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nurs 252 > Heart Failure drug > Flashcards

Heart Failure drug Flashcards

1
Q

Left heart failure

A

Not enough blood being pumped to the lungs

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2
Q

Symptoms of left heart failure

A

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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3
Q

Symptoms of right sided heart failure

A

Systemic venous congestion
Pedal edema
Jugular venous distension
Ascites
Hepatic congestion

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4
Q

Causes for heart failure

A

Myocardial deficiency and increased workload

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5
Q

Types of myocardial deficiency

A

inadequate contractility and inadequate filling

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6
Q

Types of increased workload

A

Pressure or volume overload

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7
Q

Class 1 of HF

A

No physical activity limitations

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8
Q

Class 2

A

Ordinary physical activates causes fatigue, dyspnea or other symptoms

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9
Q

Class 3 heart failure

A

Limitation in physical activity

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10
Q

Class 4 heart failure

A

Symptoms at rest or with no physical activity at all

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11
Q

Positive Inotropic drug

A

Increase the force of Myocardial contraction

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12
Q

Positive Chronotropic

A

Increase the heart rate

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13
Q

Positive dromotropic

A

Increase cardiac conduction

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14
Q

Ex of ACE inhibitor

A

Lisinopril

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15
Q

Ex of ARBs (Angiotensin II receptor blockers)

A

Valsartan

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16
Q

Ex of B blockers

A

Metoprolol

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17
Q

Ex. of Aldosterone antagonists

A

Spironolactone

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18
Q

Order of drug choice for heart failure

A

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

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19
Q

Action of Dobutamine/typa drug

A

A positive inotropic
B1 vasoactive adrenergic drug

20
Q

MOA of ACE inhibitors

A

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

21
Q

Uses of lisinopril

A

hypertension, heart failure, and acute myocardial infarction

22
Q

Adverse effects of lisnopril

A

Hyperkalemia, dry cough, decreased renal function

23
Q

MOA of ARBs

A

Causes vasodilation decreasing the afterload and overall workload of the heart

24
Q

Adverse effects of valsartan

A

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

25
Q

MOA of B blockers

A

Reducing sympathetic NS stimulation to heart reducing workload

26
Q

MOA of Spironolactone

A
  • 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
27
Q

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

A

ACE: preload
ARBS: afterload
B blockers: both

28
Q

Phosphodiesterase Inhibitors MOA and drug effects

A

Inhibits the Phosphodiesterase enzyme
Inodilators (inotropic and dilators)

29
Q

Ex of Phosphodiesterase inhibitors

A

Milrinone

30
Q

Milrinone adverse effects

A

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

31
Q

Milrinone interactions

A

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

32
Q

Ex. of cardiac glycosides

A

Digoxin

33
Q

Cardiac Glycosides indications

A

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

34
Q

Cardiac Glycosides MOA

A

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

35
Q

Drug effects of Cardiac Glycosides (inotropic etc effects)

A
  • Positive inotropic effect without increase oxygen consumption
  • Negative chronotropic effect
  • Negative dromotropic effect: decrease conduction of the heart
36
Q

Cardiac Glycosides drug effects pt 2

A

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

37
Q

Digoxin adverse effects

A
  • 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
38
Q

What are the signs and symptoms of digoxin toxicity

A

Adverse effects can be signs of toxicity

39
Q

Treatment of digoxin toxicity

A

Digoxin immune Fab therapy

40
Q

Indications of digoxin immune Fab therapy

A

Hyperkalemia, cardiac dysrhythmia, digoxin overdose

41
Q

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

A

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

42
Q

Natural health products that increase digoxin levels

A

ginseng, hawthorn, licorice

43
Q

Natural health products that decrease digoxin levels

A

St John’s Wort

44
Q

Conditions that predispose digoxin toxicity

A

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

45
Q

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

A

Hold dose and notify the prescriber

46
Q

How to give milrinone

A

Infusion pump

47
Q

avoid what 2 hrs before or after HF drug admin

A

antacids, milk and bran

nurs 252 (23 decks)

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