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Heart Failure Flashcards

1
Q

what is heart failure?

A

HF is a pathological condition in which the heart is unable to pump blood in sufficient amounts from ventricles to meet body’s metabolic needs

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2
Q

Symptoms depend on the cardiac area affected, in left sided (Left = Lung) what is affected

A
  • Pulmonary edema
  • Coughing
  • Shortness of breath
  • Dyspnea
  • Systolic: decreased contractility, decreased blood ejected
  • Diastolic: elevated filling pressures, muscle unable to relax
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3
Q

Symptoms depend on the cardiac area affected, in Right sided what is affected

A
  • Systemic venous congestion
  • Pedal edema
  • Jugular venous distension
  • Ascites
  • Hepatic congestion
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4
Q

Consequences of HF?

A
  • Blood supply to organs is reduced (kidney before heart and brains)
  • Impaired kidney filtration can lead to acute kidney injury or chronic kidney failure
  • Pulmonary edema can lead to shortness of breath and peripheral edema
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5
Q

Myocardial deficiency causes of Inadequate contractility

A

Myocardial infarction
Coronary artery disease
Cardiomyopathy
Valvular insufficiency

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6
Q

Myocardial deficiency causes of inadequate filling

A

Atrial fibrillation
Infection
Tamponade
Ischemia

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7
Q

Increased workload cause of Pressure overload

A

Pulmonary hypertension
Systemic hypertension
Outflow obstruction

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8
Q

Increased workload cause of Volume overload

A

Hypervolemia
Congenital abnormalities
Anemia
Thyroid disease
Infection
Diabetes

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9
Q

what is class I heart failure?

A

No physical activity limitations

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10
Q

what is class II HF?

A
  • Ordinary physical activity results in fatigue, dyspnea, or other symptoms.
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11
Q

what is class III HF?

A

Marked limitation in physical activity

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12
Q

What is class IV HF?

A

Symptoms at rest or with no physical activity at all

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13
Q

what does positive inotropic drugs do?

A

increase the force of myocardial contraction

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14
Q

what does positive chronotropic drugs do?

A

increase heart rate

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15
Q

Positive dromotropic drugs waht does it do?

A

accelerate cardiac conduction

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16
Q

Positive inotropic drugs types?

A
  • Phosphodiesterase inhibitors
  • Cardiac glycosides
  • B-type natriuretic peptides
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17
Q

what are the drugs of choice for early treatment of HF?

A

Angiotensin-converting enzyme inhibitors: LISINOPRIL
Angiotensin II receptor blockers: VALSARTAN
Certain ß-blockers: METOPROLOL

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18
Q

Only use loop diureteic and aldosterone inhibitors after the drugs are used with?

A

Digoxin

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19
Q

What type of HF drug is Dobutamine?

A

Positive inotropic

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20
Q

hydralazine/isosorbide dinitrate recommended specifically for use in which race?

A

Black patients

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21
Q

Angiotensin-Converting Enzyme Inhibitors example?

A

Lisinopril

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22
Q

what is the mechanism of action of Angiotensin-Converting Enzyme Inhibitor?

A
  • Prevent sodium and water resorption by inhibiting aldosterone secretion
  • Diuresis results, which decreases preload, or the left ventricular end volume, and the work of the heart
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23
Q

Angiotensin II Receptor Blockers drug?

A

Valsartan

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23
Q

Lisinopril Indications?

A

hypertension, heart failure, and acute myocardial infarction, Hyperkalemia,
Dry cough,
Decreased renal function

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24
Angiotensin II Receptor Blockers mehanism of action?
Potent vasodilators; decrease systemic vascular resistance (afterload) Used alone or in combination with other drugs such as diuretics in the treatment of hypertension or heart failure
25
Valsartan adverse effects?
Valsartan shares many of the same adverse effects as lisinopril. Angiotensin II receptor blockers are not as likely to cause the cough associated with the angiotensin-converting enzyme inhibitors. Angiotensin II receptor blockers are not as likely to cause hyperkalemia
26
example of B-blockers
Metoprolol
27
whats the mechanism, of action of b-blockers?
Cardioprotective quality of ß-blockers: prevent catecholamine-mediated actions on the heart by reducing or blocking sympathetic nervous system stimulation to the heart and the heart’s conduction system
28
example of Aldosterone Antagonists
spironolactone
29
mechanism of ation of spironolactone?
Useful in severe stages of heart failure Action: activation of the renin-angiotensin-aldosterone system causes increased levels of aldosterone, which causes retention of sodium and water, leading to edema that can worsen heart failure.
30
spironolactone (Aldactone®) use?
potassium-sparing diuretic and aldosterone antagonist shown to reduce the symptoms of heart failure
31
what causes diuresis which decreases blood volume and blood return to heart (preload)
ACE
32
what are are potent vasodilators, decrease systemic vascular resistance (afterload)
ARBs
33
whata are also effective in slowing ventricular remodeling and hypertrophy
ACE and ARBs
34
whats stops catecholamine mediated actions on the heart
B-blockers
35
whats a miscellaneous drug for HF and what does it do?
dobutamine hydrochloride, β1- selective vasoactive adrenergic drug, Structurally similar to dopamine
36
Phosphodiesterase Inhibitor does what?
Work by inhibiting the enzyme phosphodiesterase
37
what is the result of using Phosphodiesterase Inhibitor?
- Intracellular increase in cyclic adenosine monophosphate - Positive inotropic response - Vasodilation - Increase in calcium for myocardial muscle contraction.
38
Phosphodiesterase Inhibitors, whats the only one available in Canada?
Milrinone
39
Phosphodiesterase Inhibitors, indications?
- Short-term management of heart failure for patients in the Critical Care Unit.
40
Phosphodiesterase Inhibitors advised not to?
long-term infusions of milrinone
41
Milrinon is only available in what form?
Only available phosphodiesterase inhibitor Available only in injectable form
42
adverse fx of milrinone?
cardiac dysrhythmias, hypotension, angina, hypokalemia, tremor, and thrombocytopenia
43
interactions of milrinone?
diuretics (additive hypotensive effects) and digoxin (additive inotropic effects)
44
what drug cant be injected in the same line with milrinone?
Furosemide
45
Cardiac Glycosides are no longer used as?
first-line treatment
46
what is the prototype of cardiac glycoside?
Digoxin
47
Mechanism of action of cradiac glycosides?
Increase myocardial contractility Change electrical conduction properties of the heart Decrease rate of electrical conduction Prolong the refractory period Area between sinoatrial node and atrioventricular node
48
what are the positive inotropic effects of cardiac glycosides?
Increased force and velocity of myocardial contraction (without an increase in oxygen consumption)
49
what are the negative chronotropic effects of cardiac glycosides?
reduced HR
50
what are the negative dromotropic effects of cardiac glycosides?
Decreased automaticity at sinoatrial node, decreased atrioventricular nodal conduction, and other effects
51
what are the drug effects of cardiac glycosides?
Increased stroke volume Reduction in heart size during diastole Decrease in venous blood pressure and vein engorgement Increase in coronary circulation Decrease in exertional and paroxysmal nocturnal dyspnea, cough, and cyanosis Promotion of tissue perfusion and diuresis Improved symptom control, quality of life, and exercise tolerance, with no apparent reduction in mortality
52
what are the adverse effects of digoxin?
Very narrow therapeutic window Drug levels must be monitored. 0.8 to 2 ng/mL Low potassium levels increase its toxicity. Electrolyte levels must be monitored.
53
what are the adverse effects of digoxin in the cardiovascular system?
dysrhythmias, including bradycardia or tachycardia
54
what are the adverse effects of digoxin in the CNS?
headaches, fatigue, malaise, confusion, convulsions
55
Advere effects of digoxin in the eyes?
coloured vision (seeing green, yellow, purple), halo vision
56
Advere effects of digoxin in the GI?
anorexia, nausea, vomiting, diarrhea
57
what therapy is used for digoxin toxicity?
Fab therapy
58
Digoxin Toxicity
- Hyperkalemia (serum potassium greater than 5 mmol/L) in a digitalis-toxic patient - Life-threatening cardiac dysrhythmias - Life-threatening digoxin overdose
59
what are the NHPs that increase digoxin levels?
ginseng, hawthorn, licorice, st Johns wort.
60
Large amounts of what negatively affect absorption of oral digoxin?
Bran
61
what levels are important for digoxin?
Serum digoxin, potassium levels important Apical pulse between 60-100 bpm
62
Conditions That Predispose to Digoxin Toxicity
Hypokalemia Use of cardiac pacemaker Atrioventricular block Hypercalcemia Dysrhythmias Hypothyroid, respiratory, or renal disease Advanced age Ventricular fibrillation
63
HF drugs nurisng implications ( what to asses?)
Assess history, drug allergies, and contraindications. Assess clinical parameters, including blood pressure Both radial and apical pulse for 1 full minute Heart sounds, breath sounds
64
what labs to look out for in HF?
Serum labs: potassium, sodium, magnesium, calcium, renal, and liver function studies
65
what should you do before giving any HF drugs?
Before giving any dose, count apical pulse for 1 full minute. For an apical pulse less than 60 or greater than 100 beats/min Hold dose. Notify prescriber.
66
what are the signs and symptoms of HF drug toxicity?
Anorexia, nausea, vomiting, diarrhea Visual disturbances (blurred vision, seeing green or yellow halos around objects)
67
when should you hold the dose of HF drugs?
Hold dose and notify prescriber if the patient experiences signs or symptoms of toxicity.
68
Heart Failure Drugs, nursing Implications
Check dosage forms carefully and follow instructions for administering. Avoid giving digoxin with high-fibre foods (fibre binds with digitalis). Patients should immediately report a weight gain of 1 kg or more in 24 hours or 2 kg or more in 1 week.
69
milrinone nursing implications?
Use an infusion pump. Monitor input and output, heart rate and rhythm, blood pressure, daily weights, respirations, and so on
70
what to monitor fro HF drugs?
Monitor for therapeutic effects. Increased urinary output Decreased edema, shortness of breath, dyspnea, crackles, fatigue Resolution of paroxysmal nocturnal dyspnea Improved peripheral pulses, skin colour, temperature Monitor for adverse effects.

PHARM (20 decks)

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