Heart Failure Flashcards
Digoxin
VASOPRESSORS/SHOCK, Cardiac Glycoside, Inodilator
Cardiac Glycoside
Milrinone
VASOPRESSORS/SHOCK, Cardiac Glycoside, Inodilator
Inodilator
Dopamine
VASOPRESSORS/SHOCK, Cardiac Glycoside, Inodilator
VASOPRESSORS/SHOCK
Cardiac Remodeling
Ventricles constrict, hypotrophy, fibrosis, become spherical
or
Ventricles dilate, hypertrophy, fibrosis, become spherical
Ventricles dilate, hypertrophy, fibrosis, become spherical
Cardiac Remodeling
◦Increase wall stress and reduce EF
or
◦Decrease wall stress and induce EF
◦Increase wall stress and reduce EF
Cardiac Remodeling
UNDERACTIVE Sympathetic Nervous System (SNS)
or
OVERACTIVE Sympathetic Nervous System (SNS)
OVERACTIVE Sympathetic Nervous System (SNS)
Cardiac Remodeling
OVERACTIVE Renin Angiotensin Aldosterone (RAAS)
UNDERACTIVE Renin Angiotensin Aldosterone (RAAS)
OVERACTIVE Renin Angiotensin Aldosterone (RAAS)
Cardiac Remodling
Baroreceptor?
desensitization or sensitization
desensitization
Called water pills, are medications designed to increase the amount of water and salt expelled from the body as urine.
Epinephrine or Diuretic
Diuretic
stable/chronic/controlled/home
Decompensated Heart Failure
or
Compensated Heart Failure
Compensated Heart Failure
acute/hospitalization/uncontrolled
Decompensated Heart Failure
or
Compensated Heart Failure
Decompensated Heart Failure
Medications designed to prevent worsening
Decompensated Heart Failure
or
Compensated Heart Failure
Compensated Heart Failure
heart failure exacerbation
Decompensated Heart Failure
or
Compensated Heart Failure
Decompensated Heart Failure
Diuretics•Vasodilators
Decompensated Heart Failure
or
Compensated Heart Failure
Decompensated Heart Failure
Inotropic Support•Kidneys>Heart
Decompensated Heart Failure
or
Compensated Heart Failure
Decompensated Heart Failure
Cardiac Muscle, Contractility
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
INOTROPIC
SA Node, Heart rate
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
CHRONOTROPIC
Conduction Velocity
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
DROMOTROPIC
AV node ,bundle of His, Purkinje Fibers
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
DROMOTROPIC
+ increase/ - Decrease the FORCE of myocardial contraction (STRENGTH)
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
INOTROPIC
+ increase/ - Decrease the RATE of the heart beat
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
CHRONOTROPIC
+ increases/ - Decrease CONDUCTION of electrical impulses
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
DROMOTROPIC
Furosemide
Beta Blockers, Aldosterone Antagonists, Loop Diuretics, ACE-Inhibitors/ARBS
Loop Diuretics
Carvedilol
Beta Blockers, Aldosterone Antagonists, Loop Diuretics, ACE-Inhibitors/ARBS
Beta Blockers
Lisinopril
Beta Blockers, Aldosterone Antagonists, Loop Diuretics, ACE-Inhibitors/ARBS
ACE-Inhibitors/ARBS
Spironolactone
Beta Blockers, Aldosterone Antagonists, Loop Diuretics, ACE-Inhibitors/ARBS
Aldosterone Antagonists
Eplerenone
Beta Blockers, Aldosterone Antagonists, Loop Diuretics, ACE-Inhibitors/ARBS
Aldosterone Antagonists
Valsartan
Beta Blockers, Aldosterone Antagonists, Loop Diuretics, ACE-Inhibitors/ARBS
ACE-Inhibitors/ARBS
Increase Sympathetic and RAAS Activity 2
Carvedilol, Furosemide, Lisinopril, Spironolactone Valsartan, Eplerenone
Beta Blockers, Aldosterone Antagonists, Loop Diuretics, ACE-Inhibitors/ARBS
Beta Blockers’
Carvedilol
ACE-Inhibitors/ARBS
Lisinopril
Valsartan
Sodium or water retention
Carvedilol, Furosemide, Lisinopril, Spironolactone Valsartan, Eplerenone
Beta Blockers, Aldosterone Antagonists, Loop Diuretics, ACE-Inhibitors/ARBS
Loop Diuretics
Furosemide
Failure to escape from aldorsterone
Carvedilol, Furosemide, Lisinopril, Spironolactone Valsartan, Eplerenone
Beta Blockers, Aldosterone Antagonists, Loop Diuretics, ACE-Inhibitors/ARBS
Aldosterone Antagonists
Spironolactone
Eplerenone
treats Heart Failure?
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Cardiac Glycoside
Digoxin
Treats Atrial Fibrillation
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Cardiac Glycoside
Digoxin
Cardiac Glycosides: Digoxin
+ increase or - Decrease the FORCE of myocardial contraction (STRENGTH)
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
+ INOTROPIC
+ increase the FORCE of myocardial contraction (STRENGTH)
Cardiac Glycosides: Digoxin
+ increase or - Decrease the RATE of the heart beat
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
- CHRONOTROPIC
Decrease the RATE of the heart beat
Cardiac Glycosides: Digoxin
+ increases or - Decrease CONDUCTION of electrical impulses
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
DROMOTROPIC
Decrease CONDUCTION of electrical impulses
Cardiac Glycosides: Digoxin
Blocking the Na+/K+ ATPase pump
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
+INOTROPIC
Cardiac Glycosides: Digoxin
Parasympathomimetic (causes vagal stimulation) and also increases baroreceptor sensitivity
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
-CHRONOTROPIC
Cardiac Glycosides: Digoxin
Cholinergic activation in atria (AV node), less at Purkinje
CHRONOTROPIC, INOTROPIC, DROMOTROPIC
-DROMOTROPIC
Cardiac Glycosides: Digoxin
(Improved/ Declined) Cardiac Output and (Increased / Decreased) Renal Perfusion= (Increased / Decreased) Urine Production and (increased / decreased) RAAS activation
Improved
Increased
Increased
decreased
What do a nurse to check before giving Digoxin
Heart rate, Blood pressure, or Both
Sodium, Magnesium, Cholesterol, Calcium, Potassium, Cortisol
Digoxin level or no?
Heart Rate
Potassium
Yes Dig Levels to avoid tox
Cardiac Glycosides: Digoxin MOA
Digoxin competes with ?
Calcium, Sodium, or Potassium
Potassium
Cardiac Glycosides: Digoxin MOA
Since Digoxin and Potassium competes with other ranges needs to be normal to avoid Dig Tox?
Sodium, Magnesium, Cholesterol, Calcium, Potassium, Cortisol
Magnesium
Calcium
Potassium
Cardiac Glycosides: Digoxin MOA
Which results in Dig Tox?
(Hyper/ Hypo- kalema,) (Hyper / Hyper - magnesemia,) (Hyper / Hypo - calcemia)
HypoKalema
HypoMagnesemia
HyperCalcemia
Cardiac Glycosides: Digoxin MOA
What are Dig Tox Effects
Heart, Muscles, Balancing, GI, GU, CNS, SNS
Heart
GI
CNS
disturbance to an otherwise normal rhythm
arrhythmia, dysrhythmia
dysrhythmia
irregular heartbeat
arrhythmia, dysrhythmia
arrhythmia
A fast heart rhythm with a rate of more than 100 beats per minute
Bradycardia , Tachycardia
Tachycardia
A slow heart rhythm with a rate below 60 beats per minute.
Bradycardia , Tachycardia
Bradycardia
Cardiac Glycosides: Digoxin Tox Effect
Heart-
arrhythmia or dysrhythmia
Bradycardia , Tachycardia
dysrhythmia
Bradycardia
Cardiac Glycosides: Digoxin Tox Effect
Heart-
Can potassium be hyperkalemia or Hypokalemia or both .
If both which is the main concern?
Both
Hypokalemia
Cardiac Glycosides: Digoxin Tox Effect
GI-
Constipation Diarrhea Vomiting Heartburn Nausea Abdominal Pain Anorexia
Vomiting
Nausea
Anorexia
Cardiac Glycosides: Digoxin Tox Effect
CNS related-
Severe headaches. Strokes Confusion Blurred vision Weakness. Vision disturbances Seizures Fatigue
Confusion
Vision disturbances
Fatigue
Blurred vision
Cardiac Glycosides: Digoxin Tox Effect
With Vision disturbances-
(yellow or pink) tint, “Melos or Halos)
Yellow tint
Halos
Cardiac Glycosides: Digoxin Tox Effect
Can Digoxin could cause weight gain or loss?
Weight Loss
Cardiac Glycosides: Digoxin
Digoxin Normal range=
0.5- 1 ng/ml, 0.5 -2 ng/ml, 0.5 - 3 ng/ml
0.5 - 2 ng/ml
Cardiac Glycosides: Digoxin
If Digoxin level are tox is there an antedote?
Yes or No
Yes
Cardiac Glycosides: Digoxin - Which is the Antedote?
Digifind ®- Digoxin unspecific Antibody Fab fragments
Digibind ®- Digoxin specific Antibody Fab fragments
Digibind ®- Digoxin unspecific Antibody Fab fragments
Digifind ®- Digoxin specific Antibody Fab fragments
Digibind ®- Digoxin specific Antibody Fab fragments
Cardiac Glycosides: Digoxin - Diuretics
Is it true that patient who have heart failure are on Diuretics.
Yes or No
Yes
Cardiac Glycosides: Digoxin - Diuretics
Low potassium will (Increase or Decrease) the risk for digoxin to (induced or inhibit) dysrhythmias
Increase
induce
Cardiac Glycosides: Digoxin - ACE-Inhibitors/ARBs
increase K+ and (increase or decrease) digoxin response
Decrease
Cardiac Glycosides: Digoxin - Drugs/ Food Binding
Bile Acid Sequestrants- ?
Kayexalate, Cholestyramine,
Cholestyramine
Cardiac Glycosides: Digoxin - Drugs/ Food Binding
Sodium Polystyrene Sulfate- Potassium Binder
Kayexalate, Cholestyramine,
Kayexalate
Cardiac Glycosides: Digoxin - Drugs/ Food Binding
Kayexalate?
Bile Acid Sequestrants, Sodium Polystyrene Sulfate- Potassium Binder
Sodium Polystyrene Sulfate- Potassium Binder
Cardiac Glycosides: Digoxin - Drugs/ Food Binding
Do Digoxin bind to ?
Low fiber food (peaches ) or High fiber food (bran)
High fiber food - Bran
Cardiac Glycosides: Digoxin - Pharmacokinetics
Digoxin requires adjustment in (Hepatic or Renal) impairment?
Renal Kidneys
Digoxin eliminates through Hepatic or Renal system
Renal Kidneys
What are the normal potassium levels?
2.5 - 5 mEq/L, 3.5 -4 mEq/L, 3.5 -5 mEq/L
3.5 -5 mEq/L
Cardiac Glycosides: Digoxin - Nursing Considerations
a. Nurses should assess heart rate after administration
b. Educate patients to check their pulse at home after use
c. Normal range (60-100 bpm)
d. Notify provider if HR>60
e. Notify provider if patient has palpitations
f. Should see improved Urine Output (>30ml/hr)
c.
e.
f.
A.. Before
B. Before
d. <60
Feel in the blank?
If ? lb weight gain in 1 day
OR ? lb in 1 week
Need to notify provider (developing fluid overload)
2
5
Which is a Phosphodiesterase 3 Inhibitor
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Milrinone - Inodilator
Which 3 drugs are a Positive Inotropic Agents
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Milrinone - Inodilator
Dopamine- VASOPRESSORS/SHOCK
Which deals with PDE3, PDE$, PDE5
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Milrinone- Inodilator
Milrinone- Inodilator
PDE4
CHF, COPD- Theophylline, PENIS- Erectile Dysfunction
COPD- Theophylline
Milrinone- Inodilator
PDE3-
CHF, COPD- Theophylline, PENIS- Erectile Dysfunction
CHF
Milrinone- Inodilator
PDE5
CHF, COPD- Theophylline, PENIS- Erectile Dysfunction
PENIS- Erectile Dysfunction
Milrinone- Inodilator
Sildenafil/Tadalafil
PDE3, PDE4, PDE5,
PDE5
Milrinone- Inodilator
NITRATES can be mixed with?
PDE3, PDE4, PDE5,
PDE5
Severe, decompensated HF (late stages)
Bridge to await a heart transplant
Palliative therapy
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Milrinone- Inodilator
VASODILATOR AND POSITIVE INOTROPIC AGENT
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Milrinone- Inodilator
Adverse side effect ?
dysrhythmias (ventricular)- pushing the heart hard!
Hypotension
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Milrinone- Inodilator
CONTRA-INDICATIONS:
Can’t use if MI or dysrhythmia
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Milrinone- Inodilator
What do a nurse to check before giving Milrinone
Heart rate, Blood pressure, or Both
Blood pressure
Which is IV continuous drip
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Milrinone- Inodilator
Dopamine- VASOPRESSORS/SHOCK
Which is used in the late stages of heart failure
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Milrinone- Inodilator
Dopamine- VASOPRESSORS/SHOCK
Which is
Hemodynamic Support
Inotropic Support for Heart Failure
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Dopamine- VASOPRESSORS/SHOCK
Dopamine- VASOPRESSORS/SHOCK
DA Renal perfusion (oxygenate kidneys= inc urine output)
Moderate, Low, High
Low
Dopamine- VASOPRESSORS/SHOCK
(DA+Beta1+Alpha1) (improved blood pressure)
Moderate, Low, High
High
Dopamine- VASOPRESSORS/SHOCK
Beta (DA+Beta1) (Cardiac Output)
Moderate, Low, High
Moderate
Adverse side effect ?
dysrhythmias (ventricular)- pushing the heart hard!
Hypertension
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Dopamine- VASOPRESSORS/SHOCK
Which has the following Nursing conderations?
DA- urine output, improvement of the AKI/ARF (SCr/BUN down)
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Dopamine- VASOPRESSORS/SHOCK
Which has the following Nursing conderations?
Beta- inotropic support
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Dopamine- VASOPRESSORS/SHOCK
Which has the following Nursing conderations?
Alpha- BP
Inodilator, Cardiac Glycoside, VASOPRESSORS/SHOCK
Digoxin, Dopamine, Milrinone,
Dopamine- VASOPRESSORS/SHOCK