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Pharm 1 > drug therapy for heart failure > Flashcards

drug therapy for heart failure Flashcards

1
Q

what is heart failure aka congestive heart failure (CHF)

A

complex clinical condition where the heart cannot effectively pump enough blood to meet the body’s O2 and nutritional needs

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2
Q

what can CHF result from?

A

-impaired myocardial contraction during systole
-imparied relaxation and filling of the ventricles during diastole
-combination of both

other causes (which impait pumping ability or increase cardiac workload)
-hyperthyroidism
-excessive IV fluids or blood transfusions
-antidysrhythmic meds
-CAD (major cause) and HTN
-drugs that cause sodium and water retention (corticosteroids, estrogens, NSAID use)

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3
Q

describe CHF at a cellular level

A

-dysfunction of contractile myocardial and endothelial cells that line the heart and vessels
-endothelial dysfunction allowa narrowing of vessel lumen (leads to clot formation and vasoconstriction, major factors in CAD and HTN)

may or may not present with congestive s/sx whcih refers to fluid back up in the body

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3
Q

describe normal heart function

A

-ventricles fill nrmally with blood
-ventricles pump out about 60% of the blood

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4
Q

describs systolic HF

A

-failure of ventricular contraction
-most common
-reduced ejection fraction

-enlarged ventricles fill with blood
-ventricles pump out less than 40-50% of the blood

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4
Q

descrie diastolic HF

A

-failure of fillinf og the ventricles
-stiff/noncompliant muscles
-normal ejection fraction

-stiff ventricles fill with less blood than usual
-ventricles pump out about 60% of the blood but may be lower than normal

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5
Q

what are the s/sx of left sided HF

A

-SOB
-crackles
-dizziness
-activity intolerance
-orthopnea, tachypnea, pulmonary congestion
-cyanosis, restlessness, confusion

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6
Q

what are the s/sx of right sided HF

A

-weight gain
-JVD
-peripheral edema
-enlarged live and spleen, ascites
-anorexia, complaints of GI distress
-may be secondary to chronic pulmonary problems

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7
Q

what is the goal of treatment for CHF

A

symptom management

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8
Q

what are some nonpharmacologic management measures for CHF

A

prevent contributing conditions:
-restrict Na+ intake (lowNa+/heart healthy diet)
-restrict fluid (if hyponatremic)
-promote weight loss (for obese pts)
-reduce physical activity (if symptomatic)
-administer O2 (to reduce dyspnea, workload)
-prpeare for heart transplant (if indicated)

daily weights are also super important

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8
Q

give an example of a cardiac glycoside

A

digoxin

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8
Q

what is digoxin used to treat

A

-management of mild/moderate HF -> has positive inotropic effect -> increases cintractility and pumping of the heart
-management of atrial fibrillation -> negative chonotropic effect -> slows the rate of ventricular contraction

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9
Q

what are the therapeutic actions of digoxin

A

allows more calcium to enter cell -> increases intracellular calcium -> decreases cardiac workload

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10
Q

describe the pharmacokinetics of digoxin

A

-decrease metabolism in pts with HF
-excreted via the kidneys

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11
Q

what are some adverse effects of digoxin

A

-weakness
-HA
-drowsiness
-vision changes (yellow halo)
-GI upset/anorexia
-arrythmias
-breast enlargement

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12
Q

what are some nursing implications r/t digoxin

A

-monitor for improving signs og HF/afib and monitor for toxicity

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13
Q

what are some contraindications of digoxin

A

PMHx of Vtach/Vfib, HB/sick sinus, acute MI, renal insufficiency, electrolyte abnormalities

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14
Q

what other types of meds are digoxin often given with

A

ACE inhibitors and ARBs or other diuretics

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15
Q

what makes digoxin a dangerous med?

A

very narrow therpautic index, requires serum digoxin levels to be drawn

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16
Q

what are normal digoxin levels

A

0.8-2 ng/ml

below= not therapeutic
above = toxic

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17
Q

what are the signs of digoxin toxicity

A

-yellow-green halo/visual blurring and color change
-ventricular rhythm changes
-premature ventricular contractions (PVCs)
-N/V, anorexia, abdominal discomfort
-cognition changes

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18
Q

who can develop digoxin toxicity even when serum levels are WNL?

A

pts with hypokalemia, hypomagnesia, and hypercalcemia

19
Q

what is the antidote for digoxin toxicity

A

digoxin immune fab (digibind/digifab)

20
Q

give ana example of a phosphodiesterase inhibitor

A

milrinone

21
Q

describe milrinone

(phosphodiesterase inhibitor)

A

-long term bridge therapy in heart failure
-increase Ca++ in cell

22
Q

what are the therapeutic actions of phosphodiesterase inhibitors

A

increasing the force of onctraction in the ventricle -> posiitve inotropic effect -> relaxes vascular smooth muscle -> systemic and pulmonary vasodilation -> decrease in preload and afterload

23
Q

describe the pharmacokinetics of phosphodiesterase inhibitors

A

metabolized in liver and excreted via urine

24
Q

name some adverse effects of phosphodieserase inhibitors

A

-potentially fatal ventricular arrythmias
-hypotension
-chest pain
-N/V
-anorexia
-thrombocytopenia
-burning at injection site

25
Q

what are some nursing implications of phosphodiesterase inhibitors

A

monitor:
-HR
-BP
-ECG
-BMP labs for Ca++

26
Q

what are some contraindications of phosphodiesterase inhibitors

A

-acute MI
-aortic stenosis
-pregnancy
-pulmonary artery stenosis

27
Q

name an example of a human B type natriuretic peptide

A

nesiritide

28
Q

what are natriuretic peptides?

A

hormones that help maintain sodium and fluid balance = reduces preload and afterload

29
Q

describe the therapeutic actions of human B type natriuretic peptide

A

-release increases sodium excretion by the kidneys and diuresis
-direct vasodilation
-increased GFR

30
Q

where is human B type natriuretic peptide excreted?

A

kidneys

31
Q

name some adverse effects of human B type natriuretic peptides

A

-hypotension
-headache
-nausea and vomiting
-back pain
-ventricular tachycardia
-dizziness
-anxiety
-insomnia
-bradycardia

32
Q

what are some nursing implications r/t human B type natriuretic peptides

A

monitor BP and urine output

33
Q

name a contraindication of human B type natriuretic peptides

A

SBP less than 90

34
Q

why are human B type natriuretic peptides not a commonly used med?

A

bc of the adverse effects and newer, more efficient meds being available

35
Q

give an example of angiotensin receptor neprilysin inhibitors

A

sacubitril/valsartan

approved in 2015 - newer drug
combo drug

36
Q

what are angiotensin receptor neprilysin inhibitors used for

A

management of chronic HF in pts with reduced ejection fraction

EF is the amount of blood that is pumped out of the ventricles with each contraction

37
Q

describe the therapeutic actions of angiotensin receptor neprilysin inhibitors

A

-sacubitril inhibits the enzyme neprilysin, responsible for degradation of atrial and brain natriuretic peptides (BNP)
-the peptides responsible for lowering BP by reducing blood volume along with valsartan (ARB)

please just know that it lowers BP

38
Q

describe the pharmacokinetics of angiotensin receptor neprilysin inhibitors

A

-metabolized in liver
-excreted in urine and feces

39
Q

what are some adverse effects of angiotensin receptor neprilysin inhibitors

A

-hypotension
-hyperkalemia
-cough
-dizziness
-renal impairment
-angioedema may also occur

40
Q

what are some nursing implications r/t angiotensin receptor neprilysin inhibitors

A

monitor HR and BP, as well as electrolytes and adverse effects

41
Q

what are some contraindications of angiotensin receptor neprilysin inhibitors

A

-lithium rx
-pregnancy possibility

42
Q

give an axample of a sinoatrial node modulator

A

ivabradine

43
Q

what are SA node modulators used for

A

reduce risk of worsening HF in pts who have chronic heart failure while they are in the hospital

44
Q

describe the therapeutic actions of SA node modulators

A

selective inhibition of the SA node -> decreased firing from the SA nod -> decrease HR -> allows more ventricular filling

45
Q

describe pharmacokinetics of SA node modulators

A

-first pass metabolism in liver
-excreted via kindeys

46
Q

what are some adverse effects of SA node modulators

A

-bradycardia
-hypotension
-atrial fibrillation
-phosphine (a ring or spot of light caused by pressure on eye orbital)

47
Q

what are some nursing implications r/t SA node modulators

A

-HR/BP/cardiac rhythm monitoring
-no grapefruit juice

48
Q

what are some contraindications of SA node modulators

A

-acute decomposed HF
-bradycardia
-hypotension
-heart blocks
-sick sinus syndrome
-pacemaker pts
-severe hepatic impairment

49
Q

name some adjunctive meds used to treat HF

A

-loop diuretics (furosemide)
-thiazide diuretics (HCTZ, hydrodiuril)
-ACE inhibitor (enalapril)
-ARB (losartan potassium)
-beta adrenergic blockers (propranolol hydrochloride)
-aldosterone antagonists (spironolactone)

Pharm 1 (29 decks)

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