HF Flashcards
During heart failure, cardiac output is reduced which leads to a series of responses by body:
Increased sympathetic activity
Increases heart rate and force of contraction but also increases vascular resistance
Combined, cardiac workload is increased, and failure gets worse
Activation of renin-angiotensin-aldosterone system (RAAS)
Promotes vasoconstriction and volume retention which both raise blood pressure
What med blocks Activation of renin-angiotensin-aldosterone system (RAAS)
Angiotensin Receoptor Blockers
Drugs that increase the force of contraction are positive intropes for ex ___________ Drugs that decrease
Epinephrine
Drugs that decrease the force of contraction are negative intropes for ex.________ _________
Beta Blocker
Decrease HR
Optimizing breathing during HF
Supplemental O2
HOB increase
Diuretics
Nutriotonal therapy
Due to edema the patient should be on a ___________ and _________ __________.
Sodium and fluid
Fluid restriction 1.5-2 liters per day.
What is vital to monitor in a patient is at risk fluid retention?
Wt Gain
Wt gain indicative of fluid overload
2kgs in 3 days
When thinking of the symptoms of heart failure what drugs do you think could be used with this condition?
ACE inhibitors, angiotensin receptor blockers
Adrenergic agents, cardiac glycosides
Vasodilators, diuretics,
Pharm management goals
Reduction of preload
Reduction of systemic vascular resistance (reduction of afterload)
Inhibition of RAAS and vasoconstrictor mechanisms of sympathetic nervous system
Ace Inhibs does what for HF
Decrease vascular resistance by dilating the veins that return blood to the heart
Decrease secretion of aldosterone
Less Na+ retention, less fluid retention
Less cardiac remodeling
Decrease secretion of ADH
Captopril and lisinopril have been determined to improve survival rate of an MI if given 1 to 2 days following the onset of symptoms.
Ace inhib adverse effects
Cough
Angioedema
Hyperkalmic
Angioedem
Swelling in the deep layer of skin and other tissues
Treatment for angioedema
Epinephrine, benidryl
Pisinopril is
Ace Inhib
Binds ACE, preventing formation of Angiotensin II
Decreases aldosterone, ADH production causing increased fluid output, decreased thirst
Angiotensin II is a ___________thus blocking production promots vasodialation
Can cause head ache, neutropenia
Angiotensin 2 recebtor Blockers iondicated for
Hypertension and heart failure
MI
Prophylaxis against stroke (CVA)
Mechanism of ARB action
Block angiotensin II from activating their target receptors in smooth muscle
Promote _____________ _ decreases blood pressure, afterload, preload
Decrease secretion of aldosterone and ADH
Adverse effects of ARBS
More mild than Ace inhib
Beta adrenergic Blockers
Used to decrease heart rate and force of contraction ( negative Inotrope and negative chronotropic effect)
Some promote vasodilation as well by blocking alpha1 receptors
Prevent MI and remodeling of ventricles
Carevdiolol
Beta blocker
Blocks beta1 receptors
Decreases heart rate, force of contraction, O2 demand
Blocks alpha1 receptors
Reduces vascular resistance contributing to decreased blood pressure
Adverse effects of Beta Adrenergic blockers
Mask hypoglycemia
Weight gain
Fatigue
Vasodialators
Relax blood vessels causing vasodilation
Never a first choice because they have more adverse effects
WHy areen’t vadsodialators first choice
More adverse effects
Isosorbide Dinitrate
Vasodialotor
Angina pectoris
Heart failure
Donates NO molecules which promote relaxation of vascular smooth muscle cells leading to vasodialotrs
HOTN, headache, dizziness, reflex tachycardia .
Cardiac Glycosides
Used in HF
Can stablize some dysrhythmiads
Cardiac glycosides are negative chronotropes and positive inotropes
Improve symptoms by _________ heart rate while _________ force of contraction
Require digitalizstion to be effective (becomes effective once a suitable concentration of drug has built up in tissues)
What to do before giving digoxin
Take apical for full minute before giving, if less than 60 - hold
Digoxin mech of action
Blocks Na+ / K+ ATPase the critical enzyme responsible for pumping sodium out of the myocardial cell in exchange for potassium. As Na+ accumulates in myocytes calcium ions are released from their storage areas in the cell which produces a more forceful contraction.
Suppresses the SA node and slows electrical conduction through the AV node.
Thereapeutic index of Cardiac Glycosides
Narrow
Adverses effects of digoxin (digital toxicity)
Nausea, vomiting
Visual disturbances
Atrial dysrythmias
Bradycardia
Heart block
Vent dysrythmias
Assessment
Obtain complete health history including allergies and drug history
Nursing Considerations for Clients Receiving Cardiac Glycoside Therapy (2 of 3)
Monitor ECG for changes to rate and rhythm
Monitor for adverse effects including GI effects, vision changes, leg muscle cramps, shortness of breath
Note if pt reports adverse effects or HR below 50 BPM
Interventions for clients recieving cardiac glycoside thereapy
Monitor patient weight
Ensure that dose is taken regularly to avoid toxicity related to overdose
Monitor serum drug levels and report significant elevations
Monitor electrolyte levels especially ________, and renal function tests, fluid input and output
Monitor patient for signs of toxicity
GI effects, lack of energy
Visual disturbances, confusion
What nursing measure is always taken before administering digoxin?
Apical pulse, one full minute
What is digitalis toxicity?
Build up in blood
Assessing for digitalis otxicity
Assess for levels in the blood
Health conditions putting a person at ris for digitalis toxicity
CKD
Hypothryoidism
What are some signs and symptoms of it?
Decreased LOC
Visiual disturbances
N/V
How do you treat it digitalis toxicity
Antidote
Activated Charco (Stomach pump)
Diuretics work by
Lowering BP decreasing the work-load of the heart.
Used for fluid overload
Prevents the reabsorption of sodium and chloride particularly in the loop of Henle region in the nephron.
- Most Na is absorbed, therefore most effective place to stop it
When you think of massive diuresis what is your main concern?_______________
Electrolyte loss (K+ specifically)
Lasix pts need to be
Mobile
Given in the morning
Drugs for Heart Failure - Phosphodiesterase III Inhibitors
Block the enzyme phosphodiesterase in cardiac and smooth which increases the amount of calcium available for myocardial contraction
Used with patients with heart failure who have not responded to other therapiesIncreased force of myocardial contraction increasing cardiac output.
Only given IV
Main concernes with Phosphodiesterase III Inhibitors
This inhibition results in two main actions; 1. a positive inotropic action which is?
2. Vasodilation
Are calcium channel blockers useful in HF?
NO because they decrease heart rate and contractility
