Exam 4 (Cardio-2) Flashcards
when we give an increase in fluid, do we increase preload or afterload?
preload
t/f: reducing afterload is a good approach to help treat heart failure
true, reducing resistance decreases the workload of the heart
what is afterload?
the resistance that the ventricle has to overcome
stroke volume equation
end diastolic volume - end systolic
pt has MI: since MI, there is residual damage. pt has HRfEF and cannot do the things they used to do. what does that mean?
what would the nurse recognize as cues to heart failure?
has poor cardiac output, low ejection fraction
cues: SOB, edema, reduced activity
inadequate perfusion progresses to volume overload
a pt has HF becomes SOB and feels fine after some rest. what stage is their heart failure?
Stage C - structural and functional changes with prior or current symptoms of HF
what are the goals of HF treatment?
1) relief of pulmonary and peripheral congestion
2) improve quality of life
3) delay the progression of cardiac remodeling and LV dysfunction
4) reduce hospitalization and prolong life
therapeutic goals
1) correct sodium and water retention and volume overload
2) block negative compensating mechanisms (RAAS)
3) reduce cardiac workload, improve cardiac output, and myocardial contractility
4) control precipitating and complicating factors
T/F : the RAAS and SNS are mechanisms the body uses to reduce long term impacts from heart faiure
FALSE
first line drugs for HF
diuretics, ACEis, ARBS, ARNI, BBlkrs
medication newly added to guidelines for heart failure
SGLT-2 Inhibitors (dapagliflozin, etc)
what class of drug is Sacubitril/Valsartan (Entresto)
ARNI - a newer first line drug
Sacubitril – increases natriuretic peptides
Valsartan - ARB, suppresses the negative effects of the RAAS
can be used in place of ACE or ARB
ADR: angioedma, hypotension, and some hyperkalemia
fetal harm: avoid in pregnancy
would a diuretic decrease or increase preload?
decrease
name a loop diuretic
furosemide (Lasix)
which diuretic is ineffective when kidney function is low?
thiazide diuretics are ineffective
which adverse effect will the nurse monitor in a loop diuretic
hypokalemia, hypovolemia
the nurse knows to monitor for potential hyperkalemia and low blood pressure from these medications:
A) ACE/ARBs, ARNIS and aldosterone antagonists
B) ACE/ARB and loop diuretics like furosemide
C) ACE/ARB, ARNIs and loop diuretics like furosemide
D) ARNI and beta blocker
A) ACE/ARBs, ARNIS and aldosterone antagonists
hyperkalemia!!
why would a beta blocker potentially be a bad idea for a person in acute, decompensated heart failure with low blood pressure?
decompensated means they are in an acute state and are unable to support their own blood pressure, and there is poor perfusion overall
(however they are an excellent medication for stable chronic heart failure)
what are the beta blockers approved for heart failure?
metoprolol (ER), succinate, carvedilol, bisoprolol
side effects/adrs of beta blockers
fatigue, hypotension, decrease HR and contractility
start with a low dose and increase slowly
make sure pt is euvolemic and hemodynamically stable
T/F :
SGLT-2 inhibitors are helpful in persons with heart failure with or without diabetes
true!
what do you monitor for in a SGLT-2 inhibitor?
increased risk for UTI, and genital infections
how does SGLT-2 inhibitors work?
increases the amount of glucose in the urine to extract it from the body
bacteria growth is increased in the presence of glucose so there is an increase risk for UTI and genital infections
what is digoxin?
a cardiac glycoside
it can cause severe effects when given with abnormal (LOW) potassium levels
-a positive inotrope (increases contractility)
we use digoxin when we have tried all the first line drugs
what is the electrolyte to monitor for with Digoxin?
potassium
a pt is taking digoxin, what are the early signs of toxicity that the nurse should be aware or
GI upset, yellow/green visual disturbances
what is the most serious ADR of digoxin?
cardiac dysrhythmias
Dobutamine
-will increase heart rate and blood pressure
-works on beta 1 receptors only
-used for short term rescue of severe, acute heart failure
-catecholamine
sympathomimetic
what effect will IV Dobutamine have on a person with acute HFrEF heart failure? What does it do to kidney function?
increase contractility and rate, thus
improving perfusion to the kidneys
Dopamine
-activates beta 1 and dopamine receptors
-catecholamine
-short term rescue of severe heart failure
sympathomimetic
which drug class?
1) Captopril
2) HCTZ
3) Carvedilol
1) ACE inhibitor
2) diuretic
3) beta blocker
which drug class?
1) malsartan
2) enalapril
3) digoxin
4) sacubitril/valsartan
1) arb
2) ACE inhibitor
3) cardiac glycoside
4) ARNI
what is a long acting nitrate and when is it used? what are examples?
-sustained protection against angina attacks
-administered on a fixed schedule
-examples are Nitroglycerin oral capsules and transdermal pathes, Isosorbine Dinitrate, Isosorbine Mononitrate
what are short acting nitrates used for?
used to terminate acute anginal attacks
what is the range for potassium?
3.5-5
what lab is important to get before starting a statin?
what do statins do?
liver enzymes
they lower LDL and raise HDL
what drugs are used in the treatment of angina?
nitrates, beta blockers, calcium channel blockers, and Ranolazine
A pt using a long-acting nitrate for stable angina asks the nurse if it is ok to take a Cialis tablet (a PDE5 inhibitor). what does the nurse respond?
“you can try the cialis if you stop the nitrate at least 48 hr before using the weekend pill”
what are the types of angina?
1) Chronic Stable Angina (triggered by physical activity)
2) Unstable Angina (symptoms at rest)
3) Variant Angina (causes spasms of coronary arteries)
what do nitrates do?
-vasodilate the arterioles and veins
-greater effect on the veins
-decrease preload
-the pain relief of nitroglycerin comes from the venous dilation, not the arterial dilation
-it does not dilate atherosclerotic coronary arteries
what are side effects of nitrates?
hypotension headache, tachycardia
-will intensify the effects of other hypotensive agents
SAFETY ALERT: nitrates and PDE5 inhibitors lead to excessive vasodilation and life threatening hypotension
what medications do you use to treat dysrhythmias?
beta blockers, non-dihydropyridine calcium channel blockers (verapamil and diltiasam), digoxin
pt has a HR of 48-54, they are normotensive, AOx4
what is the best action for this patient?
continue to monitor and document HR
diagnosis of bradycardia
less than 60
what drug is considered first line antidysrythmic in treatment of bradycardia
atropine
what is Amiodarone
a potassium channel blocker
a strong drug with a long half live, used for re-occuring ventricular dysrhythmias
ADRS: pulmonary and cardiac toxicities, skin may turn blue with sun exposure
metabolism inhibited by grapefruit juice
thyroid impairment
how do we treat shock?
