Heart failure drugs Flashcards
Cause of heart failure
- coronary artery disease
- heart attack
- cardiomyopathy
- hig BP, thyroid, kidney, diabetes, defects
S/S of heart failure
- dyspnea
- fatigue
- fluid retention
- pulmonary edema
Progressive heart failure
- Left or right sided (left sided more common and usually causes right sided)
- reduced blood flow to the organs
- chronic renal failure (puts more stress on heart)
ACE Inhibitors MOA
- ACE = angiotensin-converting enzyme
- block the enzyme that converts angiotensin I into II
- inhibit aldosterone
- decrease Na retention
- promote diuresis
- decrease preload
ACE inhibitors also used for ___
hypertension and post MI to prevent the remodeling that can lead to HF
Lisinopril and catropril drug class
ACE inhibitors (for HF)
🧠 ACE inhibitor AE
- renal failure
- angioedema near airway (rare but life-threatening)
- fatigue, dizziness, HA, mood change, loss of taste
- hyperkalemia
- dry cough
- first dose hypotensive effect
🧠 ACE inhibitor interactions
- NSAIDS reduce BP, risk for acute kidney failure
- other antihypertensives and diuretics
- lithium
- K supplements/ K sparing diuretics
Angiotensin receptor blockers (ARB) MOA
- block angiotensin II
- potent vasoldilating effect
- decrease systemic vascular resistence (SVR)
- Valsartan, Irbesartan, Losartan, and Candesartan classification
ARBs
ARBs also used for ___
chronic kidney disease and prescribed after a heart attack
Beta blockers MOA
- cardioprotective
- decrease HR
- delay AV conduction
- decrease contractility
- decrease automaticity
Metoprolol and Carvedilol drug class
Beta-blockers (for HF)
Cardvedilol precautions
nonselective
also a calcium channel blocker
Hydralazine drug class
vasodilator
Hydralazine precaution
monitor for Lupus (SLE)
🧠Vasodilator precautions
- monitor neuro status (confusion, dizziness, syncope, hemorrhagic stroke)
- drastic BP changes
- elderly pt
Milrinone (Primacor) classification and MOA
vasodilator
inotrope
Phosphodiesterase inhibitor (PDI, relaxes smooth muscle)
Increase Ca in the heart
Milrinone (Primacor) contraindications
- allergy
- severe aortic/pulmonary valve disease
- HF from diastolic dysfunction
Milrinone (Primacor) used for
short term treatment of acute HF in the ICU
Milrinone (Primacor) AE
- hypokalemia
- hypertension
- angina
- tremor
- thrombocytopenia
- ventricular dysrhythmia
Milrinone (Primacor) interactions
Diuretics (hypovolemia)
Digoxin (increased inotropic effects)
🧠Digoxin and Lanoxin classification
Cardiac glycosides (digitalis glycosides)
🧠Digoxin and Lanoxin used for
HF and a fib
🧠Digoxin and Lanoxin MOA
positive inotropic (harder contraction for more filling to allow HR to slow)
decreased conduction
Digoxin and Lanoxin contraindications
- 2nd/3rd degree heart block
- ventricular fib
Digoxin and Lanoxin AE
- bradycardia
- hypotension
- HD, fatigue, confusion, convulsion
- colored/halo vision
- anorexia, N/V/D
🧠Digoxin and Lanoxin toxicity
normal serum level is 0.5-2ng
S/S include AE and heart block, atrial tachycardia, ventricular dysrhythmias
🧠Digoxin and Lanoxin interactions
- Amiodarone
- Quinidine
- Verapamil
- Dietary fiber (bran)🧠
- Herbal supplements
- Drugs that cause low K and Mg
🧠Digoxin and Lanoxin toxicity antidote
Digoxin immune fab (Digifab) or Digoxin-specific antibody (Digibind) used for hyperkalemia and life-threatening dysrhythmias or OD
Digoxin and Lanoxin nursing precautions
- monitor electrolytes
- digoxin levels
- CNS effects
- BP and apical
- extra heart sounds
- vision changes
🧠Antihypertensives assessment
- Full exam, history
- Vitals
- EKG,
- CBC,
- basic metabolic panel (MBP) for electrolytes
- cholesterol
- LFT
- Eye/retina exam (d/t the small blood vessels of the eye)
🧠Antihypertensives education
- Don’t stop taking abruptly to avoid rebound HTN (may cause stroke)
- Impotence
- Usually lifelong therapy
🧠Digoxin and Lanoxin medication administration
PO
IV (usually with a loading dose)
