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Pharmacology > Heart Failure & Antiarrhythmics > Flashcards

Heart Failure & Antiarrhythmics Flashcards

1
Q

Which drugs block the RAAS compensatory mechanisms?

A
  1. ARNIs (Sacubitril/Valsartan)
  2. ACE Inhibitors (Captopril/Lisinopril)
  3. ARBs
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2
Q

An aldosterone antagonist should be added for most patients as long as:

A
  1. Kidney function can tolerate the medication
  2. They do not have hyperkalemia

Example: Spironolactone

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3
Q

When would Ivabradine be indicated for treatment?

A

When heart rates are high despite maximal beta-blocker doses.

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4
Q

Which drugs decrease the sympathetic stimulation of compensatory mechanisms?

A

Beta Blockers (Bisoprolol, Carvedilol, and Metoprolol)

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5
Q

What are the prototypes for ACE Inhibitors? Include the MOA and possible adverse effects.

A

Prototypes: Captopril and Lisinopril

MOA: slows progression of HF and reduces mortality
- Lowers peripheral resistance
- Lowers blood volume
- Dilates veins which will decrease preload, pulmonary congestion, and edema

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6
Q

What would be the prototype for beta blockers r/t HF? What are the most important adverse effects and contraindications of these drugs?

A

Prototypes: Bisoprolol, Carvedilol, and Metoprolol

A/E:
- Bronchospasms in nonselective
- Hypotension/Bradycardia
- Box Warning: Do not stop abruptly taking the medication, may cause rebound excitation.

Contraindications:
- Asthma/COPD
- Hypotension, Severe Bradycardia, and Shock.

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7
Q

What are the benefits of vasodilators? Name 2 of them.

A

Benefits: they decrease blood pressure and relax blood vessels.

  1. Hydralazine with Isosorbide
  2. Nesiritide
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8
Q

What are the 3 key points about Hydralazine with Isosorbide?

A
  1. They are only approved for black patients.
  2. They decrease the workload of the heart
  3. Hypotension and reflex tachycardia are common.
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9
Q

What are the 5 key points with Nesiritide?

A
  1. It is a B-type Natriuretic Peptide
  2. It lowers preload and afterload
  3. It is only available as an IV infusion
  4. It can cause severe hypotension
  5. Only available in the hospital
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10
Q

Which drug classes are cardiotonic inotropic drugs? What will they do and what do they affect?

A

Classes:
1. Cardiac Glycosides (Digoxin)
2. Phosphodiesterase Inhibitors (Milrinone)
3. HCN Blockers (Ivabradine)
4. ARNIs (Sacubitril/Valsartan)

They affect the intracellular calcium cells in the heart muscle leading to increased contractility.

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11
Q

What is digitalization?

A

A procedure done where a dose of digoxin is gradually increased until tissue becomes saturated with the medication and symptoms of HF disppear.

It can be done rapidly with IV digoxin or over 7 days as an outpatient with PO digoxin.

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12
Q

What is the MOA of Digoxin, the route, and onset of the medication?

A

MOA:
- Inhibits enzyme responsible for sodium and potassium ion exchange
- increases intracellular calcium and allows more calcium to enter myocardial cells

Results in:
- Increased force of contraction
- Increased renal perfusion and cardiac output
- Slowed HR
- Decreased conduction velocity through the AV node

Routes: PO and IV
- Onset of IV: 5-30 minutes
- Onset of PO: 30-120 minutes

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13
Q

When caring for a patient on Digoxin, which labs will need to be monitored and what are the therapeutic ranges?

A

Labs: Potassium and Digoxin levels
- Digoxin levels should be drawn 6-12 hours after a dose

Therapeutic Range: 0.5-2ng/mL

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14
Q

What are the adverse effects of digoxin? Include contraindications.

A

A/E:
- arrhythmias
- vision changes
- digoxin toxicity (anorexia, n/v, malaise, depression, life-threatening arrhythmias)

Contraindications:
- allergy
- heart block, MI, ventricular dysrhythmias
- pregnancy/lactation
- renal insufficiency

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15
Q

What are the drug interactions with Digoxin? How do those drugs interact with the medication?

A
  1. St. John’s Wort and Psyllium (decreases the effectiveness of digoxin)
  2. Ginseng, Hawthorn, and black Licorice (increase digoxin toxicity)
  3. Potassium Losing Diuretics (increase the risk of arrhythmias)
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16
Q

What is the prototype for Phosphodiesterase III Inhibitors, the MOA, and the route?

A

Prototype: Milrinone

MOA:
- Inhibits phosphodiesterase III which increases calcium level in the cell
- Increased contractility and cardiac output

Route: IV
- Immediate onset
- Peak effects occur in 2 minutes

17
Q

What are the therapeutic uses for milrinone? Include contraindications and drug interactions. Lastly, include the adverse effects.

A

Used for short term treatment of acute decompensated HF. Therapy is limited to 2-3 days.

Contraindications: allergy to the medication or bisulfates.

Interactions: you cannot combine milrinone and furosemide IV.

A/E:
- Ventricular dysrhythmias
- Hypotension
- Thrombocytopenia

18
Q

What will the nurse monitor when they have a patient receiving Milrinone?

A

Blood pressure and ECG

19
Q

What is the prototype for HCN Channel Blockers? Include the MOA, route, adverse effects, and 2 important things to monitor. Lastly, how will this medication be stored?

A

Prototype: Ivabradine

MOA: blocks HCN which slows the heart’s pacemaker.

Route: PO

A/E:
- Bradycardia, HTN, A-Fib
- Changes in visual field

Monitor:
- BP and HR

Protect the medication from light.

20
Q

What are the contraindications for Ivabradine and what are the drug-interactions?

A

Contraindications:
- allergy to medication or bisulfites
- active decompensated HF
- Hypotension
- Heart block
- Resting HR less than 60
- Complete dependence on a pacemaker
- Severe hepatic impairment

Interactions:
- CYP3A4 Inhibitors or Inducers
- Other negative chronotropic drugs

21
Q

What are the prototypes for ARNIs? What is the MOA, indications, and route?

A

Prototype: Sacubitril/Valsartan

MOA:
- blocks neprilysin enzyme that breaks down natriuretic peptides
- causes greater sodium and water loss

Indicated to reduce hospitalization, death, and is used in children with low left ventricular systolic function.

Route: PO

22
Q

What are the adverse effects of ARNIs. Include contraindications and drug-interactions?

A

A/E:
- Hypotension
- Hyperkalemia
- Renal impairment
- Cough
- Angioedema

Contraindicated in allergies or history of angioedema.

Interactions:
- cannot be used with ACE inhibitor, need to discontinue the ACE inhibitor 36 hours before starting ARNI
- Potassium-sparing diuretic

23
Q

Class 1b Antidysrhythmics

What is the prototype, MOA, route, and indications?

A

Prototype: Lidocaine

MOA: blocks sodium channels and shortens the duration of action potential.

Route: IM or IV

24
Q

What is the therapeutic range of lidocaine? Include adverse effects, contraindications, and drug-interactions.

A

Therapeutic Range: 1.5-5mcg/mL

A/E:
- CV: proarrhythmic, hypotension, vasodilation, cardiac arrest
- Respiratory arrest or depression

Contraindications: allergy, bradycardia, heart block, HF, hypotension, electrolyte disturbances.

Interactions:
- Other antiarrhythmics
- Beta-blockers
- Phenytoin

25
Q

Class II Antidysrhythmics: Beta Blockers

Name the prototype, MOA, Adverse effects, and contraindications.

A

Prototypes: acebutolol, esmolol, and propanolol.

MOA:
- slows HR, cardiac excitation, and cardiac output.
- slows conduction through the AV node
- decreases renin release

A/E:
- Hypotension
- Bradycardia
- Cardiac Excitation

Contraindicated in severe bradycardia or heart block.

26
Q

Class II Antidysrhythmics: Potassium Channel Blockers

What is the prototype, route, and MOA?

A

Prototype: Amiodarone

Route: PO or IV

MOA: blocks potassium ions in myocardial cells which delays repolarization and prolongs refractory period to decrease automaticity.

27
Q

Class II Antidysrhythmics: Potassium Channel Blockers

What are the adverse effects, contraindications, and drug interactions with amiodarone?

A

A/E:
- liver toxicity
- weakness, phototoxicity
- bradycardia, creates or worsens dysrhythmias, hypotension
- Box warning: possibility of Pneumonia syndrome

Interactions:
- digoxin
- antihistamines
- TCAs
- Phenothiazines

28
Q

When a patient is administered amiodarone, what labs will the nurse be responsible for monitoring? What should the therapeutic range be?

A
  • Monitor lung function
  • Therapeutic range should be 1-2.5 mcg/mL
29
Q

Class IV Antidysrhytmics: Calcium Channel Blockers

What is the prototype, MOA, route, and therapeutic indications?

A

Prototype: Diltiazem/Verapamil

MOA: blocks movement of calcium ions in cardiac and smooth muscle cells.

Route: PO or IV

Indicated only for atrial dysrhythmias.

30
Q

What are the adverse effects of diltiazem and verapamil? Include contraindications and drug interactions.

A

A/E:
- dizzy, Ha, hypotension, HF, shock, arrhythmias

Contraindications: allergy, severe block, HF, hypotension

Interactions: alcohol, grapefruit juice, and beta-blockers.

31
Q

Honorable Mention: Adenosine

  1. How is this medication administered?
  2. What does this medication do?
  3. What does this medication terminate?
A
  1. Push this medication super fast, 1-2 seconds IV
  2. It stops heart rhythm and lets the SA node/pacemaker of the heart start rhythm again
  3. Terminates paroxysmal super ventricular tachycardia

Pharmacology (16 decks)

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