heart failure: chapter 25 Flashcards
what are 4 symptoms of left sided heart failure. what is a way to remember these symptoms
pulmonary edema, cough, sob, dyspnea
LEFT=LUNG
what are 3 symptoms of right sided heart failure
pedal edema, jugular vein distension, hepatic congestion
what are the 4 classes of heart failure
- no limit to normal physical activity
- physical activity leads to fatigue and sob
- limitation in normal physical activity
- symptoms at rest or with any activity
what do positive inotropic drugs do
increase the force of myocardial contraction
what are the 2 classes of positive inotropic drugs
phosphodiesterase inhibitors, cardiac glycosides
what do positive chronotropic drugs do
increase heart rate
what do positive dromotropic drugs do
accelerate conduction
what do loop diuretics do
reduce symptoms of heart failure secondary to fluid overload
when would digoxin be used for heart failure
when all other drugs have been tried
mechanism of action of ace inhibitors
prevent sodium and water reabsorption by inhibiting aldosterone secretion
what are the 3 effects of ace inhibitors on the body
cause diuresis, decrease blood volume and blood return to the heart, decrease preload and work of the heart
what is a key ace inhibitor
lisinopril
3 adverse effects of linsopril
hyperkalemia, dry cough, decrease in kidney function
2 effects of angiotensin II receptor blockers on the body
vasodilation, decrease systemic vascular resistance
between lisinopril and valsartan, which drug is less likely to cause cough and hyperkalemia
valsartan
what is a key ARB
valsartan
mechanism of action of beta blockers
prevent catecholamine actions on the heart
what are 4 effects of beta blockers on the body
reduced hr, delayed av node conduction, reduced myocardial contractility, decreased myocardial automaticity
what is a key beta blocker
metoprolol
when would aldosterone antagonists be used
in the case of severe heart failure
mechanism of action of aldosterone antagonists and how does this have an effect on the body
block the release of aldosterone which decreases the retention of sodium and water
what is a key aldosterone antagonist
spironolactone
what drug class is dobutamine
b1 selective vasoactive adrenergic drug
mechanism of action of dobutamine and how does this have an effect on the body
stimulate b1 receptors which increases contractility leading to increased cardiac output
mechanism of action of phosphodiesterase inhibitors (2)
increase cAMP, inhibit phosphodiesterase
how does the increase in cAMP have an effect on the body (2)
positive inotropic response, vasodilation which reduces the force of contractions
how does the inhibition of phosphodiesterase have an effect on the body
increases availability of calcium for myocardial muscle contraction. heart muscle is able to relax more than normal because it is more responsive
indication for phosphodiesterase inhibitors
acute heart failure
contraindication for phosphodiesterase inhibitors
heart failure due to diastolic dysfunction
2 adverse effects of phosphodiesterase inhibitors
ventricular dysrhythmia, hypokalemia
what is the main sign of phosphodiesterase inhibitor toxicity
hypotension
what is the treatment for phosphodiesterase inhibitor overdose
reduce the dose or temporarily discontinue
what is a key phosphodiesterase inhibitor
milrinone
what are 3 adverse effects of milrinone
dysrhythmia, hypokalemia, elevated liver enzymes
what are 2 drugs that milrinone interacts with
diuretics and digoxin
what drug classes are first line for treating heart failure
ace inhibitors and diuretics
what is a negative chronotropic effect
decreased heart rate
what is a negative dromotropic effect
decrease automaticity of the sa node, decreased av node conduction, prolonged atrial and ventricular refractory periods
what are 5 effects that cardiac glycosides have on the body
- increased stroke volume
- decreased heart size during diastole
- decreased bp
- increased coronary circulation
- promote perfusion
- improve symptom control
what is the mechanism of action of cardiac glycosides
positive inotropic effect, negative chronotropic effect, negative dromotropic effect
2 indications for cardiac glycosides
systolic heart failure, atrial fibrilation
what is the normal level for cardiac glycosides
0.8-2ng/mL
what 3 things can increase the risk of cardiac glycoside toxicity
low potassium, low magnesium, decreased kidney function
what are 4 signs of cardiac glycoside toxicity
bradycardia, dizziness, confusion, visual disturbances in the form of blurred or yellow vision
what can be used in the case of cardiac glycoside toxicity
digoxin immune fab therapy
what is digoxin immune fab therapy
an antibody is used to inactivate free digoxin
what are 3 situations where digoxin immune fab therapy would be used
hyperkalemia, life threatening cardiac dysrhythmia, life threatening overdose
5 interactions of digoxin
bran, ginseng, hawthorn, licorice, st. johns wart
what are 6 conditions that can increase the risk of digoxin toxicity
pacemaker, hypokalemia, hypercalcemia, dysrhythmia, kidney dysfunction, ventricular fibrillation
what should you assess in terms of pulse before administration of a heart failure drug
hr at the apical and radial for 1min
