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pharm exam 2 > drug therapy heart failure > Flashcards

drug therapy heart failure Flashcards

1
Q

heart failure is

A

the hearts inability to pump an adequate blood supply of blood to the body, does not meet body O2 and nutritional needs; a complex clinical condition or collection of symptoms that weaken your heart

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2
Q

the most common cause of heart failure

A

coronary artery disease: cause narrowing of arteries; cardio myopathy, myocardial infarction, heart valve disease, arrhythmias, emphysema

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3
Q

heart failure may result from

A

impaired myocardial contraction during systole or impaired relaxation and filling of ventricles during diastole or combination

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4
Q

other causes of HF which impair pumping ability or increase cardiac workload

A

hyperthyroidism, excessive IV fluids or blood transfusions, antidysrhythmic medications, drugs that cause sodium and water retention (estrogens, NSAIDs, corticosteroids use)

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5
Q

cellular level of HF

A

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

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6
Q

systolic HF

A

failure of ventricular contraction, reduced ejection fraction, enlarged ventricles (most common) (pump ~40-50% out)

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7
Q

diastolic HF

A

failure of filling, stiff/noncompliant muscle, normal ejection fraction (pump ~ 60% out)

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8
Q

s/sx of left sided heart failure

A

SOB, crackles, dizziness, activity intolerance, tachycardia, fatigue

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9
Q

s/sx of right sided heart failure

A

weight gain, JVD, peripheral edema, fatigue,

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10
Q

normal blood flow

A

inferior/ superior vena cava -> right atrium -> right ventricle -> pulmonary artery -> lungs -> pulmonary veins -> left atrium -> left ventricle -> aorta -> systemic circulation of body

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11
Q

nonpharmacologic management measures

A

restrict Na+ intake, restrict fluid(if hyponatremic), promote weight loss(if obese), reduce physical activity(if symptomatic), administer O2 (to reduce dyspnea, workload), prepare for heart transplant

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12
Q

drug therapy for HF

A

cardiac glycoside, phosphodiesterase inhibitor, human B type natriuretic peptides, angiotensin receptor neprilysin inhibitors, sinoatrial node modulators

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13
Q

drug therapy for HF: cardiac glycoside

A

digoxin; management for mild-moderate HF = positive inotropic effect= increases contractility and pumping of heart & management of atrial fibrillation = negative chonotropic effect = slows the rate of ventricular contraction

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14
Q

cardiac glycoside action

A

allows more Ca2+ to enter cell/ increases intracellular Ca2+/ decreased workload of the heart

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15
Q

pharmacokinetics of cardiac glycoside

A

decreases metabolism in pt’s with HF/ excreted via kidneys

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16
Q

adverse effects of cardiac glycoside

A

weakness, HA, drowsiness, vision changes, GI upset, arrhythmias, breast enlargement

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17
Q

nursing concerns for cardiac glycoside

A

monitor for improving signs of HF/ Afib and monitor digoxin toxicity

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18
Q

digoxin has a very narrow therapeutic window which means

A

it is very hard to dose because you have to keep it in a very small range; if lower -> not therapeutic; if higher -> become toxic (serum: 0.8-2 ng/mL)

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19
Q

contraindications of cardiac glycoside

A

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

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20
Q

digoxin can be given with what other medications

A

ACE inhibitors & ARB’s or other diuretics

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21
Q

signs of digoxin toxicity

A

yellow-green halo/ visual blurring and color change, ventricular rhythm changes

22
Q

patients with what electrolyte abnormalities can develop digoxin toxicity when serum levels is WNL

A

hypokalemia, hypomagnesemia, hypercalcemia

23
Q

antidote for digoxin toxicity

A

digoxin immune fab (digibind/ digifab)

24
Q

phosphodiesterase inhibitor medication

A

milrinone

25
Q

phosphodiesterase inhibitor is what

A

long term bridge therapy in HF/ increase in Ca2+ in cell

26
Q

phosphodiesterase inhibitor therapeutic action

A

increase the force of the contraction in the ventricle= positive inotropic effect = relaxes vascular smooth muscle = systemic & pulmonary vasodilation = decrease in preload and after load

27
Q

pharmacokinetics of phosphodiesterase inhibitor

A

metabolized in liver/ excreted via the urine

28
Q

adverse effects of phosphodiesterase inhibitor

A

potentially fatal ventricular arrhythmias, hypotension, CP, N/V, anorexia, burning at injection site

29
Q

nursing concerns of phosphodiesterase inhibitor

A

HR, BP, ECG, BMP labs for clacium levels

30
Q

contraindications for phosphodiesterase inhibitor

A

acute MI, aortic stenosis, pregnancy, pulmonary artery stenosis

31
Q

human B type natriuretic peptides medication

A

nestiritide

32
Q

natriuretic peptides are hormones that

A

help maintain sodium and fluid balance = reduces preload and after load

33
Q

therapeutic action of human B type natriuretic peptides

A

release increases sodium excretion by the kidney and diruesis, direct vasodilation, increased glomerular filtration rate

34
Q

pharmacokinetics of human B type natriuretic peptides

A

excreted via kidneys

35
Q

adverse effects of human B type natriuretic peptides

A

hypotension, HA, N/V, back pain, ventricular tachycardia, dizziness, insomnia

36
Q

nursing concerns for human B type natriuretic peptides

A

monitor BP, I & O

37
Q

contraindications of human B type natriuretic peptides

A

systolic BP < 90, hold

38
Q

angiotensin receptor neprilysin inhibitor (combo drug) medication

A

sacubitril/valsartan; management of chromic HF in patients with a reduced EF

39
Q

therapeutic action of angiotensin receptor neprilysin inhibitor

A

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

40
Q

pharmacokinetics of angiotensin receptor neprilysin inhibitor

A

metabolized in liver, excreted in urine and feces

41
Q

adverse effects of angiotensin receptor neprilysin inhibitor

A

hypotension, hyperkalemia, cough, dizziness, renal impairment, angioedema

42
Q

nursing concerns of angiotensin receptor neprilysin inhibitor

A

monitor HR/ BP, electrolytes, monitor for adverse effects

43
Q

contraindications of angiotensin receptor neprilysin inhibitor

A

lithium Rx(psych drug), pregnancy possibility(women practice birth control)

44
Q

sinoatrial node modulator medication

A

Ivabradine; reduce the risk of worsening HF in patients who have chronic HF while they are in the hospital

45
Q

therapeutic action of sinoatrial node modulator

A

selective inhibition in the SA node = decreased firing from the SA node = decrease in HR = allows more ventricular filling

46
Q

pharmacokinetics of sinoatrial node modulator

A

first pass metabolism in liver, excreted via kidneys

47
Q

adverse effects of sinoatrial node modulator

A

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

48
Q

nursing concerns of sinoatrial node modulator

A

HR/ BP/ cardiac rhythm monitoring/ no grapefruit juice

49
Q

contraindications of sinoatrial node modulator

A

acute decompensated HF, bradycardia, hypotension, HB, sick sinus syndrome, pacemaker pts, severe hepatic impairment

50
Q

additional medications used to treat heart failure

A

loop diuretics, thiazide diuretics, ACE inhibitors(enalapril), angiotensin II receptor blockers(losartan potassium), beta-adrenergic blocking agents(propranolol hydrochloride), aldosterone antagonists

pharm exam 2 (8 decks)

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