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MSII Medication Review > Lewis 38 - Heart Failure > Flashcards

Lewis 38 - Heart Failure Flashcards

1
Q

MOA/Class

furosemide, bumetanide

A

Blocks chloride pump in the loop of Henle thus keeping sodium and chloride (and H2O) in the tubule for excretion

Loop diuretic

Tucker 51

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2
Q

Side Effects

furosemide, bumetanide

A

Significant loss of potassium
Can cause alkalosis
Calcium loss can contribute tetany

Tucker 51

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3
Q

Nursing Considerations

furosemide, bumetanide

A

Monitor electrolytes, I&O, daily weight.
Rapid IV administration can cause permantant ototoxicity/tinnitus.
Consider potential for potassium alterations when given concurrently with digixin/risk for digoxin toxicity.

Tucker 51

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4
Q

Indications

furosemide, bumetanide

A

Heart failure, pulmonary edema, edema associated with renal or liver disease

Tucker 51

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5
Q

MOA/Class

nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate

A

Increases coronary blood flow through healthy arteries and decreases cardiac workload through decreased SVR/afterload (through vasodilation)

Nitrate

Tucker 46

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6
Q

Side Effects

nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate

A

Hypotension, orthostatic hypotension, reflex tachycardia, headache.

Tucker 46

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7
Q

Nursing Considerations

nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate

A

SL doses may be given every 5 minutes up to 3 doses. Sit/lie down before administration. Should tingle when placed under the tongue. Store away from heat and moisture in dark area/container.
Rotate sites for transdermal application.
Use nitrate-free period with topical and long-acting nitrations (overnight) to decrease tolerance.
Do not give within 24 hours of ED drugs (sildenafil, tadalafil, etc.) as serious hypotension may occur.

Tucker 46

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8
Q

Indications

nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate

A

Treatment and prevention of angina.
Decrease afterload for patients with heart failure or significant hypertension (IV or topical applications)

Tucker 46

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9
Q

MOA/Class

hydralazine, nitroprusside

A

Acts directly on vascular smooth muscle causing vasodilation

Vasodilator

Tucker 43

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10
Q

Side Effects

hydralazine, nitroprusside

A

Hypotension, dizziness, reflex tachycardia

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11
Q

Nursing Considerations

hydralazine, nitroprusside

A

Monitor BP closely during therapy.
Increased fall risk r/t orthostatic hypotension.
Cyanide toxicity can occur with overuse of nitroprusside (dyspnea, headache, ataxia, decreased reflexes, dilated pupils, pink color)

Tucker 43

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12
Q

Indications

hydralazine, nitroprusside

A

Significant hypertension
Increased SVR/afterload

Tucker 43

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13
Q

MOA/Class

nestiritide

A

Venous and arterial vasodilator

Recombinant BNP

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14
Q

Side Effects

nestiritide

A

Hypotension

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15
Q

Nursing Considerations

nestiritide

A

Monitor BP carefully.

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16
Q

Indications

nestiritide

A

Short-term treatment of ADHF after a failed response to IV diuretics

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17
Q

MOA/Class

morphine

A

Binds to opioid receptors producing analgesia and sedation. Dilates pulmonary and systemic blood vessels. Decreases anxiety.

Tucker 26

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18
Q

Side Effects

morphine

A

respiratory depression, itching (from histamine release), orthostatic hypotension, CNS depression, constipation (with long-term use)

Tucker 26

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19
Q

Nursing Considerations

morphine

A

Antidote - naloxone
Monitor respiratory status, BP, neuro status, and oxygenation.

Tucker 26

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20
Q

Indications

morphine

A

pain
(adjunct management of anxiety, angina/HF, and air hunger)

Tucker 26

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21
Q

MOA/Class

dopamine, dobutamine, norepinephrine

A

Binds to adrenergic receptors stimulating SNS response;
Positive inotrope

Adrenergic agonist

Tucker 30

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22
Q

Side Effects

dopamine, dobutamine, norepinephrine

A

dysrhythmias

Tucker 30

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23
Q

Nursing Considerations

dopamine, dobutamine, norepinephrine

A

Monitor IV site for extravasation (phentolamine)

Tucker 30

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24
Q

Indications

dopamine, dobutamine, norepinephrine

A

Significant hypotension; shock

Tucker 30

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25
Q

MOA/Class

milrinone

A

Inodilator (positive inotrope/vasodilator)

Phosphodiesterase inhibitor

Tucker 44

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26
Q

Side Effects

milrinone

A

dysrhythmias, thrmobocytopenia, liver toxicity

Tucker 44

27
Q

Nursing Considerations

milrinone

A

Precipitates when given in the same IV line as furosemide.

Tucker 44

28
Q

Indications

milrinone

A

HF that is unresponsive to other therapies

Tucker 44

29
Q

MOA/Class

digoxin

A

Increases intracellular calcium - positive inotrope, negative chronotrope, negative dromotrope

Digitalis/cardiac glycoside

Tucker 44

30
Q

Side Effects

digoxin

A

Bradycardiac, hypotension

Tucker 44

31
Q

Nursing Considerations

digoxin

A
  • Avoid giving with high-fiber foods
  • Always check apical pulse before administration (hold if less than 60 bpm)
    *** Digoxin toxicity **
  • Increased risk of toxicity with hypokalemia. Often, toxicity can be corrected by correcting potassium level . Monitor closely when giving with other medications that alter the potassium level.
  • Early signs – anorexia, nausea, vomiting, diarrhea
  • Later signs – visual disturbances (blurred vision, green/yellow halos around objects)
  • Digoxin immune fab – give for toxicity with hyperkalemia, life-threatening dysrhythmias, overdose

Tucker 44

32
Q

Indications

digoxin

A

HF
A-fib/A-flutter (for rate control)

Tucker 44

33
Q

MOA/Class

lisinopril, enalapril, captopril, etc.

A

Prevents conversion of angiotensin 1 to angiotensin 2 (causing vasodilation)

Angiotensin-Converting Enzyme (ACE) Inhibitor

Tucker 43

34
Q

Side Effects

lisinopril, enalapril, captopril, etc.

A

Dry cough
Hyperkalemia
First-dose hypotension, orthostatic hypotension
Angioedema

Tucker 43

35
Q

Nursing Considerations

lisinopril, enalapril, captopril, etc.

A
  • NSAIDs may decrease therapeutic effect and contribute to kidney injury
  • Monitor other medications that strongly depend on fluid/electrolyte balance (digoxin, lithium, etc.)
  • Avoid potassium supplements
  • Note: While ACE inhibitors have some effect on all portions of the cardiac system (“pump, pipes, and volume”), they are most effective on the “pipes” portion.

Tucker 43

36
Q

Indications

lisinopril, enalapril, captopril, etc.

A

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling

Tucker 43

37
Q

MOA/Class

losartan, valsartan, etc.

A

Blocks the binding of A2 to receptors

Angiotensin II Receptor Blocker (ARB)

Tucker 43

38
Q

Side Effects

losartan, valsartan, etc.

A

Hypotension
Hyperkalemia (less common than ACEIs, but still need to monitor)
Less dry cough than ACEIs

Tucker 43

39
Q

Nursing Considerations

losartan, valsartan, etc.

A

Avoid potassium supplements
Like ACEIs, most important to monitor BP

Tucker 43

40
Q

Indications

losartan, valsartan, etc.

A

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling

Tucker 43

41
Q

MOA/Class

sacubitril-valsartan

A

Promotes diuresis
Vasodilates

Neprilysin-angiotensin receptor inhibitor

Tucker 44

42
Q

Side Effects

sacubitril-valsartan

A

Hypotension
Angioedema

Tucker 44

43
Q

Nursing Considerations

sacubitril-valsartan

A

Monitor BP, renal function

Tucker 44

44
Q

Indications

sacubitril-valsartan

A

Heart failure

Tucker 44

45
Q

MOA/Class

spironolactone

A

Blocks the action of aldosterone in the renal tubule; creates loss of sodium (and water) while retaining potassium

Aldosterone antagonist/ K+ sparing diuretic

Tucker 51

46
Q

Side effects

spironolactone

A

Hyperkalemia, hirsutism, gynecomastia, voice deepening, irregular menses

Tucker 51

47
Q

Nursing Considerations

spironolactone

A

May be used in combination with loop diuretics to help offset potassium loss

Tucker 51

48
Q

Indications

spironolactone

A

Ascites, HTN, nephrotic syndrome, HF, hyperaldosteronism

Tucker 51

49
Q

MOA/Class

atenolol, esmolol, metoprolol

A

Blocks beta receptors in the heart decreasing HR, contractility, and excitability. Also blocks beta receptors in the juxtaglomerular cells this decreasing activation of the RAAS.

Beta-1 adrenergic blocker

Tucker 31

50
Q

Side Effects

atenolol, esmolol, metoprolol

A

fatigue, dizziness, bradycardia, impotence

Tucker 31

51
Q

Nursing Considerations

atenolol, esmolol, metoprolol

A

Monitor BP and heart rate.
B1 selectivity decreases with higher doses.
Teach safety interventions for postural hypotension.
Decreased effect when given with NSAIDs

Tucker 31

52
Q

Indications

atenolol, esmolol, metoprolol

A

MI/chronic angina (decreased workload/increased supply), HTN, tachycardia (SVT, A-fib, A-flutter), heart failure (decreased workload)

Tucker 31

53
Q

MOA/Class

Hydralazine-isosorbide dinitrate

A

Vasodilation - increasing myocardial perfusion and decreasing cardiac workload

Vasodilator-Nitrate

54
Q

Side Effects

Hydralazine-isosorbide dinitrate

A

Hypotension

55
Q

Nursing Considerations

Hydralazine-isosorbide dinitrate

A

Teach safety interventions to avoid postural hypotension

56
Q

Indications

Hydralazine-isosorbide dinitrate

A

Heart failure (works particularly well in African-Americans)

57
Q

MOA/Class

azathioprine
cyclosporine

A

Suppresses cell-mediated immunity

Immunosuppressant

Tucker 17

58
Q

Side Effects

azathioprine, cyclosporine, tacrolimus

A

Bone marrow suppression. Hepatotoxicity.

Tucker 17

59
Q

Nursing Considerations

azathioprine, cyclosporine, tacrolimus

A

Increased risk for infection and cancers. Avoid live-virus vaccines. Good infection control implementation. Avoid grapefruit juice.

Tucker 17

60
Q

Indications

azathioprine, cyclosporine, tacrolimus

A

Crohn’s disease/UC, transplant rejection, RA

Tucker 17

61
Q

MOA/Class

mycophenolate

A

Inhibits proliferation of B and T lymphocytes

Tucker 17

62
Q

Side Effects

mycophenolate

A

Hypertension, GI upset

Tucker 17

63
Q

Nursing Considerations

mycophenolate

A

Increased risk for infection and cancers. Avoid live-virus vaccines. Good infection control implementation. Avoid grapefruit juice.

Tucker 17

64
Q

Indications

mycophenolate

A

Prevent transplant rejection

Tucker 17

MSII Medication Review (13 decks)

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