotrope
• Decreases heart rate
• Negative dromotrope
• Decreases conduction
• Increase stroke volume
• Increases cardiac output
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DIGOXIN
• Side effects
• Bradycardia
• Anorexia, nausea, vomiting, diarrhea
• Headache, blurred or yellow vision
• Dizziness, weakness
• Toxicity
• Anorexia, vomiting, diarrhea
• Blurred vision, green or yellow halos
• Bradycardia, cardiac dysrhythmias
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DIGOXIN TOXICITY AND INTERACTIONS
Antidote
• Digoxin immune fab (Digibind)
• Drug interactions
• Diuretics
• Hypokalemia
• Cortisone
• Sodium retention
• Antacids
• Decrease digitalis absorption
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OTHER HEART FAILURE
MEDICATIONS
• Vasodilators
• Angiotensin-converting enzyme (ACE)
inhibitors
• Angiotensin II receptor antagonists (ARBs)
• Diuretics
• Some beta blockers
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ANGINA
• Classic (stable)
• Occurs with predictable stress or exertion
• Unstable (preinfarction)
• Unrelated to activity; unpredictable regarding
stress/exertion and intensity
• Variant (Prinzmetal)
• Occurs due to vasospasm
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PROTOTYPE: NITROGLYCERIN
(TRIDIL, NITROSTAT)
• Action
• Promote vasodilation
• Decrease preload and afterload
• Side effects and adverse reactions
• Headache, hypotension, flushing
• Dizziness, weakness, syncope
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