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UNRS 113 > Heart Failure Drugs > Flashcards

Heart Failure Drugs Flashcards

1
Q

What is heart failure?

A

Condition in which the heart cannot pump enough blood to keep up with the body’s demand

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2
Q

What is the order of the flow of blood?

A 
Veins
R atrium
R ventricle
Lungs
L atrium
L ventricle
Body
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3
Q

What are the causes of a heart failure?

A

Major:
Chronic hypertension
Myocardial infarction

Other:
Valve deficiency
Atrial fibrillation/flutter
Aging of myocardium

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4
Q

What is the most common cause of left-sided heart failure?

A

Left ventricular hypertrophy due to hypertension

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5
Q

What are the symptoms of a left-sided heart failure?

A

Pulmonary edema
Coughing
Dyspnea

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6
Q

What are the symptoms of a right-sided heart failure?

A

Jugular vein distention
Ascites (swelling of abdomen)
Pedal edema

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7
Q

What are the diagnostic studies performed for heart failure?

A

BNP test

Echocardiography

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8
Q

What are the drug classes used to treat heart failure?

A 
Diuretics
ACE inhibitors
Beta-blockers
Cardiac glycosides
B-type natriuretic peptides
Vasodilators
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9
Q

What do chronotropic drugs do?

A

Influence rate of the heartbeat

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10
Q

What do dromotropic drugs do?

A

Influence the conduction of electrical impulses of the heart

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11
Q

What do inotropic drugs do?

A

Influence the force of myocardial contraction

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12
Q

What is preload?

A

The pressure in ventricles after they are filled but before ejection

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13
Q

What is afterload?

A

Pressure against which the heart must work to eject blood during systole (systolic pressure)

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14
Q

What is cardiac remodeling?

A

The changes in size, shape, structure, and function of the heart

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15
Q

What is compensated heart failure?

A

Refers to the chronic form of CHF that is under control with medication

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16
Q

What is decompensated heart failure?

A

Symptoms are frequent, which go away in the morning or when sitting up and moving around, with or without treatment

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17
Q

What is congestive heart failure?

A

Heart failure which also results in fluid building up in other parts of the body

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18
Q

What is the mechanism of action of loop diuretics (Lasix, furosemide)?

A

Decreases sodium, chlorine, and potassium reabsorption in ascending loop of Henle, resulting in profound diuresis

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19
Q

What are the drug effects of loop diuretics (furosemide, Lasix) for heart failure?

A

Reduced blood volume decreases venous pressure (preload) and arterial pressure (afterload)
Reduced pulmonary and peripheral edema

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20
Q

What is a loop diuretic (furosemide, Lasix) used for heart failure?

A

Furosemide (Lasix)

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21
Q

What are the indications of loop diuretics (furosemide, Lasix)?

A

Acute and chronic heart failure

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22
Q

What are the dosages and routes of loop diuretics (furosemide, Lasix) for heart failure?

A

Oral: 20 - 80 mg/daily or BID; Max dose 600 mg/day
IV: 20 - 40 mg/dose IV x 1; May increase by 20 mg q2h

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23
Q

What are the adverse effects of loop diuretics (furosemide, Lasix)?

A

Hypokalemia (increased risk of digoxin toxicity)

Severe hypotension

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24
Q

What are the nursing implications for loop diuretics (furosemide, Lasix)?

A

Assess patient’s fluid volume status
Assess vital signs
Assess labs

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25
Q

What should you educate the patient about loop diuretics (furosemide, Lasix)?

A

Avoid taking late in the afternoon (nocturia)
Eat foods rich in potassium
Report signs of hypokalemia

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26
Q

What are some foods rich in potassium?

A 
Bananas
Oranges
Potatoes
Tomatoes
Meats
Fish
Wheat bread
Legumes
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27
Q

What are signs of hypokalemia?

A

Lethargy
Weakness
Leg cramps

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28
Q

What is the mechanism of action of ACE inhibitors?

A

Inhibition of ACE prevents conversion of angiotensin I to angiotensin II (a powerful vasoconstrictor)
Reduces aldosterone secretion
Suppresses degradation of kinins (vasodilator)

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29
Q

What are the drug effects of ACE inhibitors (end in -pril) for heart failure?

A 
Arteriolar and venous dilation
Reduced preload
Reduced afterload
Decreased pulmonary and pedal edema
Increased cardiac output
Increased kinins reduces cardiac remodeling
30
Q

What are some ACE inhibitors used for heart failure?

A

Lisinopril (Prinvil)
Captopril (Capoten)
Enalapril (Vasotec)

31
Q

What are the indications of ACE inhibitors (end in -pril) ?

A

Cornerstone of heart failure therapy

32
Q

What are the adverse effects of ACE inhibitors (end in -pril) ?

A

Hypotension
Dry cough
Hyperkalemia
Angioedma

33
Q

What is the mechanism of action of beta-blockers?

A

Protect heart from excessive sympathetic stimulation

34
Q

What are the drugs effects of beta-blockers for heart failure?

A

Improve left ventricular ejection fraction (1 - 3 months)
Slow the progression of heart failure
Reduce need for hospitalization
Prolong survival

35
Q

What are the beta-blockers used for heart failure?

A

Carvedilol (Coreg)
Bisoprolol
Sustained-release metoprolol (Toprol XL)

36
Q

What are the dosages and routes of beta-blockers for heart failure?

A

Start low and go slow

Excessive beta blockade can reduce ventricular contractility

37
Q

What are the contraindications of beta-blockers?

A

Heart block CRISTAL SAYS NO

38
Q

What are the adverse effects of beta-blockers?

A 
Fluid retention
Worsening heart failure
Bradycardia
Heart block
Hypotension
39
Q

What is an example of a cardiac glycoside?

A

Digoxin (Lanoxin)

40
Q

What is the oldest group of cardiac drugs?

A

Cardiac glycosides

41
Q

What is the mechanism of action of cardiac glycoside?

A

Inhibits sodium-potassium adenosine triphosphatase pump
Causes accumulation of calcium within cardiac myocytes
The calcium then augments contractile force by facilitating the interaction of myocardial actin and myosin

42
Q

What are the drug effects of cardiac glycosides?

A 
Positive inotropic (increased contractility) which increases cardiac output
Increased cardiac output can reverse all the overt manifestations of heart failure
43
Q

What are the indications of cardiac glycosides?

A

Second-line heart failure

Atrial fibrillation

44
Q

What are the precautions for cardiac glycosides?

A

Lasix (secondary to risk of hypokalemia)

45
Q

What are the adverse effects of cardiac glycosides?

A

Digoxin toxicity

Cardiac dysrhythmia

46
Q

What is the therapeutic window of digoxin (Lanoxin)?

A

0.5 - 0.8 ng/mL

47
Q

What is the normal range of potassium levels?

A

3.5 - 5 mEq/L

48
Q

What are the signs and symptoms of digoxin toxicity?

A

Heart rate below 60 or new irregular rhythm
Anorexia
Nausea
Confusion
Blurred, yellow tinged appearance of halos

49
Q

How long does it take for digoxin to be eliminated from the body?

A

About 1 week

50
Q

What is the antidote for digoxin toxicity?

A

Digoxin immune Fab (Digibind)

51
Q

What are the indications of digoxin immune Fab (Digibind)?

A

Serious life-threatening over dosage with digoxin

52
Q

What is the action of digoxin immune Fab (Digibind)?

A

An antibody produced in sheep that binds to unbound digoxin in serum

53
Q

What is the therapeutic effect of digoxin immune Fab (Digibind)?

A

Binding and subsequent removal of digoxin, preventing toxic effects in overdose

54
Q

What are the nursing implications for cardiac glycosides?

A

Monitor vital signs
Monitor for EKG changes
Monitor labs: Potassium and digoxin levels

55
Q

What are some things to educate the patient about cardiac glycosides?

A

Teach to monitor pulse rate and regularity
Signs and symptoms of digoxin toxicity
Monitor for signs and symptoms of hypokalemia

56
Q

What is the vasodilator used for heart failure?

A

Isosorbide Dinitrate plus Hydralize

57
Q

What is the mechanism of action and drug effect of Isosorbid Dinitrate (Isordil)?

A

Causes selective dilation of veins, which decreases preload and reduces congestive symptoms

58
Q

What is the mechanism of action and drug effect of Hydralize (Apresoline)?

A

Causes selective dilation of arterioles, which can improve cardiac output (decreased afterload) and renal blood flow (increase urine output/decrease volume)

59
Q

What is an example of an Isosorbide Dinitrate plus Hydralize vasodilator?

A

Bidil (37.5 mg of hydralizine / 20 mg isosorbide dinitrate)

60
Q

What is the newest class of medication for heart failure?

A

B-type natriuretic peptide

61
Q

What is the mechanism of action and drug effect of B-type natriuretic peptide?

A

Suppresses of RAAS
Suppresses SNS
Direct dilation of arterioles and veins (decreased preload and decreased afterload)

62
Q

What is an example of a B-type Natriuretic Peptide?

A

Nesiritide (Natrecor)

63
Q

What is the indication/route of B-type natriuretic peptide?

A

Acutely decompensated congestive heart failure via continuous intravenous infusion only

64
Q

What are the nursing implications for digoxin?

A

Take apical pulse for one minute before giving medication
Hold dose and notify physician if bradycardia or new arrhythmias occur
Check potassium level prior to giving medication
Check baseline kidney function
Educate patient on signs/symptoms of digoxin toxicity

65
Q

What are some things to educate the patient about digoxin?

A

Instruct patient to immediately report weight gain of 2+ pounds in 1 day or 5+ pounds in 1 week

66
Q

What are the signs that show the effectiveness of digoxin?

A

Increased urinary output
Decreased fatigue, edema, shortness of breath, dyspnea, and crackles
Improved peripheral pulses, skin color, and temperature
Serum digoxin levels 0.5 - 0.8 ng/mL

67
Q

What is the mechanism of action for calcium channel blockers (amlodipine, cardizem)?

A

Prevents influx of calcium ions across cell membrane of vascular smooth muscle.

68
Q

What are the drug effects for calcium channel blockers (amlodipine, cardizem)?

A

Dilation of peripheral and coronary arteries and arterioles decreasing afterload

69
Q

What are the adverse effects for calcium channel blockers (amlodipine, cardizem)?

A 
Constipation
Suppression of cardiac function
Peripheral edema
Hypotension
Dizziness
70
Q

What are the nursing implications for for calcium channel blockers (amlodipine, cardizem)?

A

Monitor BP and HR

71
Q

What is the patient education for calcium channel blockers (amlodipine, cardizem)?

A

Increase fluid and fiber intake unless otherwise instructed by MD
Change position slowly

UNRS 113 (7 decks)

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