Chapter 48- drugs for heart failure Flashcards
What are the 4 clinical manifestations of left-sided heart failure that deal with lungs?
-pulmonary congestion
-orthopnea
-PND (Paroxysmal nocturnal dyspnea)
-Cough
What are clinical manifestations of right-sided heart failure?
-perepheral edema
-weight gain
-hepatomegaly
-JVD (jugular vein distention)
What are the 4 main classification of drugs recommended for treatment in those with heart failure?
-diuretics
-Beta blockers
-Cardiac glycosides
-Drugs that inhibit the RAAS
What are 3 specific mechanisms r/t pharmacotherapy of heart failure?
- Slowing the heart rate
-increasing contractility
-reducing cardiac workload
What is the first line diuretic for immediate relief from volume overload and why?
Furosemide
It is more rapid and effective
What is the reason for avoiding excessive diuresis?
To prevent compromised tissue PERFUSION d/t reduces cardiac output and blood pressure.
What is released to compensate for deteriorating cardiac function?
Natriuretic peptides
ANP is secreted in response to atrial stretching or _______?
Pressure
BNP is secreted in response to ventricular dilation or________?
Volume
ANP acts as an antagonist to ________ and ________?
Renin and aldosterone
BNP acts as a _______ and ________.
Vasodilator and diuretic
Cardiac glycosides are best known for their ________ inotropic actions which mean they _________ the force of myocardial contraction.
positive
increase
What are the 2 groups of inotropic drugs?
-Sympathomimetics
-Phosphodiesterase inhibitors
What 3 receptors can dopamine activate?
-dopamine
-Beta-1
-Alpha-1
Dobutamine does not activate which receptor?
therefore, what is not increased?
- Alpha-1
- vascular resistance
What drug increases the level of calcium which also increases myocardial contraction?
milrinone
What enzyme does the drug milrinone inhibit?
PDE3
Milrinone promotes_______?
Vasodilation
Inhibiting PDE3 and the promotion of vasodilation increases________?
Cardiac output
Which drug can cause hepatotoxicity?
milrinone
What is an ADR of milrinone?
Thrombocytopenia ( person may have excess bleeding because of this)
What are the 3 MOA’s of nesiritide?
-suppression of sympathetic outflow from the CNS
-Suppress the RAAS
-Directly dilates arterioles and veins
Nesiritide is a synthetic form of ______?
B-Natriuretic peptide
What can nesiritide cause?
Severe, symptomatic hypotension.
Can you give nesiritIde >48 hours?
NO
Which drug classification increases secretion of natriuretic peptides and suppresses negative effects of the RAAS?
Angiotensin receptor Neprilysin inhibitor
Angiotensin redp5o4 neprilysin inhibitor is a combination drug that contains an ___?
ARB
Digoxin has direct effects on what 2 things?
-Cardiac muscle
-electrical conduction system
What drug causes severe cardiac dysrhythmias?
Digoxin
Digoxin exerts a ________ inotropic effect and a _______ chronotropic effect on the heart.
positive, negative
What drug has a narrow margin of safety?
Digoxin
What enzyme does digoxin inhibit?
NA+-K+-ATPase
The inhibition of NA+-K+-ATPase promotes ______ accumulation within myocytes.
Calcium
The calcium facilitates the interaction of what 2 myocardial contractile proteins?
-actin
-myosin
What electrolyte leads to the rise in intracellular calcium?
Sodium
Due to the inhibition of soidum, the uptake of sodium is blocked, as the extrusion of __________.
Potassium
What electrolyte competes with digoxin for binding to this enzyme?
K+
An increase in potassium can impair _____ responses of digoxin and a decrease in potassium can cause _______________?
Therapeutic
digoxin toxicity
normal physiological ranges of potassium?
3.5-5.0 mEq/L
Does digoxin improve exercise tolerance and reduce fatigue?
YES
What hormone does digoxin suppress in the kidneys?
Renin
What 2 actions are seen when digoxin produces its effects on the vagus nerve?
- decreased sympathetic outflow from CNS
-increased sensitivity of cardiac baroreceptors
Due to the vagotonic effects, what is the result that digoxin has on the SA and AV node?
decrease
What is digoxin considered a positive or negative dromotropic agent?
Negative dromotropic
What is the optimal therapeutic range for digoxin?
0.5-0.8 ng/mL
If Digoxin toxicity occurs what drug should you administer?
Digibind (Fab Antibody Fragments)
What is the most frequent CNS ADR effect of digoxin?
Fatigue
What effects on vision does digoxin have?
Yellow-tinge to their vision and/or seeing halos around dark objects
What should you teach a pt while taking digoxin?
teach pt how to take their pulse rate. Hold the drug if it falls below 60 bpm
What is the use of a loading dose to achieve therapeutic plasma levels quickly?
Digitalization
Does digoxin have a short or long half life?
Long
How many days does digoxin reach a steady state if a loading dose were not administered?
6 days
nesiritide causes a _____ in preload and afterload
reduction
