Heart Failure Meds Flashcards
LEFT Ventricular Dysfunction
clinical manifestations
Dyspnea; orthopnea, nocturnal dyspnea
Fluid Retention; peripheral edema, ankle edema, pulmonary congestion
HF w/ REDUCED ejection fraction (HFREF)
decreased pumping ability to body r/t Increased AFTERLOAD; aka Left side failure
HF w/ PRESERVED ejection fraction (HFPEF)
amount of blood returned to heart r/t PRELOAD
Asymptomatic is what functional class
class I; pt w/ hypertension or CAD
Symptomatic w/ moderate exertion is
class II; pt w/ structural heart disease but asymptomatic
Symptomatic w/ minimal exertion is
class III; pt current/prior symptoms of HF associated w/ structural heart disease
Symptomatic at rest is
class IV; pt w/ refractory HF requiring specialized interventions
How does the body compensate for LOW CO
stimulation of SNS ( increase E, NE, TPR, afterload) => activation of RAAS (aldosterone, NA+ & H2O retention)
RAAS
HF med options (4)
ACE inhibitors
Diuretics
Vasodilators
Digitalis
ACE Inhibitors are
Angiotensin II receptor blockers (ARBS)
ARNI (ARB + neprilysin inhibito)
Aldosterone antagonist & some B blockers
What do ACE inhibitors do
reverse cardiac remodiling w/ long term improvement in clinical status & risk of major cardiac event
Diuretics are
(LOOP, Thiazide) No evidence for survival usually + other Rx especially ACEI/ARB
Vasodilators are
Hydralazine, Nitrates
symptomatic relief w/ questionable long term benefit
Digitalis are
short term, NO long term benefit
The -PRIL family
ACE
Angiotensin Converting Enzyme Inhibitors
(ACE) MEDS
CAPTOPRIL
ENALAPRIL
FOSINOPRIL
LISINOPRIL
QUINAPRIL
RAMIPRIL
ACE MOA
blocks the conversion of angiotensin I to angiotensin II in the RAAS system => vasodilation and NA+ & H2O excretion by blocking aldestorone
ACE indication:
severe HTN & HF
Whats common w/ ACE 1st dose
hypotension, lightheadedness
*careful in diuretics-treated pts.
ADR’s of ACE
HYPOTENSION
COUGH
HYPERKALEMIA
ANGIOEDEMA
PROTEINURIA
AGEUSIA (loss of taste)/DYSGEUSIA (abnormal taste) *resolves in 2-3 months
ACE black box warning
contraindicated in pregnancy= fetal harm such as malformation, deaths, hypotension, anuria, renal failure
ACE nursing consideration
take med as directed
avoid salt substitutes or foods high in potassium (K)
persisten cough may occur, consider ARB
The ARTAN family
AGIOTENSIN RECEPTOR BLOCKERS (ARB)
ARB arent given with … bc they have…
ACE, similar action but different ADR
Major difference between ARBs & ACE inhibitors
cough & hyperkalemia are not ADR of ARBs
ARB MOA
blocks angiotensin II in the RAAS system=> vasodilation
ARBs indications:
treat HTN & prevents nephropathy in DM pts.
ARBs considerations
NOT indicated in pregnant women
ARBs ADR
HYPOTENSION
DIZZINESS
ANDIOEDEMA
PROTEINURIA
*NO salt substitutes or high K foods
