congestive heart failure drugs

Question 1

Action of ACE-I & ARBs

Answer 1

lowers BP, reduced preload & afterload, remodels the heart (improves LV function)

Question 2

First choice for CHF, ACE-I or ARBS?

Answer 2

ACE-I’s “pails”

Question 3

adverse reactions of ACE-I’s

Answer 3

-hyperkalemia
-avoid in pregnancy
-angioedema (ACEI)
-cough (only ACE-I)

Question 4

adverse reactions of ARB

Answer 4

-hyperkalemia (avoid k+ rich food)
-NO cough

Question 5

action of beta blockers

Answer 5

-lowers heart rate
-force contraction
-decreases after load primarily
-remodels heart

Question 6

beta blocker indication

Answer 6

for chronic heart failure management

Question 7

what to monitor with beta blockers?

Answer 7

-Bradycardia
-bronchospasm
-bad for worsening heart failure
-blood sugars (mask symptoms of hyper/hypoglycemia)
-Blah’s - fatigue

Question 8

diuretic indications

Answer 8

-relieve vascular congestion by blocking sodium and fluid reabsorption in the kidneys
-decrease preload

Question 9

names of loop diuretics

Answer 9

furosemide

Question 10

is furosemide potassium depleting or sparing?

Answer 10

depleting

Question 11

is spironolactone potassium sparing or depleting?

Answer 11

potassium sparking

Question 12

what do you monitor in patients taking diuretics?

Answer 12

-renal function
-electrolytes (K+ & Ca2+)
-blood sugars

Question 13

digoxin action

Answer 13

-promotes claim intake so heart pumps more effectively, slows contraction through SA& AV nodes
-improves cardiac output
-increases contractibility

Question 14

indications of digoxin

Answer 14

-heart failure (decreases volume in ventricle)
-control of resistant a fib, which may worsen heart failure symptoms

Question 15

digoxin administration

Answer 15

-IV: SLOW IV over 5-10 minutes
-oral: once a day

Question 16

important teaching factor about oral digoxin?

Answer 16

compliance is essential

Question 17

administration assessments of digoxin

Answer 17

-apical rate prior to admin
-cardiac monitoring
-hold for less than 60 beats per minute (apical)
-hold for change in rhythm

Question 18

digoxin antidote

Answer 18

digoxin immune FAB

Question 19

what does digoxin immune FAB do?

Answer 19

-binds to digoxin to form molecules that can be excreted in urine

Question 20

normal digoxin level

Answer 20

0.8-2.0

Question 21

signs of digoxin toxicity

Answer 21

-Bradycardia
-heart blocks
-blurred viiso
-white, green, yellow halos around objects

Question 22

what kind of patient will you be careful giving digoxin to?

Answer 22

someone with renal impairment

Question 23

vasodilator

Answer 23

nitroglycerin

Question 24

nitroglycerin action

Answer 24

-relaxes vascular smooth muscle and dilates coronary arteries
-decreases preload/afterload
-decreases oxygen demand

Question 25

indications for nitroglycerin

Answer 25

-heart failure, hypertension, angina

Question 26

adverse reaction of nitroglycerin (vasodilators)

Answer 26

-headache (very common, treat with Tylenol)
-orthostatic hypotension
-reflect tachycardia
-tolerance (allow 8 hours drug free daily)

Question 27

how do you fix reflect tachycardia in vasodilators?

Answer 27

beta blockers

Question 28

how long should someone go without nitroglycerin a day?

Answer 28

8 hours

Question 29

nitroglycerin interactions

Answer 29

-alcohol makes hypotension worse
-caution when adding to other BP lowering meds

Question 30

SGLT2 inhibitor action

Answer 30

-mild diuretic effect
-reducing sodium & fluid overload
-lowers bp
-preload and after load effects

Question 31

SGLT-2 inhibitors names

Answer 31

dapaglifozin, empagliflozin

Question 32

why would you give dapagluflozin?

Answer 32

heart failure after ACE-I, Bblockers, & aldosterone antagonist don’t work
-DM