Heart Failure Drugs

Question 1

What are the classes of HF drugs?

Answer 1

• Digoxin
• ARNI
• Vasopressor
• Inodilator

Question 2

What is an example of a First Race Based Drugs?

Answer 2

BiDil

Question 3

What is important to know about the history of BiDil?

Answer 3

• the FDA approved BiDil® specifically for self identified African Americans
• it is important for us to recognize that race is a social construct, not biological

Question 4

What are some examples of Chronic HF Drugs?

Answer 4

• Cardiac Glycoside
  ~ Digoxin
• ARNI
  ~ Sacubitril + Valsartan

Question 5

What is Digoxin used to treat?

Answer 5

• Heart Failure
• Atrial Fibrillation

Question 6

Describe the mechanism of action of Digoxin.

Answer 6

I DIG CD’s

• I = Inotropic (POSITIVE)
• DIG = Digoxin
• CD’s = Chronotropic and Dromotropic (NEGATIVE)

Question 7

What is the relationship between Digoxin and Potassium?

Answer 7

Due to Digoxin + Potassium competing, we must have normal potassium levels

Question 8

Describe some Toxicity Effects of Digoxin.

Answer 8

• Heart Related
  
  • Bradycardia
• GI related
  
  • Anorexia, Nausea, Vomiting
• CNS related
  
  • Fatigue, Confusion
  • Vision disturbances

Question 9

What can cause Digoxin toxicity?

Answer 9

hypokalemia

Question 10

How to treat Digoxin toxcity?

Answer 10

Digibind ®- Digoxin specific Antibody Fab fragments

Question 11

What drugs do Digoxin interact with?

Answer 11

• Diuretics that lower potassium
• Drugs/Foods that can bind up Digoxin and result in lower levels

Question 12

Digoxin nursing consideration?

Answer 12

• Always think about POTASSIUM!
• Encourage a diet high in potassium

Question 13

What is Angiotensin Receptor-Neprilysin Inhibitor (ARNI)?

Answer 13

This contains two drugs in one:

• Sacubitril (new drug- Neprilysn Inhibitor)
• Valsartan (an Angiotensin II Receptor Blocker (ARB))

Question 14

What is Sacubitril-Valsartan used to treat?

Answer 14

Heart Failure

Question 15

Sacubitril-Valsartan adverse effects?

Answer 15

• Hyperkalemia
• Chronic, non-productive cough
• Angioedema
• Orthostatic hypotension (dizziness/fall risk)

Question 16

Boxed Warning for Sacubitril-Valsartan?

Answer 16

Drugs that work on the RAAS can cause injury and death to a developing fetus

Question 17

Sacubitril-Valsartan drug interactions?

Answer 17

• Lithium can accumulate
• COX Inhibitors/NSAID use can decrease effective

Question 18

What are examples of acute IV drugs for Inotropic and/or Hemodynamic support?

Answer 18

• Vasopressor
  ~ Dopamine
• Inodilator
  ~ Milrinone

Question 19

What are some goals for Dopamine and Milrinone?

Answer 19

• increase cardiac output
• reduce organ damage (such as kidneys)

Question 20

What is Dopamine used to treat?

Answer 20

• Hemodynamic Support
• Inotropic Support for Heart Failure

Question 21

Dopamine adverse effect?

Answer 21

• hypertension
• too much demand on heart (tachycardia, dysrhythmias, ischemic damage)

Question 22

What is Milrinone used to treat?

Answer 22

• Severe, decompensated HF (late stages)
• Bridge to await a heart transplant

Question 23

Milrinone adverse effects?

Answer 23

• can overstress the heart and lead to dysrhythmias (ventricular)
• due to vasodilatory effect, can lead to hypotension

Question 24

Milrinone contraindications?

Answer 24

Can’t use if MI or dysrhythmia

Question 25

What are some goals to prevent Heart Failure exacerbation?

Answer 25

• If fluid overloaded- remove excess fluid
  ~ Patient should weigh daily!
• Increase cardiac output to reduce end organ dysfunction

Question 26

What are some common factors that precipitate Acute Decompensated HF?

Answer 26

• Recent addition of negative inotropic drugs
• Initiation of drugs that increase salt retention
• Excessive alcohol or illicit drug use