Heart Failure Drugs (Flashcards)
What happens in left sided heart failure?
Left sided (Left = Lung)
Pulmonary edema
Coughing
Shortness of breath
Dyspnea
what happens in right sided HF?
Right sided
Systemic venous congestion
Pedal edema
Jugular venous distension
Ascites
Hepatic congestion
Differences between Class I, II, II, IV HF?
Class I
No physical activity limitations
Class II
Ordinary physical activity results in fatigue, dyspnea, or other symptoms.
Class III
Marked limitation in physical activity
Class IV
Symptoms at rest or with no physical activity at all
Positive inotropic drugs do what?
Increase myocardial contraction
Positive chronotropic drugs do what?
Increase HR
Positive dromotropic drugs do what?
accelerate cardiac conduction
whats the ACE inhibitor used?
Lisinopril
Whats the ARBS used?
Valsartan
whats the b-blocker used?
Metoprolol
Dobutamine, what does it do?
Has a positive inotropic effect (increased myocardial contractility).
what does lisinopril do?
Prevent sodium and water resorption by inhibiting aldosterone secretion
Diuresis results, which decreases preload, or the left ventricular end volume, and the work of the heart
Uses of lisinopril?
Uses: hypertension, heart failure, and acute myocardial infarction
Hyperkalemia
Dry cough
Decreased renal function
what does Valsartan do?
Potent vasodilators; decrease systemic vascular resistance (afterload)
Used alone or in combination with other drugs such as diuretics in the treatment of hypertension or heart failure
Valsartan adverse effects?
same as lisinopril except cough, and hyperkalemia.
What does metoprolol do?
Cardioprotective quality of ß-blockers: prevent catecholamine-mediated actions on the heart by reducing or blocking sympathetic nervous system stimulation to the heart and the heart’s conduction system
What does spironolactone do?
potassium-sparing diuretic and aldosterone antagonist shown to reduce the symptoms of heart failure
What does dobutamine do?
β1-selective vasoactive adrenergic drug
Structurally similar to dopamine
what does Phosphodiesterase Inhibitors do, and whats the only drug of this available in Canada?
inhibits phosphodiesterase which results in?
Result in
Intracellular increase in cyclic adenosine monophosphate
Positive inotropic response
Vasodilation
Increase in calcium for myocardial muscle contraction.
Inodilators (inotropics and dilators)
(the only drug available is milrinone)
What are cardiac glycoside drug effects?
Positive inotropic effect
- Increased force and velocity of myocardial contraction (without an increase in oxygen consumption)
Negative chronotropic effect
- Reduced heart rate
Negative dromotropic effect
- Decreased automaticity at sinoatrial node, decreased atrioventricular nodal conduction, and other effects
Cardiac Glycosides, adverse Effects
Cardiovascular: dysrhythmias, including bradycardia or tachycardia
Central nervous system: headaches, fatigue, malaise, confusion, convulsions
Eyes: coloured vision (seeing green, yellow, purple), halo vision
Gastrointestinal: anorexia, nausea, vomiting, diarrhea
MOST ADVERSE EFFECTS SIGNS AND SYMPTOMS OF TOXICITY
what to do in digoxin toxicity?
digoxin immune Fab therapy
Hyperkalemia (serum potassium greater than 5 mmol/L) in a digitalis-toxic patient
Life-threatening cardiac dysrhythmias
Life-threatening digoxin overdose
large amounts of what negatively effcets absorption of oral digoxin?
bran
NHP that increase digoxin levels?
ginseng, hawthorn, licorice; St John’s Wort
Conditions That Predispose to Digoxin Toxicity?
Hypokalemia
Use of cardiac pacemaker
Atrioventricular block
Hypercalcemia
Dysrhythmias
Hypothyroid, respiratory, or renal disease
Advanced age
Ventricular fibrillation
Hold dose and notify prescriber if the patient experiences signs or symptoms of toxicity such as?
Anorexia, nausea, vomiting, diarrhea
Visual disturbances (blurred vision, seeing green or yellow halos around objects)
How much weight should a patient report
Patients should immediately report a weight gain of 1 kg or more in 24 hours or 2 kg or more in 1 week.
Avoid giving what med with high-fibre foods
Avoid giving digoxin with high-fibre foods (fibre binds with digitalis).
How to administer milrinone?
use an infusion pump.
