McKenna's Pharmacology for Nursing, 2e

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P A R T 8  Drugs acting on the cardiovascular system

www.heartfoundation.org.au/information-for- professionals/Clinical-Information/Pages/heart-failure. aspx Heart Foundation guidelines for prevention, detection, management of chronic heart failure. BIBLIOGRAPHY Aarnoudse, A. L. H. J., Dieleman, J. P. & Stricker, B. H. C. (2007). Age- and gender-specific incidence of hospitalisation for digoxin intoxication. Drug Safety , 30(5) , 431–436. Albert, N. M. (2012). Fluid management strategies in heart failure. Critical Care Nurse , 32(2) , 20–33. Bowers, M. T. (2013). Managing patients with heart failure. Journal for Nurse Practitioners , 9(10) , 634–642. Braunwald, E. & Bonow, R. O., MD Consult LLC (2012). Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine (9th edn). Philadelphia: Elsevier Saunders. Chan, K. E., Lazarus, J. M. & Hakim, R. M. (2010). Digoxin associates with mortality in ESRD. Journal of the American Society of Nephrology , 21 , 1550–1559. Farrell, M. & Dempsey, J. (2014). Smeltzer & Bare’s Textbook of Medical-Surgical Nursing (3rd edn). Sydney: Lippincott Williams & Wilkins. Goodman, L. S., Brunton, L. L., Chabner, B. & Knollmann, B. C. (2011). Goodman and Gilman’s Pharmacological Basis of Therapeutics (12th edn). New York: McGraw-Hill. Gover, T. L. & Galvan, E. (2013). Diabetes and heart failure. Critical Care Nursing Clinics of North America , 25(1) , 93–99. Graven, L. J. & Grant, J. (2013). The impact of social support on depressive symptoms in individuals with heart failure. Journal Cardiovascular Nursing , 28(5) , 429–443. Hurst, J. W., Fuster, V., Walsh, R. A. & Harrington, R. A. (Eds.). (2011). Hurst’s the Heart (13th edn). New York: McGraw-Hill. McKenna, L. (2012). Pharmacology Made Incredibly Easy (1st Australian and New Zealand edn). Sydney: Lippincott Williams & Wilkins. McKenna, L. & Mirkov, S. (2014). McKenna’s Drug Handbook for Nursing and Midwifery (7th edn). Sydney: Lippincott Williams & Wilkins. Porth, C. M. (2011). Essentials of Pathophysiology: Concepts of Altered Health States (3rd edn). Philadelphia: Lippincott Williams & Wilkins. Porth, C. M. (2009). Pathophysiology: Concepts of Altered Health States (8th edn). Philadelphia: Lippincott Williams & Wilkins. Pressler, S. J., Gradus-Pizio, I., Chubinski, S. D., Smith, G., Wheeler, S., Sloan, R. & Jung, M. (2013). Family caregivers of patients with heart failure. Journal of Cardiovascular Nursing , 28(5) , 417–428. Raja Rao, M. P., Panduranga, P., Sulaiman, K. & Al-Jufaili, M. (2013). Digoxin toxicity with normal digoxin and serum potassium levels: Beware of magnesium, the hidden malefactor. Journal of Emergency Medicine , 45(2) , e31–e34. Scott, I. & Jackson, C. (2013) Chronic heart failure management in Australia: Time for general practice centred models of care? Australian Family Physician , 42(5) , 343–346. Sykes, C. & Simpson, S. (2011). Managing the psychosocial aspects of heart failure: A case study. British Journal of Nursing , 20(5) , 272–279.

■■ The sarcomere—the functioning unit of the heart muscle—is made up of protein fibres: thin actin fibres and thick myosin fibres, which react with each other when calcium is present to inactivate troponin. The fibres slide together, resulting in contraction. Failing cardiac muscle cells lose the ability to effectively use energy to move calcium into the cell, and contractions become weak and ineffective. ■■ Cardiotonic (inotropic) agents are one class of drugs used in the treatment of heart failure. These agents directly stimulate the muscle to contract more effectively. ■■ Cardiac glycosides increase the movement of calcium into the heart muscle. This results in increased force of contraction, which increases blood flow to the kidneys (causing a diuretic effect), slows the heart rate and slows conduction through the atrioventricular node. All of these effects decrease the heart’s workload. Digoxin is the cardiac glycoside most commonly used to treat HF. ■■ Phosphodiesterase inhibitors block the breakdown of cAMP in the cardiac muscle. This allows more calcium to enter the cell (leading to more forceful contraction) and enhances the effects of sympathetic stimulation (which can lead to vasodilation but also can increase pulse, blood pressure and workload on the heart). Because these drugs are associated with severe effects, they are reserved for use in extreme situations. Knowing your strengths and weaknesses helps you to study more effectively. Take a PrepU Practice Quiz to find out how you measure up!

ONLINE RESOURCES

An extensive range of additional resources to enhance teaching and learning and to facilitate understanding of this chapter may be found online at the text’s accompanying website, located on thePoint at http://thepoint.lww.com. These include Watch and Learn videos, Concepts in Action animations, journal articles, review questions, case studies, discussion topics and quizzes.

WEB LINKS

Healthcare providers and students may want to consult the following Internet sources: www.aihw.gov.au/heart-failure-publications Link to Australian Institute of Health and Welfare publications on heart failure.