Heart Failure Meds

Question 1

LEFT Ventricular Dysfunction
clinical manifestations

Answer 1

Dyspnea; orthopnea, nocturnal dyspnea
Fluid Retention; peripheral edema, ankle edema, pulmonary congestion

Question 1

HF w/ REDUCED ejection fraction (HFREF)

Answer 1

decreased pumping ability to body r/t Increased AFTERLOAD; aka Left side failure

Question 2

HF w/ PRESERVED ejection fraction (HFPEF)

Answer 2

amount of blood returned to heart r/t PRELOAD

Question 3

Asymptomatic is what functional class

Answer 3

class I; pt w/ hypertension or CAD

Question 4

Symptomatic w/ moderate exertion is

Answer 4

class II; pt w/ structural heart disease but asymptomatic

Question 5

Symptomatic w/ minimal exertion is

Answer 5

class III; pt current/prior symptoms of HF associated w/ structural heart disease

Question 6

Symptomatic at rest is

Answer 6

class IV; pt w/ refractory HF requiring specialized interventions

Question 7

How does the body compensate for LOW CO

Answer 7

stimulation of SNS ( increase E, NE, TPR, afterload) => activation of RAAS (aldosterone, NA+ & H2O retention)

Question 8

RAAS

Question 9

HF med options (4)

Answer 9

ACE inhibitors
Diuretics
Vasodilators
Digitalis

Question 10

ACE Inhibitors are

Answer 10

Angiotensin II receptor blockers (ARBS)
ARNI (ARB + neprilysin inhibito)
Aldosterone antagonist & some B blockers

Question 11

What do ACE inhibitors do

Answer 11

reverse cardiac remodiling w/ long term improvement in clinical status & risk of major cardiac event

Question 12

Diuretics are

Answer 12

(LOOP, Thiazide) No evidence for survival usually + other Rx especially ACEI/ARB

Question 13

Vasodilators are

Answer 13

Hydralazine, Nitrates
symptomatic relief w/ questionable long term benefit

Question 14

Digitalis are

Answer 14

short term, NO long term benefit

Question 15

The -PRIL family

Answer 15

ACE

Question 16

Angiotensin Converting Enzyme Inhibitors
(ACE) MEDS

Answer 16

CAPTOPRIL
ENALAPRIL
FOSINOPRIL
LISINOPRIL
QUINAPRIL
RAMIPRIL

Question 17

ACE MOA

Answer 17

blocks the conversion of angiotensin I to angiotensin II in the RAAS system => vasodilation and NA+ & H2O excretion by blocking aldestorone

Question 18

ACE indication:

Answer 18

severe HTN & HF

Question 19

Whats common w/ ACE 1st dose

Answer 19

hypotension, lightheadedness
*careful in diuretics-treated pts.

Question 20

ADR’s of ACE

Answer 20

HYPOTENSION
COUGH
HYPERKALEMIA
ANGIOEDEMA
PROTEINURIA
AGEUSIA (loss of taste)/DYSGEUSIA (abnormal taste) *resolves in 2-3 months

Question 21

ACE black box warning

Answer 21

contraindicated in pregnancy= fetal harm such as malformation, deaths, hypotension, anuria, renal failure

Question 22

ACE nursing consideration

Answer 22

take med as directed
avoid salt substitutes or foods high in potassium (K)
persisten cough may occur, consider ARB

Question 23

The ARTAN family

Answer 23

AGIOTENSIN RECEPTOR BLOCKERS (ARB)

Question 24

ARB arent given with … bc they have…

Answer 24

ACE, similar action but different ADR

Question 25

Major difference between ARBs & ACE inhibitors

Answer 25

cough & hyperkalemia are not ADR of ARBs

Question 26

ARB MOA

Answer 26

blocks angiotensin II in the RAAS system=> vasodilation

Question 27

ARBs indications:

Answer 27

treat HTN & prevents nephropathy in DM pts.

Question 28

ARBs considerations

Answer 28

NOT indicated in pregnant women

Question 29

ARBs ADR

Answer 29

HYPOTENSION
DIZZINESS
ANDIOEDEMA
PROTEINURIA
*NO salt substitutes or high K foods