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PHARM > Heart Failure > Flashcards

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
Q

Angiotensin II Receptor Blockers mehanism of action?

A

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

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25
Q

Valsartan adverse effects?

A

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

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26
Q

example of B-blockers

A

Metoprolol

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27
Q

whats the mechanism, of action of b-blockers?

A

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

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28
Q

example of Aldosterone Antagonists

A

spironolactone

29
Q

mechanism of ation of spironolactone?

A

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
Q

spironolactone (Aldactone®) use?

A

potassium-sparing diuretic and aldosterone antagonist shown to reduce the symptoms of heart failure

31
Q

what causes diuresis which decreases blood volume and blood return to heart (preload)

A

ACE

32
Q

what are are potent vasodilators, decrease systemic vascular resistance (afterload)

A

ARBs

33
Q

whata are also effective in slowing ventricular remodeling and hypertrophy

A

ACE and ARBs

34
Q

whats stops catecholamine mediated actions on the heart

A

B-blockers

35
Q

whats a miscellaneous drug for HF and what does it do?

A

dobutamine hydrochloride, β1- selective vasoactive adrenergic drug,
Structurally similar to dopamine

36
Q

Phosphodiesterase Inhibitor does what?

A

Work by inhibiting the enzyme phosphodiesterase

37
Q

what is the result of using Phosphodiesterase Inhibitor?

A
  • Intracellular increase in cyclic adenosine monophosphate
  • Positive inotropic response
  • Vasodilation
  • Increase in calcium for myocardial muscle contraction.
38
Q

Phosphodiesterase Inhibitors, whats the only one available in Canada?

A

Milrinone

39
Q

Phosphodiesterase Inhibitors, indications?

A
  • Short-term management of heart failure for patients in the Critical Care Unit.
40
Q

Phosphodiesterase Inhibitors advised not to?

A

long-term infusions of milrinone

41
Q

Milrinon is only available in what form?

A

Only available phosphodiesterase inhibitor
Available only in injectable form

42
Q

adverse fx of milrinone?

A

cardiac dysrhythmias, hypotension, angina, hypokalemia, tremor, and thrombocytopenia

43
Q

interactions of milrinone?

A

diuretics (additive hypotensive effects) and digoxin (additive inotropic effects)

44
Q

what drug cant be injected in the same line with milrinone?

A

Furosemide

45
Q

Cardiac Glycosides are no longer used as?

A

first-line treatment

46
Q

what is the prototype of cardiac glycoside?

A

Digoxin

47
Q

Mechanism of action of cradiac glycosides?

A

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
Q

what are the positive inotropic effects of cardiac glycosides?

A

Increased force and velocity of myocardial contraction (without an increase in oxygen consumption)

49
Q

what are the negative chronotropic effects of cardiac glycosides?

A

reduced HR

50
Q

what are the negative dromotropic effects of cardiac glycosides?

A

Decreased automaticity at sinoatrial node, decreased atrioventricular nodal conduction, and other effects

51
Q

what are the drug effects of cardiac glycosides?

A

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
Q

what are the adverse effects of digoxin?

A

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
Q

what are the adverse effects of digoxin in the cardiovascular system?

A

dysrhythmias, including bradycardia or tachycardia

54
Q

what are the adverse effects of digoxin in the CNS?

A

headaches, fatigue, malaise, confusion, convulsions

55
Q

Advere effects of digoxin in the eyes?

A

coloured vision (seeing green, yellow, purple), halo vision

56
Q

Advere effects of digoxin in the GI?

A

anorexia, nausea, vomiting, diarrhea

57
Q

what therapy is used for digoxin toxicity?

A

Fab therapy

58
Q

Digoxin Toxicity

A
  • Hyperkalemia (serum potassium greater than 5 mmol/L) in a digitalis-toxic patient
  • Life-threatening cardiac dysrhythmias
  • Life-threatening digoxin overdose
59
Q

what are the NHPs that increase digoxin levels?

A

ginseng, hawthorn, licorice, st Johns wort.

60
Q

Large amounts of what negatively affect absorption of oral digoxin?

A

Bran

61
Q

what levels are important for digoxin?

A

Serum digoxin, potassium levels important
Apical pulse between 60-100 bpm

62
Q

Conditions That Predispose to Digoxin Toxicity

A

Hypokalemia
Use of cardiac pacemaker
Atrioventricular block
Hypercalcemia
Dysrhythmias
Hypothyroid, respiratory, or renal disease
Advanced age
Ventricular fibrillation

63
Q

HF drugs nurisng implications ( what to asses?)

A

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
Q

what labs to look out for in HF?

A

Serum labs: potassium, sodium, magnesium, calcium, renal, and liver function studies

65
Q

what should you do before giving any HF drugs?

A

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
Q

what are the signs and symptoms of HF drug toxicity?

A

Anorexia, nausea, vomiting, diarrhea
Visual disturbances (blurred vision, seeing green or yellow halos around objects)

67
Q

when should you hold the dose of HF drugs?

A

Hold dose and notify prescriber if the patient experiences signs or symptoms of toxicity.

68
Q

Heart Failure Drugs, nursing Implications

A

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
Q

milrinone nursing implications?

A

Use an infusion pump.
Monitor input and output, heart rate and rhythm, blood pressure, daily weights, respirations, and so on

70
Q

what to monitor fro HF drugs?

A

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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