Heart Failure Medications Flashcards
starting at slide 20 on the meds
1
Q
what three classes of meds are used to treat heart failure?
A
Vasodilators
Loop diuretics
Beta-adrenergic antagonists
2
Q
what vasodilators are used to treat HF?
A
ACE inhibitors
Nitrates
Hydralazine
3
Q
how do vasodilators work to treat HF?
A
Decrease the workload of overworked cardiac muscle
4
Q
how do loop diuretics treat HF?
A
Decrease blood volume, which decreases venous return and blood pressure
5
Q
what type of Beta-Adrenergic Antagonists are used to treat HF?
A
beta blockers
6
Q
how do beta blockers work to treat HF?
A
Block the beta-receptors in the sympathetic nervous system, decreasing calcium flow into the myocardial cells, and causing decreased contraction and workload
7
Q
what do ACE inhibitors prevent?
A
the conversion of angiotensin 1 to angiotensin 2
8
Q
ACE inhibitors contribute to _________ improvement, reduced __________, and improved ________
A
symptomatic;
hospitalization;
survival
9
Q
If able to tolerate, all pts with systolic heart failure should be on what type of meds?
A
ACE inhibitors
10
Q
how do ace inhibitors effect preload and afterload?
A
they decrease both preload and afterload
11
Q
ACE inhibitors work by _________ and by blocking ___________
A
vasodilation;
RAAS/aldosterone
12
Q
ACE inhibitors help prevent cardiovascular _________
A
remodeling
13
Q
ACE inhibitors do not work as well with who? why?
A
African Americans and Asians bc of genetic factors
14
Q
what can be used for pts who cannot tolerate ACE inhibitors?
A
Angiotensin receptor blockers (ARBs)
15
Q
what is in entresto?
A
sacubitril plus valsartan
16
Q
what type of med is sacubitril?
A
neprilysin inhibitor
17
Q
what type of med is valsartan?
A
Angiotensin receptor blockers (ARBs)
18
Q
what is entresto used for?
A
Used for systolic heart failure to improve symptoms and reduce remodeling
19
Q
Is entresto a vasocontrictor or vasodilator?
A
vasodilator
20
Q
what does entresto increase?
(hint: 3)
A
Naturetic peptides (like BNP)
Bradykinin (vasodilation)
Other mediators which increase vasodilation
21
Q
list the side effects of entresto
(hint: 5)
A
angioedema
hypotension
hyperkalemia
renal failure
cough
22
Q
who is entresto contraindicated in and why?
A
pregnancy bc it can cause fetal harm
23
Q
what drug interaction occurs with entresto and what specifically happens?
A
NSAIDS interact
NSAIDs vasoconstrict while entresto vasodilates (contraindicate)
24
Q
what does entresto inhibit?
A
the RAAS system as well as angiotensin II
25
what do loop diuretics inhibit?
Inhibit reabsorption of sodium or chloride at the loop of Henle
26
what do loop diuretics decrease?
(hint: 4)
workload on heart
preload
stroke volume
cardiac output
27
loop diuretics are initially given ______ then changed to _____
intravenously;
oral
28
what are the 3 loop diuretics listed in class?
Bumetanide
Furosemide (Lasix)
Torsemide
29
list the side effects of loop diuretics
(hint: 6)
hyponatremia
hypokalemia
hypovolemia
hypomagnesemia
hyperglycemia
ototoxicity
30
list the nursing considerations for loop diuretics
monitor potassium level
monitor intake and output
31
loop diuretics help decrease pulmonary ________
congestion
32
loop diuretics help decrease workload because there is going to be less _____
volume
33
If a diabetic patient is on loop diuretics for heart failure what is the last thing you'd want? what should you check for?
last thing you want to do is increase their blood sugar
check for hyperglycemia
34
spironolactone and eplerenone are given as a combo drug. what type of med are they? what are they also known as?
Mineralocorticoid receptor antagonist
AKA: Aldosterone receptor blockers
35
what are the indications for spironolactone and eplerenone combo drug?
hypertension and heart failure
36
Aside from indications, when would spironolactone and eplerenone combo drug be given?
Used when one drug is not enough to treat symptoms
when the ACE inhibitor is NOT enough!!!
37
what does spironolactone and eplerenone combo drug block?
Blocks the exchange of sodium for potassium in the distal tubules
38
how should spironolactone and eplerenone combo drug be taken?
with meals
39
what should be monitored for a pt taking spironolactone and eplerenone combo drug?
(hint: 4)
potassium
LFTs
BUN
Creatinine
40
when should spironolactone and eplerenone combo drug NOT be given?
pts with renal insufficiency
41
what can spironolactone and eplerenone combo drug cause?
gynecomastia
42
what should you avoid taking with spironolactone and eplerenone combo drug?
(hint: 4)
Angiotensin-Converting Enzyme Inhibitors (ACEI)
Angiotensin receptor blockers (ARBs)
Heparin
NSAIDS
43
taking spironolactone and eplerenone combo drug can increase _________ level
potassium
44
why do we not give spironolactone and eplerenone combo drug to pts with renal impairment?
we want them to urinate more but the kidneys cannot properly filter and excrete
45
What are the benefits of beta blockers?
(hint: 3)
Helps to improve symptoms
reduces hospitalization
enhances survival in HF pts with reduced ejection fraction (HFrEF)
46
what do beta blockers decrease/reduce/slow?
(hint: 5)
Decreases catecholamine stimulation
Decreases myocardial energy demands
Reduce remodeling
Slows heart rate
Decreases afterload
47
beta blockers reduce remodeling that occurs due to what?
due to cardiac myocyte hypertrophy and death
48
what do beta blockers promote?
arrhythmias
49
beta blockers should ONLY be used if the pt has what? when should they not be used?
only used for stable HR
Not used for end-stage HF
50
beta blockers stimulate other detrimental systems such as what?
RAAS
51
do beta blockers affect preload?
no
52
list the beta blockers we discussed in class
(hint: 3)
Carvedilol
Metoprolol Succinate
Bisoprolol
53
how should beta blockers be started?
Always start at very low doses, as it can make HF worse
54
Adverse effects of beta blockers include ________ __ _____ _____ especially when first started
worsening of heart failure
55
Beta blockers should never be what?
never stopped abruptly; need to taper off
56
what should ALWAYS be checked on a pt taking a beta blocker? When would the doctor need to be called?
apical HR; call doctor if <60
57
list the adverse effects of beta blockers
(hint: 8)
Hypotension
Fatigue
Depression
Impotence
Sleep issues
Bradycardia
Bronchospasm
Exacerbation of peripheral vascular disease
58
What can happen in pts with COPD and asthma who are taking beta blockers for HF?
bronchospasm which can cause more bronchoconstriction
59
what do beta blocker drug names end with?
"lol"
60
why should pts never stop beta blockers on their own?
it will cause a sympathetic surge and go from one extreme to another!!
61
what are the indications for taking nitrates?
prevention and treatment of attacks of angina pectoris and heart failure
62
nitrates are arterial and venous ______
dilators
63
what do nitrates decrease?
(hint: 3)
preload
afterload
myocardial O2 demand
64
how do nitrates decrease myocardial O2 demand?
they increase O2 to the heart which decreases myocardial O2 demand
65
how are nitrates absorbed?
very rapidly
66
what develops easy when taking nitrates? what must the pt have?
tolerance develops easily
must have drug-free periods
67
nitrates are used primarily for the decrease in what?
HF symptoms
68
what drug interaction occurs with nitrates and what specifically happens?
interaction with sildenafil (viagra)
It can cause an abrupt drop in BP
69
what are the routes of administration for nitroglycerin?
(hint: 7)
Sublingual (common)
Translingual Spray
Transmucosal Tablet
Oral, SR Tablet
Intravenous
Topical Ointment
Transdermal
70
Why should you always wear gloves when administering nitroglycerin?
it is very potent; and side effects can easily affect the HC provider
71
how long are transdermal patches of nitroglycerin worn? what is important to note and why?
they can be worn up to 24 hr but they stop working a few hours before that.
this is to have a break before taking off the old one and putting on new one to decrease ability of developing drug tolerance
72
How often can sublingual nitroglycerin be given and what is the max doses?
Every 5 minutes for a max of 3 doses
73
what should the pt do if they have no relief after taking sublingual nitroglycerin?
call 911
74
what is important to know about storage of sublingual nitroglycerin?
Must stay in the original bottle and be protected from light (bc light will degrade the med)
75
how should the pt be positioned when taking sublingual nitroglycerin?
must be sitting or laying
76
list the side effects of sublingual nitroglycerin
(hint: 3)
tingles or burns under tongue
Headache
dizziness
77
what should be watched before and after giving sublingual nitroglycerin?
BP
78
what symptom of sublingual nitroglycerin means that the med is doing its job?
tingling or burning under tongue
79
what drug is not widely used anymore and is reserved for pts who cannot tolerate ACE or ARB?
hydralazine and nitrate (isosorbide) combo drug
80
isosorbide is an ____ _____
oral nitrate
81
isosorbide has a ____ _____ period in the delivery system
drug free
82
isosorbide can be _____ acting or a ______ ______
short acting or a sustained release
83
how long does isosorbide work for?
about 18 hours
84
isosorbide has side effects similar to ________
nitroglycerin
85
what is the first drug regimen shown to improve the symptoms of heart failure?
Hydralazine + Nitrates
86
combined use of hydralazine and nitrate (isosorbide) decreases what?
(hint: 3)
preload
afterload
systemic and pulmonic vascular resistance
87
how does combined use of hydralazine and nitrate (isosorbide) decrease preload and afterload?
by achieving both venous and arterial vasodilation.
88
combined use of hydralazine and nitrate (isosorbide) has a ______ inotropic effect on heart
positive
89
combined use of hydralazine and nitrate (isosorbide) is used in patients who...?
Have symptoms despite ACE inhibitors, beta blockers, and diuretic therapy
Those who can not tolerate routine therapy
90
what cardiac glycoside did we discuss?
digoxin
91
what are the indications for digoxin?
heart failure
atrial fibrillation
92
digoxin is not ___ ____ treatment
first line
93
digoxin increases ________ ________
intracellular calcium
94
digoxin allows for what?
Allows more calcium to enter the myocardial cell during depolarization
95
digoxin has a _____ inotropic effect. what does this mean?
positive;
means it increases contraction
96
digoxin causes increased ______ perfusion with a _______ effect. this causes a decrease in ____ ______
renal;
diuretic;
renin release
97
digoxin causes slowed conduction through the ___ _____ which ______ ____ _____
AV node;
decreases heart rate
98
digoxin has a very _____ therapeutic margin
narrow
99
what is the normal level for digoxin? what is the desired level?
Normal level: 0.5-2.0
Desired level 0.8
100
what is digoxin made from?
fox glove plant (digitalis)
101
what must be done/monitored on pts taking digoxin?
drug monitoring (peak & trough)
102
too much digoxin can cause what?
toxicity
103
how can digoxin be given?
oral and IV (not the same dosing)
104
digoxin has rapid ____ and ______
onset and absorption
105
how is digoxin excreted?
kidneys
106
what should ALWAYS be checked on a pt taking digoxin? When would the doctor need to be called?
ALWAYS Check Apical Heart Rate, call MD if <60 bpm
107
what should be monitored for a pt taking digoxin?
(hint: 3)
BUN
Creatinine
Potassium
108
what are the signs of digoxin toxicity?
(hint: 3)
vision changes
nausea/vomiting
dizziness
109
digoxin toxicity causes increased risk of _________
hypokalemia
110
what is given when someone goes into digoxin toxicity?
antidote
111
what is the antidote for digoxin?
digibind
112
who should caution be taken in when giving digoxin?
(hint: 4)
pregnancy/lactation
Pediatric patients
geriatric patients
Renal insufficiency
113
Digoxin toxicity can be very _____
fatal
114
when caring for a pt with heart failure, why should the nurse question any orders for IV fluids?
Sx can get way worse; b/c they are holding onto fluid not urinating
115
what are nursing interventions when caring for a pt with HF?
(hint: 9)
Monitor lungs
Monitor heart rate
Monitor blood pressure
Monitor BUN
Monitor Creatinine
Monitor potassium
Monitor weight daily
Question any orders for IV fluids
Pt Education
116
what should be included in education for a pt with HF?
(hint: 4)
No sodium
No over-the-counter medications
When to report signs/ Sx to provider
Weight gain of 3 lbs in 2 days
