Heart Failure Drugs Flashcards
What is heart failure?
Condition in which the heart cannot pump enough blood to keep up with the body’s demand
What is the order of the flow of blood?
Veins R atrium R ventricle Lungs L atrium L ventricle Body
What are the causes of a heart failure?
Major:
Chronic hypertension
Myocardial infarction
Other:
Valve deficiency
Atrial fibrillation/flutter
Aging of myocardium
What is the most common cause of left-sided heart failure?
Left ventricular hypertrophy due to hypertension
What are the symptoms of a left-sided heart failure?
Pulmonary edema
Coughing
Dyspnea
What are the symptoms of a right-sided heart failure?
Jugular vein distention
Ascites (swelling of abdomen)
Pedal edema
What are the diagnostic studies performed for heart failure?
BNP test
Echocardiography
What are the drug classes used to treat heart failure?
Diuretics ACE inhibitors Beta-blockers Cardiac glycosides B-type natriuretic peptides Vasodilators
What do chronotropic drugs do?
Influence rate of the heartbeat
What do dromotropic drugs do?
Influence the conduction of electrical impulses of the heart
What do inotropic drugs do?
Influence the force of myocardial contraction
What is preload?
The pressure in ventricles after they are filled but before ejection
What is afterload?
Pressure against which the heart must work to eject blood during systole (systolic pressure)
What is cardiac remodeling?
The changes in size, shape, structure, and function of the heart
What is compensated heart failure?
Refers to the chronic form of CHF that is under control with medication
What is decompensated heart failure?
Symptoms are frequent, which go away in the morning or when sitting up and moving around, with or without treatment
What is congestive heart failure?
Heart failure which also results in fluid building up in other parts of the body
What is the mechanism of action of loop diuretics (Lasix, furosemide)?
Decreases sodium, chlorine, and potassium reabsorption in ascending loop of Henle, resulting in profound diuresis
What are the drug effects of loop diuretics (furosemide, Lasix) for heart failure?
Reduced blood volume decreases venous pressure (preload) and arterial pressure (afterload)
Reduced pulmonary and peripheral edema
What is a loop diuretic (furosemide, Lasix) used for heart failure?
Furosemide (Lasix)
What are the indications of loop diuretics (furosemide, Lasix)?
Acute and chronic heart failure
What are the dosages and routes of loop diuretics (furosemide, Lasix) for heart failure?
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
What are the adverse effects of loop diuretics (furosemide, Lasix)?
Hypokalemia (increased risk of digoxin toxicity)
Severe hypotension
What are the nursing implications for loop diuretics (furosemide, Lasix)?
Assess patient’s fluid volume status
Assess vital signs
Assess labs
What should you educate the patient about loop diuretics (furosemide, Lasix)?
Avoid taking late in the afternoon (nocturia)
Eat foods rich in potassium
Report signs of hypokalemia
What are some foods rich in potassium?
Bananas Oranges Potatoes Tomatoes Meats Fish Wheat bread Legumes
What are signs of hypokalemia?
Lethargy
Weakness
Leg cramps
What is the mechanism of action of ACE inhibitors?
Inhibition of ACE prevents conversion of angiotensin I to angiotensin II (a powerful vasoconstrictor)
Reduces aldosterone secretion
Suppresses degradation of kinins (vasodilator)
What are the drug effects of ACE inhibitors (end in -pril) for heart failure?
Arteriolar and venous dilation Reduced preload Reduced afterload Decreased pulmonary and pedal edema Increased cardiac output Increased kinins reduces cardiac remodeling
What are some ACE inhibitors used for heart failure?
Lisinopril (Prinvil)
Captopril (Capoten)
Enalapril (Vasotec)
What are the indications of ACE inhibitors (end in -pril) ?
Cornerstone of heart failure therapy
What are the adverse effects of ACE inhibitors (end in -pril) ?
Hypotension
Dry cough
Hyperkalemia
Angioedma
What is the mechanism of action of beta-blockers?
Protect heart from excessive sympathetic stimulation
What are the drugs effects of beta-blockers for heart failure?
Improve left ventricular ejection fraction (1 - 3 months)
Slow the progression of heart failure
Reduce need for hospitalization
Prolong survival
What are the beta-blockers used for heart failure?
Carvedilol (Coreg)
Bisoprolol
Sustained-release metoprolol (Toprol XL)
What are the dosages and routes of beta-blockers for heart failure?
Start low and go slow
Excessive beta blockade can reduce ventricular contractility
What are the contraindications of beta-blockers?
Heart block CRISTAL SAYS NO
What are the adverse effects of beta-blockers?
Fluid retention Worsening heart failure Bradycardia Heart block Hypotension
What is an example of a cardiac glycoside?
Digoxin (Lanoxin)
What is the oldest group of cardiac drugs?
Cardiac glycosides
What is the mechanism of action of cardiac glycoside?
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
What are the drug effects of cardiac glycosides?
Positive inotropic (increased contractility) which increases cardiac output Increased cardiac output can reverse all the overt manifestations of heart failure
What are the indications of cardiac glycosides?
Second-line heart failure
Atrial fibrillation
What are the precautions for cardiac glycosides?
Lasix (secondary to risk of hypokalemia)
What are the adverse effects of cardiac glycosides?
Digoxin toxicity
Cardiac dysrhythmia
What is the therapeutic window of digoxin (Lanoxin)?
0.5 - 0.8 ng/mL
What is the normal range of potassium levels?
3.5 - 5 mEq/L
What are the signs and symptoms of digoxin toxicity?
Heart rate below 60 or new irregular rhythm
Anorexia
Nausea
Confusion
Blurred, yellow tinged appearance of halos
How long does it take for digoxin to be eliminated from the body?
About 1 week
What is the antidote for digoxin toxicity?
Digoxin immune Fab (Digibind)
What are the indications of digoxin immune Fab (Digibind)?
Serious life-threatening over dosage with digoxin
What is the action of digoxin immune Fab (Digibind)?
An antibody produced in sheep that binds to unbound digoxin in serum
What is the therapeutic effect of digoxin immune Fab (Digibind)?
Binding and subsequent removal of digoxin, preventing toxic effects in overdose
What are the nursing implications for cardiac glycosides?
Monitor vital signs
Monitor for EKG changes
Monitor labs: Potassium and digoxin levels
What are some things to educate the patient about cardiac glycosides?
Teach to monitor pulse rate and regularity
Signs and symptoms of digoxin toxicity
Monitor for signs and symptoms of hypokalemia
What is the vasodilator used for heart failure?
Isosorbide Dinitrate plus Hydralize
What is the mechanism of action and drug effect of Isosorbid Dinitrate (Isordil)?
Causes selective dilation of veins, which decreases preload and reduces congestive symptoms
What is the mechanism of action and drug effect of Hydralize (Apresoline)?
Causes selective dilation of arterioles, which can improve cardiac output (decreased afterload) and renal blood flow (increase urine output/decrease volume)
What is an example of an Isosorbide Dinitrate plus Hydralize vasodilator?
Bidil (37.5 mg of hydralizine / 20 mg isosorbide dinitrate)
What is the newest class of medication for heart failure?
B-type natriuretic peptide
What is the mechanism of action and drug effect of B-type natriuretic peptide?
Suppresses of RAAS
Suppresses SNS
Direct dilation of arterioles and veins (decreased preload and decreased afterload)
What is an example of a B-type Natriuretic Peptide?
Nesiritide (Natrecor)
What is the indication/route of B-type natriuretic peptide?
Acutely decompensated congestive heart failure via continuous intravenous infusion only
What are the nursing implications for digoxin?
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
What are some things to educate the patient about digoxin?
Instruct patient to immediately report weight gain of 2+ pounds in 1 day or 5+ pounds in 1 week
What are the signs that show the effectiveness of digoxin?
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
What is the mechanism of action for calcium channel blockers (amlodipine, cardizem)?
Prevents influx of calcium ions across cell membrane of vascular smooth muscle.
What are the drug effects for calcium channel blockers (amlodipine, cardizem)?
Dilation of peripheral and coronary arteries and arterioles decreasing afterload
What are the adverse effects for calcium channel blockers (amlodipine, cardizem)?
Constipation Suppression of cardiac function Peripheral edema Hypotension Dizziness
What are the nursing implications for for calcium channel blockers (amlodipine, cardizem)?
Monitor BP and HR
What is the patient education for calcium channel blockers (amlodipine, cardizem)?
Increase fluid and fiber intake unless otherwise instructed by MD
Change position slowly
