Heart Failure drug Flashcards by maya chan

Left heart failure

Not enough blood being pumped to the lungs

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Symptoms of left heart failure

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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Symptoms of right sided heart failure

Systemic venous congestion
Pedal edema
Jugular venous distension
Ascites
Hepatic congestion

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Causes for heart failure

Myocardial deficiency and increased workload

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Types of myocardial deficiency

inadequate contractility and inadequate filling

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Types of increased workload

Pressure or volume overload

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Class 1 of HF

No physical activity limitations

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Class 2

Ordinary physical activates causes fatigue, dyspnea or other symptoms

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Class 3 heart failure

Limitation in physical activity

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Class 4 heart failure

Symptoms at rest or with no physical activity at all

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Positive Inotropic drug

Increase the force of Myocardial contraction

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Positive Chronotropic

Increase the heart rate

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Positive dromotropic

Increase cardiac conduction

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Ex of ACE inhibitor

Lisinopril

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Ex of ARBs (Angiotensin II receptor blockers)

Valsartan

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Ex of B blockers

Metoprolol

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Ex. of Aldosterone antagonists

Spironolactone

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Order of drug choice for heart failure

ACE inhibitor, ARBs, B Blockers, Loop diuretics, Aldosterone blocker (potassium sparring), then digoxin once everything else is being used

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Action of Dobutamine/typa drug

A positive inotropic
B1 vasoactive adrenergic drug

MOA of ACE inhibitors

Prevent sodium and water reabsorption by blocking aldosterone. Decreasing preload, left ventricular end volume and overall workload of the heart

Uses of lisinopril

hypertension, heart failure, and acute myocardial infarction

Adverse effects of lisnopril

Hyperkalemia, dry cough, decreased renal function

MOA of ARBs

Causes vasodilation decreasing the afterload and overall workload of the heart

Adverse effects of valsartan

same adverse effects as lisinopril without the dry cough and hyperkalemia (decreased renal function)

MOA of B blockers

Reducing sympathetic NS stimulation to heart reducing workload

MOA of Spironolactone

- Stops aldosterone, stopping the retention of sodium and water. Stopping edema which can worsen the heart - Is Potassium sparing which is shown to reduce the symptoms of HF

Where do ACE inhibitors, ARBs and B blocker affect the heart

ACE: preload ARBS: afterload B blockers: both

Phosphodiesterase Inhibitors MOA and drug effects

Inhibits the Phosphodiesterase enzyme Inodilators (inotropic and dilators)

Ex of Phosphodiesterase inhibitors

Milrinone

Milrinone adverse effects

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

Milrinone interactions

Diuretics (additive hypotensive), digoxin (additive inotropic), do not give furosemide in the same IV lines

Ex. of cardiac glycosides

Digoxin

Cardiac Glycosides indications

Are no longer first line treatment, used for HF and to control ventricular response to Afib

Cardiac Glycosides MOA

increase myocardial contractility through changing electrical conductions by decreasing conduction and making the contraction last longer

Drug effects of Cardiac Glycosides (inotropic etc effects)

- Positive inotropic effect without increase oxygen consumption - Negative chronotropic effect - Negative dromotropic effect: decrease conduction of the heart

Cardiac Glycosides drug effects pt 2

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

Digoxin adverse effects

- Narrow therapeutic window so it must be monitored (0.8-2 ng/ml) - Low potassium causes toxicity - Cardiovascular: dysrhythmias, including bradycardia or tachycardia - Central nervous system: headaches, fatigue, malaise, confusion, convulsions - Eyes: coloured vision (seeing green, yellow, purple), halo vision - Gastrointestinal: anorexia, nausea, vomiting, diarrhea

What are the signs and symptoms of digoxin toxicity

Adverse effects can be signs of toxicity

Treatment of digoxin toxicity

Digoxin immune Fab therapy

Indications of digoxin immune Fab therapy

Hyperkalemia, cardiac dysrhythmia, digoxin overdose

T or F one should take bran (fibre) when taking oral digoxin Why?

False as the fibre will absorb the digoxin and make it ineffective

Natural health products that increase digoxin levels

ginseng, hawthorn, licorice

Natural health products that decrease digoxin levels

St John’s Wort

Conditions that predispose digoxin toxicity

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

What to do when apical pulse less than 60 or greater than 100 beats/min

Hold dose and notify the prescriber

How to give milrinone

Infusion pump

avoid what 2 hrs before or after HF drug admin

antacids, milk and bran