Heart Failure

Question 1

Vasodilators: Nesiritide (Natrecor) characteristics

Answer 1

• Reduces preload and afterload to compensate for diminished cardiac function
• IV infusion
• For patients with acutely decompensated HF
• Lab value for BNP is not valid after a patient has been on nesiritide
• synthetic B-type natriuretic peptide

Question 2

Cardiac Glycosides: examples and characteristics

Answer 2

• Digoxin (Lanoxin) is the most common drug in this category
• Increased force of myocardial contraction (inotropic agent)
• Increased cardiac output and renal perfusion
• Increased urine output and decreased blood volume
• Slowed heart rate
• Decreased conduction velocity through the AV node
• Stabilize cardiac conduction abnormalities.
• Loading doses of digoxin might be given (0.125-0.25mg with loading 0.5-1mg)
• Narrow therapeutic effect

Question 3

Cardiac Glycosides: nursing considerations and contraindications

Answer 3

• Pregnancy category A
• ***Digoxin must be withheld and the physician notified if the heart rate is less than or equal to 60 after the apical pulse is taken for one full minute
• Cardiac glycosides have low therapeutic index so blood levels must be monitored (normal is 0.5 to 2 ng/mL)
• Need lower doses with the elderly because of decreased renal clearance
• Daily weights; report weight gain of 2 pounds in a day or 5 pounds in a week – means its not working, should v edema
• Hypokalemia can increase Digoxin toxicity.
• Renal insufficiency will increase digoxin levels

Contraindications

• AV block
• Ventricular dysrhythmias

Question 4

Cardiac Glycosides: regular and serious adverse effects

Answer 4

Adverse effects

• General malaise
• Dizziness
• Headache
• Anorexia – toxicity, first
• Nausea
• Vomiting
• Visual disturbances – colors and halos

Serious adverse effects

• Ventricular dysrhythmias
• AV block
• Atrial dysrhythmias
• Sinus bradycardia

Question 5

Cardiac Glycosides: pt and family teaching

Answer 5

• Take radial pulse daily
• Immediately report adverse effects
• Check weight daily
• Take as prescribed
• Do not take any OTC medications
• Do not switch brands
• Do not breast-feed

Question 6

Digoxin Toxicity: adverse effects

Answer 6

Cardiovascular
- Dysrhythmias including premature ventricular contractions (PVC), bradycardia, tachycardia

Central nervous System
- Headache, fatigue, malaise, confusion, convulsions

Gastrointestinal
- Anorexia, nausea, vomiting, diarrhea

Visual
- Colored vision (green, yellow, purple), halo vision, or flickering lights

Question 7

Management of Digoxin Toxicity

Answer 7

Varies depending on the severity of the problem but can include:

• Discontinue the drug (withhold the drug)
• Check digoxin and electrolyte levels
• Administer potassium supplements if the client is hypokalemic (decreased potassium levels)
• Supportive therapy for diarrhea, N, V
• Monitor heart rhythms

Question 8

Digoxin Antidote

Answer 8

• Digoxin Immune Fab (Digibind or Digifab)
• Used for the treatment of life threatening digoxin intoxication
• Patient should be on a cardiac monitor

Indicated for:

• Digoxin toxic patient with potassium levels greater than 5 mEq/L
• Digoxin toxicity associated with life threatening cardiac dysrhythmias
• Life threatening digoxin overdose

Question 9

Phosphodiesterase Inhibitors: examples and characteristics

Answer 9

• **Inamrinone (Inocor): Approved only for use in patients with HF that has not responded to digoxin, diuretics, or ACE inhibitors
• **Milrinone (Primacor): Short-term management of HF in patients who are receiving digoxin and diuretics

MI + -none

Classification
- Second class of drugs that act as cardiotonic (inotropic) agents.  They are inodilators

Question 10

Phosphodiesterase Inhibitors: nursing considerations and teaching

Answer 10

Nursing responsibilities

• Monitor cardiac status during and following infusion
• Monitor BP
• Monitor fluid/electrolyte balance

Patient/family teaching
- Immediately report chest pain