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NSG 323 (mcp) > HF Drugs > Flashcards

HF Drugs Flashcards

1
Q

What are the 6 Drug Classes used for HF?

A
  1. Diuretics
  2. RAAS drugs
    - ACE, ARBs, ARNI, Aldosterone antagonists
  3. Beta-Blockers
  4. HCN Channel Blocker
  5. Cardiac Glycosides
  6. Vasodilators

Acute HF drugs: IV infusions

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2
Q

What are the 6 Drug Classes used for HF?

A
  1. Diuretics
  2. RAAS drugs
    - ACE, ARBs, ARNI, Aldosterone antagonists
  3. Beta-Blockers
  4. HCN Channel Blocker
  5. Cardiac Glycosides
  6. Vasodilators

Acute HF drugs: IV infusions

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3
Q

How are diuretics used in HF?

A

1st line therapy
Reduce symptoms, does NOT prolong survival!
-Given for acute pulmonary edema from HF

Used in combination with other HF drugs

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4
Q

What is the action of diuretics related to HF?

A

Reduce the blood volume (preload) –>

decreases the workload on the heart

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5
Q

How is the dosing of diuretics different in HTN and HF?

What do we use to determine the dosing in HF?

A

Diuretic Dosing in HF is based on DAILY WEIGHTS

Patients may be given a “Sliding scale” based on daily weight measurements

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6
Q

What are the 4 classes of Diuretics used for HF?

Indicate the Prototype

A
  1. ACE inhibitor: Lisinopril
  2. ARBs: Valsartan
  3. ARNI: Sacubitril/Valsartan (Entresto)
  4. Aldosterone antagonists: Spironolactone
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7
Q

ACE inhibitors + HF:

A

GOLD STAR!
IMPROVES functional status & PROLONGS LIFE

Action:

  1. Arteriolar dilation: ↓ Afterload, ↑ renal perfusion
  2. Venous Dilation: ↓ Preload
  3. Inhibits Aldosterone
  4. Prevents cardiac remodeling
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8
Q

ARBs + HF:

A

Many of the same protective qualities of ACE inhibitors, but doesn’t decrease cardiac remodeling.

Used with those who don’t tolerate ACE

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9
Q

ACE inhibitors + HF:

A

GOLD STAR!
IMPROVES functional status & PROLONGS LIFE

Action:

  1. Arteriolar dilation: ↓ Afterload, ↑ renal perfusion
  2. Venous Dilation: ↓ Preload
  3. Inhibits Aldosterone
  4. Prevents cardiac remodeling
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10
Q

Sacubitril/Valsartan (Entresto) Route:

A

PO

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11
Q

Sacubitril/Valsartan (Entresto) Side Effects:

A

SAME AS ARBS**

  1. Dry cough
  2. Hypotension
    - 1st dose phenomenon
  3. Hyperkalemia
  4. Angioedema
    - 8% Cross-sensitivity with ACE for angioedema
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12
Q

Sacubitril/Valsartan (Entresto)

A
  1. PREGNANCY
  2. Concurrent use w/ Spironolactone
  3. K+ supplements
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13
Q

Sacubitril/Valsartan (Entresto) Contraindications:

A
  1. PREGNANCY
  2. Concurrent use w/ Spironolactone
  3. K+ supplements
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14
Q

Aldosterone Receptor Blocker + HF

A

Spironolactone (Aldactone)
Reduces symptoms
Decreases hospitalizations and PROLONGS LIFE!

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15
Q

What are the 3 Beta-blockers approved for HF?

A

carvedilol (Coreg)
metoprolol XL (Toprol-XL)
bisoprolol (Zebeta)

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16
Q

Beta-blockers + HF:

A

Usually used in combination with ACE + diuretics

Start with small doses 1/10 or 1/20 and doubled every 2 weeks

WATCH FOR S/S OF HF EXACERBATION!
-reduce cardiac output

17
Q

What is the prototype for HCN Channel Blockers?

A

Ivabradine

18
Q

Ivabradine Uses & MOA:

A

Uses:
1. HF

MOA:
↓ HR by blocking channels responsible for cardiac pacemaker current

19
Q

Ivabradine Route:

20
Q

Ivabradine Side Effects:

A
  1. Bradycardia
  2. AFib
  3. HTN
  4. Luminous phenomena
21
Q

Ivabradine Nursing Considerations:

A
  1. Check radial pulse & Report Bradycardia or irregular pulse
  2. Teach about visual changes—transient and will disappear
22
Q

What is the prototype for Cardiac Glycosides?

A

Digoxin (Lanoxin)

23
Q

Digoxin (Lanoxin) Uses & MOA:

A

Uses:
1. HF

MOA:

  1. ↓ HR
  2. ↑ Contractility
    - increases CO
    - improves efficiency
24
Q

Digoxin (Lanoxin) Uses & MOA:

A

Uses:
1. HF

MOA:

  1. ↓ HR
  2. ↑ Contractility
    - increases CO
    - improves efficiency
25
Q

Digoxin (Lanoxin) Route & Dosing:

A
  1. PO
Dosing: 
Narrow therapeutic range: 0.5-0.8ng/ml
LONG half-life: 1 day
Digitalization: loading dose to get to therapeutic levels 
      -Common dose 0.125-0.25mg daily
26
Q

Digoxin (Lanoxin) Side Effects:

A
  1. Fatigue, drowsiness, dizziness
  2. cardiac dysrhythmias
  3. AV Heart block
  4. Bradycardia
  5. Risk for toxicity!
27
Q

Digoxin (Lanoxin) Toxicity Side Effects

A

Early signs:
Nausea, vomiting, anorexia, fatigue

Late signs:
Visual disturbances (yellow/green halos, blurring)
28
Q

Digoxin (Lanoxin) Antidote:

A

Digoxin immune Fab (Digibind)

29
Q

Digoxin (Lanoxin) Nursing Considerations:

A
  1. Check apical pulse
    • Hold if <60
  2. Teach patients to check pulse daily
  3. Teach patients of drug-drug, drug-food interactions
    • Fiber, Antacids, lots more…..
30
Q

Prototype for Direct Vasodilator used for HF:

A

Isosorbide dinitrate (Isordil) and hydralazine

31
Q

Isosorbide dinitrate (Isordil) + Hydralazine MOA:

A

Isosorbide: Causes direct relaxation of venous smooth muscle
Hydralazine: causes dilation of arterioles

32
Q

Isosorbide dinitrate (Isordil) + Hydralazine Uses:

A
  1. HF

2. If pt unable to use ACE or ARBs

33
Q

Isosorbide dinitrate (Isordil) + Hydralazine Side Effects:

A
  1. Orthostatic hypotension
  2. Reflex tachycardia
  3. SLE syndrome (hydralazine)

NSG 323 (mcp) (14 decks)

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