Lecture Week 6 Heart Failure and Diuretics

Question 1

Digoxin (Lanoxin) class

Answer 1

cardiac glycoside

Question 2

Digoxin (Lanoxin) Therapeutic Use

Answer 2

management of mild to moderate heart failure in adults and children

also controls the ventricular response rate in adults with chronic atrial fibrillation

Question 3

Digoxin (Lanoxin) EPA

Answer 3

improves the contractility and pumping ability of the heart by increasing calcium and inhibiting sodium and potassium

Question 4

Digoxin (Lanoxin) ADRs

Answer 4

digoxin toxicity - cardiac dysrhythmias

Question 5

Digoxin (Lanoxin) Interventions and Education

Answer 5

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

Question 6

Digoxin (Lanoxin) contraindications and interactions

Answer 6

ventricular dysrhythmias, AV block, severe heart disease

higher risk for toxicity in children and older adults

Question 7

digoxin toxicity

Answer 7

dysrhythmias and bradycardia, heart blocks
nausea and vomiting
abdominal pain
blurry, yellow-tinted, vision or halos

Question 8

reversal agent for digoxin toxicity

Answer 8

digibind (digoxin immune fab)

Question 9

Dobutamine class

Answer 9

Inotropic Agent sympathomimetics

Question 10

Dobutamine therapeutic use

Answer 10

severe heart failure, should only be short term use

Question 11

Dobutamine EPA

Answer 11

Beta-1 adrenergic agonist = increased inotropy = increased cardiac output

Question 12

Dobutamine ADRs

Answer 12

tachycardia
dysrhythmias
anginal pain

Question 13

Dobutamine interventions and education

Answer 13

cardiac monitoring
continuous VS
monitor urine output

Question 14

Dobutamine interactions

Answer 14

MAOI and tricyclic antidepressants
general anesthesia

Question 15

Milrinone class

Answer 15

Inotropic Agent
Phosphodiesterase Inhibitor

Question 16

Milrinone therapeutic use

Answer 16

short term for severe heart failure

patients not responsive to Digoxin, diuretics and vasodilators

Bridge to therapy or longer term for palliation of symptoms.

Question 17

Milrinone EPA

Answer 17

blocks PDE3 - enzyme that breaks down cyclic AMP = positive inotropic effect

Question 18

Milrinone ADRs

Answer 18

ventricular dysrhythmias
hypotension
hypokalemia
anginal chest pain

Question 19

Milrinone interventions and education

Answer 19

Continuous monitoring of BP, HR and cardiac rhythm.

Monitoring of electrolytes - K+

Monitor for chest pain

Question 20

Milrinone contraindications

Answer 20

Caution: aortic/pulmonary valve issues, acute MI

Renal impairment, history of arrhythmias, electrolyte imbalances, abnormal digoxin levels

Question 21

Furosemide (Lasix) class

Answer 21

loop diuretics

Question 22

Loop diuretics other drugs

Answer 22

Bumetanide (Bumex)
Torsemide (Demadex)

Question 23

Furosemide (Lasix) therapeutic use

Answer 23

used when rapid effects are needed - pulmonary edema

used when renal function is impaired

Question 24

Furosemide (Lasix) EPA

Answer 24

Inhibits sodium and chloride reabsorption in the loop of Henle

Question 25

Furosemide (Lasix) ADRs

Answer 25

Hypokalemia, hyponatremia, hypochloremia fluid volume deficit (dehydration) hypotension - orthostatic hypotension Hyperglycemia and Hyperuricemia

Question 26

Furosemide (Lasix) interventions and education

Answer 26

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

Question 27

Furosemide (Lasix) contraindications

Answer 27

caution with electrolyte imbalance and dehydration caution with other ototoxic meds can increase lithium toxicity

Question 28

Hydrochlorothiazide (Microzide) class

Answer 28

thiazide diuretics

Question 29

Hydrochlorothiazide (Microzide) therapeutic use

Answer 29

mild-mod HTN edema d/t HF nephrotic syndrome Long-term management of HF and HTN

Question 30

Hydrochlorothiazide (Microzide) EPA

Answer 30

Inhibits reabsorption of sodium, water, chloride and bicarbonate in the distal convoluted tubule

Question 31

Hydrochlorothiazide (Microzide) ADRs

Answer 31

electrolyte imbalances (hyponatremia, hypokalemia, hypochloremia) hyperglycemia, hyperuricemia

Question 32

Hydrochlorothiazide (Microzide) interventions and education

Answer 32

give with food before 1500 monitor BP daily weight Is and Os monitor potassium

Question 33

Hydrochlorothiazide (Microzide) contraindications and interactions

Answer 33

renal decompensation or anuria increase lithium toxicity risk

Question 34

Spironolactone (Aldactone) class

Answer 34

Potassium Sparing Diuretic - Aldosterone Antagonist

Question 35

Spironolactone (Aldactone) therapeutic use

Answer 35

heart failure ascites hypertension

Question 36

Spironolactone (Aldactone) EPA

Answer 36

aldosterone antagonist because aldosterone has sodium retaining properties, decreases potassium excretion

Question 37

Spironolactone (Aldactone) ADRs

Answer 37

dizziness headache abdomial cramping diarrhea hyperkalemia androgen effects - deep voice, gynecomastia, menstrual irregularity, testicular atrophy

Question 38

Spironolactone (Aldactone) interventions and education

Answer 38

BP, I&O, daily weight hyperkalemia can cause heart irregularities avoid potassium foods and salt substitutes

Question 39

Spironolactone (Aldactone) contraindications

Answer 39

teratogenic increased risk of hyperkalemia with ACEs and ARBs