Heart Failure Medications Flashcards
digoxin (Lanoxin) therapeutic use
- Cardiac Glycosides/inotropic
- Second-line drug for HF
- Treats some cardiac dysrhythmias
- Atrial fibrillation
- Atrial flutter
- Paroxysmal atrial tachycardia
digoxin adverse reactions
- Cardiac dysrhythmias, especially likely with digoxin toxicity
- Any dysrhythmia may occur, with AV block being most common
- GI symptoms – early signs of toxicity
- Nausea, vomiting, anorexia
- CNS symptoms
- Fatigue, visual disturbances, such as yellow vision and blurred vision
- Increased mortality in women
digoxin contraindications and precautions
Contraindications:
* Uncontrolled Ventricular dysrhythmias
* AV block or severe heart disease
* Digoxin toxicity
Precautions:
* Hypokalemia, hypercalcemia
* Concurrent use of diuretics
* Impaired kidney function
* Infants, children and older adults
digoxin interactions
- Erythromycin and some other antibiotics increase digoxin levels
- Other antidysrhythmics (verapamil, quinidine, amiodarone, flecainide)
increase digoxin levels; decrease digoxin dosage for concurrent
administration - Diuretics increase risk for digoxin toxicity by decreasing potassium
levels - Herbal ginseng increases risk of digoxin toxicity; St. John’s wort
decreases digoxin levels - Note that the above interactions do not comprise a complete list. It’s
important to check for interactions when other drugs are given along
with digoxin
digoxin administration
- Available as oral tablets, capsules, and elixir, as well as for IV use
- Give oral form with or without food
- Tablets may be crushed and mixed with food if necessary
- IV form may be administered directly over at least 5 min; monitor site
carefully for infiltration, which can cause tissue damage
digoxin nursing interventions
- Recognize that vomiting can cause hypokalemia, which increases risk
for digoxin toxicity - Monitor for and report GI symptoms
- Monitor for and report CNS effects
- Take apical pulse for 1 full minute before administering digoxin;
withhold drug if pulse falls below prescribed parameters (such as 60/
min in adults) - Monitor digoxin levels frequently
- Monitor serum potassium levels; administer potassium for low or
borderline low values - Monitor cardiac rhythm and treat dysrhythmias per protocol
- For severe digoxin toxicity, digoxin immune FAB (Digibind) is
administered IV as an antidote to neutralize digoxin
digoxin client educations
- Report nausea, loss of appetite, or vomiting to provider
- Report headache, visual disturbances to provider
- Report heart palpitations to provider
- Learn to monitor pulse rate and report decrease or increase beyond
prescribed parameters - To decrease risk of toxicity or low serum levels, take digoxin at the
same time each day; do not skip or double a dose - Report signs of hypokalemia, such as muscle weakness
- High risk of toxicity
hydrochlorothiazide (Microzide, Oretic) therapeutic use
- Thiazide diuretics
- Used with other drugs, treats heart failure
- Treats cirrhosis of the liver and renal failure
- Treats hypertension
hydrochlorothiazide adverse reactions
- Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss
(dehydration), and hypokalemia (most common) - Hyperglycemia (especially in clients who are diabetic)
- Increased uric acid levels (hyperuricemia) with possible gouty arthritis
in susceptible clients
hydrochlorothiazide nursing interventions
- Monitor serum electrolyte levels periodically; notify provider for
abnormal levels - Monitor carefully for signs of electrolyte imbalance
- If hypokalemia occurs, monitor for dysrhythmias
- If hypokalemia is a risk (e.g. client also taking digoxin)
hydrochlorothiazide may be combined with a potassium supplement or
potassium-sparing diuretic - Monitor blood glucose periodically in all clients
- Monitor blood glucose more frequently in clients who have diabetes
mellitus; insulin or oral antidiabetic drug dosage may need to be
increased - Monitor uric acid levels periodically
hydrochlorothiazide medication administration
- Available orally alone and in fixed-dose combination with multiple other
drugs, such as potassium-sparing diuretics, ACE inhibitors, ARBs, beta
blockers and other antihypertensive drugs - Chlorothiazide is available in IV form
- Give with food to minimize GI effects
- Give last dose of day by 3 p.m. to prevent nocturia and sleep loss
hydrochlorothiazide client education
- Eat foods rich in potassium (if indicated) such as citrus fruits, potatoes,
bananas - Report signs of electrolyte imbalance, such as confusion, muscle
twitching or weakness, irregular pulse, nausea, and others - Clients who have diabetes mellitus need to carefully monitor blood
glucose levels and notify provider for persistent hyperglycemia - Be aware that this effect may occur; usually without symptoms
- Clients with history of gout need to report symptom onset to provider
hydrochlorothiazide contraindications and precautions
Contraindications:
* Allergy to thiazides or sulfonamides
* Greatly decreased urine output (anuria)
* Electrolyte imbalance
Precautions:
* Renal or hepatic disorders
* Older adults
* Pregnancy/lactation
hydrochlorothiazide interactions
- Lithium toxicity may occur
- Increased risk of digoxin toxicity with potassium or magnesium
deficiency - Corticosteroids and amphotericin B increase risk for hypokalemia
- Decreased absorption with cholestyramine (Questran) or colestipol
(Colestid) - NSAIDS can reduce effectiveness
furosemide (Lasix) therapeutic use
- Loop diuretic
- Treats pulmonary edema in heart failure
- Treats edema caused by renal, hepatic or cardiac failure not affected by
other diuretics - Treats hypertension not controlled by other diuretics
furosemide (Lasix) adverse reactions
- Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss
(dehydration), and hypokalemia - Hypotension
- Ototoxicity (all loop diuretics can be temporary or permanent
depending on the specific drug) - Hyperglycemia (especially in clients who have diabetes mellitus)
- Increased uric acid levels (hyperuricemia) with possible gouty arthritis
in susceptible clients
furosemide (Lasix) nursing interventions
- Monitor serum electrolyte levels periodically; notify provider for
abnormal levels - Monitor carefully for signs of electrolyte imbalance
- If hypokalemia occurs, monitor for cardiac dysrhythmias
- If hypokalemia is a risk (e.g., client also taking digoxin) furosemide can
be combined with a potassium-sparing diuretic - Monitor blood pressure frequently during treatment
- Ensure that the client does not take other ototoxic drugs (additive
effect) - Monitor for hearing loss, tinnitus, and vertigo
- Monitor blood glucose periodically in all clients
- Monitor blood glucose more frequently in clients who have diabetes
mellitus; insulin or oral antidiabetic drug dosage can need to be
increased - Monitor uric acid levels periodically
furosemide (Lasix) medication administration
- Available for oral, IM, or IV use
- Give oral form with food to prevent GI symptoms
- If prescribed more than once daily, give second dose by early afternoon
to prevent nocturia and sleep loss - Give IV form undiluted; administer slowly to prevent ototoxicity
- Protect all forms from light; store oral solution in refrigerator and other
forms at controlled room temperature
furosemide (Lasix) client education
- Eat foods rich in potassium (if indicated), such as citrus fruits, potatoes,
and bananas - Report signs of electrolyte imbalance, such as confusion, muscle
twitching or weakness, irregular pulse, and nausea - Teach client to have blood pressure monitored frequently
- Report dizziness, syncope to provider
- Avoid hazardous activities (e.g., driving) until effects are known
- Report new onset of hearing loss, ringing in ears, or vertigo to provider
- Clients who have diabetes mellitus need to carefully monitor blood
glucose levels and notify provider for persistent hyperglycemia - Know that this effect can occur, usually without symptoms
- Clients who have a history of gout need to report symptom onset to
provider
furosemide (Lasix) contraindications and precautions
Contraindications:
* Allergy to furosemide
* Hepatic coma
* Electrolyte imbalance or dehydration
* Anuria
Precautions:
* Renal or hepatic disorders
* Diabetes mellitus
* Older adults
* Pregnancy/lactation
furosemide (Lasix) interactions
- Digoxin toxicity is a high risk with hypokalemia
- Other diuretics increase the diuretic effect
- NSAIDs can decrease diuretic effect
- Neuromuscular blocking agents can have prolonged effect
- Lithium toxicity can occur
- Amphotericin B and corticosteroids increase risk for hypokalemia
- Other ototoxic drugs (e.g., aminoglycoside antibiotics) increase risk for
ototoxicity
spironolactone (Aldactone) therapeutic use
- Potassium-sparing diuretics
- Hypertension
- Edema caused by heart failure
- Cirrhosis of the liver
- Nephrotic syndrome
- Hypokalemia
spironolactone (Aldactone) adverse reactions
- Hyperkalemia
- Menstrual irregularities, abnormal hair growth (e.g. on face), and
deepening of voice may occur in women; gynecomastia (growth of
breast tissue) and impotence may occur in men
spironolactone (Aldactone) nursing interventions
- Monitor serum potassium levels during treatment
- If hyperkalemia occurs, monitor for cardiac dysrhythmias
- Spironolactone may be combined with a thiazide or loop diuretic to
maintain normal potassium levels - Monitor and report these endocrine effects
spironolactone (Aldactone) medication administration
- Available orally
- Take with food to increase absorption
- Tablets may be crushed and mixed with food or fluid if client is unable
to swallow them whole
spironolactone (Aldactone) client education
- Report palpitations, irregular pulse, or other signs of hyperkalemia
- Avoid potassium supplements, large amounts of high potassium foods,
and salt substitutes - Report these endocrine symptoms to the provider
spironolactone (Aldactone) contraindications and precautions
Contraindications:
* Teratogenic
* Renal failure and severe renal insufficiency, or increase in renal
impairment
* Hyperkalemia
Precautions:
* Hepatic disease
* Diabetes
* Older adults
spironolactone (Aldactone) interactions
- Counteracts adverse effect (hypokalemia) of loop and thiazide diuretics
(may be the desired effect) - ACE inhibitors, ARBs, direct renin blockers, potassium supplements, salt
substitutes increase risk of hyperkalemia - Increased risk of hypotension can occur with concurrent ingestion of
alcohol, nitrates or other antihypertensives
dobutamine therapeutic use
- Inotropic/Sympathomimetics
- Increases cardiac output in severe heart failure (short-term use only)
dobutamine adverse reactions
- Tachycardia, cardiac dysrhythmias, and possible angina pain
dobutamine nursing interventions
- Monitor ECG rhythm and vital signs continuously during infusion
- Treat cardiac dysrhythmias as needed and prepare to decrease or
discontinue dobutamine for tachydysrhythmias
dobutamine medication administration
- Available for IV infusion only
- Dose based on client’s weight and titrated based on continuous
monitoring of vital signs, ECG, urine output, and (if available) cardiac
output and pulmonary wedge pressures - Peak effect obtained about 10 minutes after infusion begins
- Multiple infusion incompatibilities exist; use dedicated IV line for
infusion - Correct any fluid volume deficits before administering dobutamine
dobutamine client instructions
- Be aware that continuous monitoring is performed during
administration - Report chest pain to staff immediately
dobutamine contraindications and precautions
CONTRAINDICATIONS:
* Allergy to sympathomimetics or sulfites
* Ventricular tachycardia
* Idiopathic hypertrophic aortic stenosis
* Dehydration
* Children younger than age 2
PRECAUTIONS:
* Use with MAOI or tricyclic antidepressants or with general anesthetics
* Heart disease, hypertension, or tachycardia
* Hypovolemia
* Pregnancy/lactation
dobutamine interactions
- MAOI and tricyclic antidepressants cause toxicity with greatly increased
risk for tachydysrhythmias (decrease dobutamine dosage) - General anesthetics also can cause dysrhythmias
- Beta blockers decrease effects of dobutamine
