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NURS 252 (Pharmacology 2) > Heart Failure Drugs > Flashcards

Heart Failure Drugs Flashcards

1
Q

What is HF?

A

A pathological condition where the heart is unable to pump blood in sufficient amounts from ventricles to meet the body’s metabolic needs

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2
Q

What are the syndromes of HF

A

Failure of ventricle to eject blood
Fluid overload
Chamber dilation
Elevated intracardiac pressure

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3
Q

What are the symptoms of left sided HF? (lungs)

A

Pulmonary edema
Coughing
SOB
Dyspnea

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4
Q

What are the symptoms of right sided HF?

A

Systemic venous congestion
Pedal edema
JVD
Ascites
Hepatic congestion

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5
Q

What are the 2 primary causes of HF?

A

Myocardial deficiency
Increased workload

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6
Q

What conditions fall under myocardial deficiency and what specific categories (2)?

A

Inadequate contractility:
MI, CAD, Cardiomyopathy, Valvular insufficiency
Inadequate filling:
A-fib, Infection, tamponade, ischemia

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7
Q

What conditions fall under increased workload and what specific categories (2)?

A

Pressure overload:
Pulmonary and systemic HTN, Outflow obstruction
Volume overload:
Hypervolemia, congenital abnormalities, anemia, thyroid disease, infection, diabetes

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8
Q

Describe the 4 classes of HF

A

1:
No physical activity limitations
2:
Ordinary physical activity results in fatigue, dyspnea, etc.
3:
Marked limitation in physical activity
4:
Symptoms at rest or with no activity

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9
Q

What is the difference b/w positive inotropic, chronotropic and dromotropic?

A

I: Increase the force of myocardial contraction
C: Increase HR
D: Speed up cardiac conduction

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10
Q

What are the drugs of choice for early treatment of HF?

A

ACE inhibitors: Lisinopril
ARBs: Valsartan
B-blockers: Metoprolol
Positive inotropic drug: Dobutamine

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11
Q

T/F: Digoxin is given before these drugs

A

False; digoxin is given AFTER the drugs of choice

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12
Q

How does lisinopril help w HF, what are its ID and AE

A

Causes diuresis which decreases preload and the work of the heart
ID: HF, HTN, Acute MI
AE: Dry cough, hyperkalemia, decreased renal function

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13
Q

Why is valsartan (ARB) preferred over lisinopril (ACE i)

A

ARBs are less likely to cause a dry cough and hyperkalemia

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14
Q

How does spironolactone help w HF?

A

It’s a K-sparing diuretic that is shown to reduce the symptoms of HF

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15
Q

T/F: ARBs decrease preload and ACE i decrease afterload

A

False: ARBs = afterload
ACE = Preload

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16
Q

What are phosphodiesterase inhibitors?

A

Inhibit phosphodiesterase resulting in:
Intracellular increase in cAMP
Positive inotropic responses
Vasodilation
Increase in Ca for myocardial muscle contraction

17
Q

What is the only available phosphodiesterase inhibitor in canada?

A

Milrinone

18
Q

What is milrinone? (AE, forms, IE)

A

Only injectable
AE: Dysrhythmias, hypotension, angina, hypokalemia, tremor, thrombocytopenia
IE: Diuretics and digoxin

19
Q

Name a cardiac glycosides and it’s ID

A

Digoxin
Used in HF and to control ventricular response to a-fib

20
Q

What is the MOA of digoxin?

A

Increase myocardial contractility
Change electrical conduction properties of the heart
Decrease the rate of electrical conduction
Prolong the refractory period

21
Q

What are the tropic effects of cardiac glycosides ?

A

+ve inotropic effect: Increased force and velocity of myocardial contraction
-ve chronotropic effect: Reduced HR
-ve dromotropic effect: Decreased automaticity at SA node, decreased AV nodal conduction

22
Q

What are other drug effects of cardiac glycosides?

A

Increased stroke volume
Reduction in heart size during diastole
Decrease in venous BP and vein engorgement
Increase in coronary circulation
Decrease in exertional and paroxysmal nocturnal dyspnea, cough and cyanosis
Promotion of perfusion and diuresis

23
Q

What is a consideration regarding the therapeutic window of digoxin?

A

Very narrow
Low K levels increase its toxicity

24
Q

What is the optimal drug level of digoxin?

A

0.8 - 2 ng/mL

25
Q

What are the AE of digoxin?

A

Dysrhythmias, headaches, fatigue, malaise, confusion, convulsions, coloured vision, halo vision, anorexia, nausea, vomiting, diarrhea

26
Q

What is Digoxin immune fab therapy?

A

Activates free digoxin in the blood

27
Q

What are some points to remember regarding digoxin?

A

Large amounts of bran decrease absorption of oral digoxin
Ginseng, hawthorn, licorice increase its levels
St johns wort decrease its levels

28
Q

What conditions predispose pts to digoxin toxicity?

A

Hypokalemia
Use of a pacemaker
AV block
Hypercalcemia
Dysrhythmias
Hypothyroid, resp or renal disease
Older adults
Vent-fib

29
Q

Before giving any HF drugs, count apical pulse for _____

A

1 minute

30
Q

What should you do if the apical pusle is <60 or >100

A

Hold dose and notify prescriber

31
Q

Why should you avoid giving digoxin with high-fibre foods?

A

Fibre binds with digitalis

NURS 252 (Pharmacology 2) (23 decks)

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