Lecture Week 6 Heart Failure and Diuretics Flashcards
Digoxin (Lanoxin) class
cardiac glycoside
Digoxin (Lanoxin) Therapeutic Use
management of mild to moderate heart failure in adults and children
also controls the ventricular response rate in adults with chronic atrial fibrillation
Digoxin (Lanoxin) EPA
improves the contractility and pumping ability of the heart by increasing calcium and inhibiting sodium and potassium
Digoxin (Lanoxin) ADRs
digoxin toxicity - cardiac dysrhythmias
Digoxin (Lanoxin) Interventions and Education
give 1 hr prior to antacid
hold for pulse <60
slow IV push >5 mins
monitor serum levels
educate on toxicity symptoms
take at same time - do not skip or double dose
Digoxin (Lanoxin) contraindications and interactions
ventricular dysrhythmias, AV block, severe heart disease
higher risk for toxicity in children and older adults
digoxin toxicity
dysrhythmias and bradycardia, heart blocks
nausea and vomiting
abdominal pain
blurry, yellow-tinted, vision or halos
reversal agent for digoxin toxicity
digibind (digoxin immune fab)
Dobutamine class
Inotropic Agent sympathomimetics
Dobutamine therapeutic use
severe heart failure, should only be short term use
Dobutamine EPA
Beta-1 adrenergic agonist = increased inotropy = increased cardiac output
Dobutamine ADRs
tachycardia
dysrhythmias
anginal pain
Dobutamine interventions and education
cardiac monitoring
continuous VS
monitor urine output
Dobutamine interactions
MAOI and tricyclic antidepressants
general anesthesia
Milrinone class
Inotropic Agent
Phosphodiesterase Inhibitor
Milrinone therapeutic use
short term for severe heart failure
patients not responsive to Digoxin, diuretics and vasodilators
Bridge to therapy or longer term for palliation of symptoms.
Milrinone EPA
blocks PDE3 - enzyme that breaks down cyclic AMP = positive inotropic effect
Milrinone ADRs
ventricular dysrhythmias
hypotension
hypokalemia
anginal chest pain
Milrinone interventions and education
Continuous monitoring of BP, HR and cardiac rhythm.
Monitoring of electrolytes - K+
Monitor for chest pain
Milrinone contraindications
Caution: aortic/pulmonary valve issues, acute MI
Renal impairment, history of arrhythmias, electrolyte imbalances, abnormal digoxin levels
Furosemide (Lasix) class
loop diuretics
Loop diuretics other drugs
Bumetanide (Bumex)
Torsemide (Demadex)
Furosemide (Lasix) therapeutic use
used when rapid effects are needed - pulmonary edema
used when renal function is impaired
Furosemide (Lasix) EPA
Inhibits sodium and chloride reabsorption in the loop of Henle
Furosemide (Lasix) ADRs
Hypokalemia, hyponatremia, hypochloremia
fluid volume deficit (dehydration)
hypotension - orthostatic hypotension
Hyperglycemia and Hyperuricemia
Furosemide (Lasix) interventions and education
IV dose administered slowly - 2 min per 20 mg
daily weight
monitor Is and Os
monitor electrolytes
take BP before and after
monitor renal function
report hearing loss or tinnitus
Furosemide (Lasix) contraindications
caution with electrolyte imbalance and dehydration
caution with other ototoxic meds
can increase lithium toxicity
Hydrochlorothiazide (Microzide) class
thiazide diuretics
Hydrochlorothiazide (Microzide) therapeutic use
mild-mod HTN
edema d/t HF
nephrotic syndrome
Long-term management of HF and HTN
Hydrochlorothiazide (Microzide) EPA
Inhibits reabsorption of sodium, water, chloride and bicarbonate in the distal convoluted tubule
Hydrochlorothiazide (Microzide) ADRs
electrolyte imbalances (hyponatremia, hypokalemia, hypochloremia)
hyperglycemia, hyperuricemia
Hydrochlorothiazide (Microzide) interventions and education
give with food before 1500
monitor BP
daily weight
Is and Os
monitor potassium
Hydrochlorothiazide (Microzide) contraindications and interactions
renal decompensation or anuria
increase lithium toxicity risk
Spironolactone (Aldactone) class
Potassium Sparing Diuretic - Aldosterone Antagonist
Spironolactone (Aldactone)
therapeutic use
heart failure
ascites
hypertension
Spironolactone (Aldactone)
EPA
aldosterone antagonist because aldosterone has sodium retaining properties, decreases potassium excretion
Spironolactone (Aldactone)
ADRs
dizziness
headache
abdomial cramping
diarrhea
hyperkalemia
androgen effects - deep voice, gynecomastia, menstrual irregularity, testicular atrophy
Spironolactone (Aldactone)
interventions and education
BP, I&O, daily weight
hyperkalemia can cause heart irregularities
avoid potassium foods and salt substitutes
Spironolactone (Aldactone)
contraindications
teratogenic
increased risk of hyperkalemia with ACEs and ARBs
