heart failure meds

Question 1

morphine

Answer 1

used for vasodilation
acute decompensated HF
decreases pulm pressure, O2 demand, & pre/afterload
reduces dyspnea and anxiety
IV PUSH (1-5mg/2mins+)
causes resp. depression
have narcan on standby

Question 2

ACE inhibitors

Answer 2

lisinopril- decreases BP, vasodilates
NOT FIRST LINE TX
causes nagging cough and angioedema
counters RAAS
contraindicated w/ pregnancy
dont stop abruptly

Question 3

ARBS

Answer 3

losartan - decreases BP, vasodilates
monitor hyperkalemia
avoid sunlight
s/s otho hypertension, JVD, angioedema

Question 4

metoprolol

Answer 4

blocks SNS, decreases HR and BP

assess HR and BP before admin.
hold if HR under 60 BP under 100

preferred for asthma/copd pt - less risk for bronchospasm
can mask s/s of hypoglycemia and increase BS
dont give w ADHF unless already taking it
monitor I+Os, daily weights BS

Question 5

carvedilol

Answer 5

preferred in HF
can cause bronchospasm
dont give with ADHF unless already taking it

Question 6

cardiac sinus node inhibitors

Answer 6

ivabradine
lowers HR, decreased risk for toxicity
hold if HR under 70
pt must be normal sinus rhythm
can be given with BB, causes a fib & bradycardia

Question 7

digoxin

Answer 7

lowers HR and makes contractions stronger
hold if HR under 60
risk for toxicity, s/s vision changes, dysrhythmias, fatigue

antidote is digibond
dont stop abruptly

Question 8

furosemide

Answer 8

diuretic, decreases BP
possible dig toxicity -hypokalemia, hyperglycemia and ototoxicity
check K+ and BP before admin.
IV PUSH SLOWLY (10-20mg/min)
kidney fxn test periodically

Question 9

hydrochlorotiazide

Answer 9

decreased BP (water, sodium, K+, and CL excretion)
hypokalemia, hyperglycemia risk

Question 10

spironolactone

Answer 10

potassium sparing
excretion of NaCl
risk for hyperkalemia
avoid K+ foods
risk for GI bleed, caution with alertness activities

Question 11

farxiga

Answer 11

used in DM but can prevent HF
mild diuretic effect - cardiac death and hospitalization
can cause ketoacidosis and hypoglycemia

I+Os and daily weights

Question 12

when should you take diuretics for HF

Answer 12

in the morning to avoid nocturia
r/f orthostatic hypotension

Question 13

vasodilators

Answer 13

BiDil
vasodilates to decrease BP
african americans
Tx of HFrEF, decreases vascular resistance and CO demand
assess for edema, angina, ortho BP
take on empty stomach, no alcohol
have to use with ACE or BB

Question 14

entresto

Answer 14

lowers BP
use if ACE or ARB does work
blocks BNP inhibitor
monitor BP and K+
angioedema rx: wait 36 hr when transitioning from ACE

Question 15

HF diet

Answer 15

limit sodium 2-3g/day
limit fluid to 2L/day (replace with ice chips, gum, hard candy, popsicles)
DASH DIET- fruits, vegs, low-fat milk, whole grains, fish, pulty, bean,seeds,nuts)

Question 16

HF teaching

Answer 16

avoid NSAIDs
elevate HOB when relaxing
FACES (fatigue, activity intolerance, chest congestion/cough, edema, SOB)
weigh yourself everyday, same time, same clothes, same scale)

call PCP if you gain 2-3lbs in 2 days or 3-5lbs in one week