Cardiac drugs: new inotropes

Conventional pharmacologic therapy for the management of congestive heart failure includes inotropic, vasodilator, and diuretic agents. Phosphodiesterase inhibitors are a new class of inotropic agent that possesses both inotropic and vasodilating capability. Currently, only one of these agents, amrinone (Inocor), has been approved for clinical use in the United States. Nursing management of the patient receiving amrinone requires knowledge of the appropriate vehicle for administration, the recommended dose, and adverse reactions. A thorough understanding of the hemodynamic alterations in CHF, as well as the effect of amrinone on these hemodynamic parameters, is an essential component of nursing care. Amrinone is only available for intravenous administration. Clinical trials, involving several investigational phosphodiesterase inhibitors, are being conducted. These drugs are being administered orally and intravenously. The goal of research is to develop a potent positive inotrope that will be available for both oral and intravenous administration. The focus of current research involving phosphodiesterase inhibitors includes studying the effect of these agents on myocardial ischemia as well as the mortality and morbidity of CHF. Additional knowledge regarding these and other issues is needed before the new inotropes can become a routine component of the pharmacological armamentarium for treatment of CHF.