chapter 30- heart failure Flashcards
what is HF normally related to
CAD
the main goal of HF treatment
symptom management, normally fluid management
what is HF
the heart’s inability to pump enough blood
direct causes of HF
-impaired contraction during systole – most common
-impaired relaxation during diastole
-combination
other causes of HF
-hyperthyroidism
-fluid volume overload
-antidysrhythmic meds
-meds that cause sodium and water retention (corticosteroids, estrogens, NSAIDS)
signs of left-sided HF
SOB, crackles, dizziness, activity intolerance
-the blood backs up and stays in the lungs
signs of right-sided HF
weight gain, JVD, peripheral edema
-the blood backs up into the veins, specifically in the lower extremities
nonpharm management of HF
-restrict Na intake, eat heart healthy
-restrict fluids
-promote weight loss
-reduce physical activity – if needed
-administer o2
-prepare for heart transplant –normally not an option due to comorbidities
what do cardiac glycosides do
allows more Ca to enter the cell, decreasing the workload of the heart
common cardiac glycoside
digoxin
what are cardiac glycosides used for
mild to moderate HF – positive inotropic
management of A fib – negative chonotropic
side effects of cardiac glycoside
weakness, HA, drowsiness, vision changes (YELLOW) GI, arrhythmias, breast enlargement
who cannot take cardiac glycoside
v tach, v fib, HB, sick sinus, acute MI, renal, electrolyte abnormalities
what is the problem with digoxin
small therapeutic window 0.8-2 ng
antidote to digoxin
digoxin immune fab
how do phosphodiesterase inhibitors work
INCREASES Ca
increase the force of contraction, having a positive inotropic effect, will decrease preload and afterload
example of a phosphodiesterase inhibitor
milrinone
side effects of milrinone
potentially fatal ventricular arrhythmias, hypotension, CP, N/V, thrombopenia, burning at injection sign
who should not take milrinone
acute MI, aortic stenosis, PREGNANCY, pulmonary artery stenosis
what is milrinone used for
long term bridge therapy for HF
What do human B-type natriuretic peptides do
increased sodium excretion, direct vasodilation
example of a human B-type natriuretic peptide
nesiritide
side effects of nesiritide
hypotension, headache, n/v, back pain, ventricular tachycardia, dizziness, anxiety, bradycardia
who should not take nesiritide
BP less than 90
is nesiritide commonly used
no, there are newer more efficient meds
how do angiotensin receptor neprilysin inhibitors work
degrades the atrial and brain peptide BNP to lower BP along with an ARB (valsartan)
common angiotensin receptor neprilysin inhibitor
sacubitril/valsartan
side effects of sacubitril/valsartan
hypotension, hyperkalemia, cough, dizziness, renal impairment, angioedema
who can not take sacubitril/valsartan
people taking lithium, pregnancy
how do sinoatrial node modulators work
inhibition in the SA node allows for ventricular filling
common sinoatrial node modulator
Ivabradine
adverse effects of ivabradine
bradycardia, hypotension, a fib, phosphine (ring/spot on the eye)
who should not use ivabradine
acute decompensated HF, bradycardia, hypotension, heart blocks, sick sinus, pacemaker, severe hepatic impairment
common ACE inhibitor used for HF
enalapril
common ARB used for HF
losartan potassium
common beta blocker used for HF
propranolol
common aldosterone antagonist for HF and why
spironolactone, helps keep potassium up
diuretics commonly used in HF
loop diuretics – furosemide
thiazide diuretics – hydrochlorothiazide HCTZ
latest time diuretics are given
4-5 pm
