Lewis 38 - Heart Failure Flashcards
MOA/Class
furosemide, bumetanide
Blocks chloride pump in the loop of Henle thus keeping sodium and chloride (and H2O) in the tubule for excretion
Loop diuretic
Tucker 51
Side Effects
furosemide, bumetanide
Significant loss of potassium
Can cause alkalosis
Calcium loss can contribute tetany
Tucker 51
Nursing Considerations
furosemide, bumetanide
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
Indications
furosemide, bumetanide
Heart failure, pulmonary edema, edema associated with renal or liver disease
Tucker 51
MOA/Class
nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate
Increases coronary blood flow through healthy arteries and decreases cardiac workload through decreased SVR/afterload (through vasodilation)
Nitrate
Tucker 46
Side Effects
nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate
Hypotension, orthostatic hypotension, reflex tachycardia, headache.
Tucker 46
Nursing Considerations
nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate
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
Indications
nitroglycerin (SL tablet/spray, paste, IV)
isosorbide dinitrate, isosorbide mononitrate
Treatment and prevention of angina.
Decrease afterload for patients with heart failure or significant hypertension (IV or topical applications)
Tucker 46
MOA/Class
hydralazine, nitroprusside
Acts directly on vascular smooth muscle causing vasodilation
Vasodilator
Tucker 43
Side Effects
hydralazine, nitroprusside
Hypotension, dizziness, reflex tachycardia
Tucker 43
Nursing Considerations
hydralazine, nitroprusside
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
Indications
hydralazine, nitroprusside
Significant hypertension
Increased SVR/afterload
Tucker 43
MOA/Class
nestiritide
Venous and arterial vasodilator
Recombinant BNP
Side Effects
nestiritide
Hypotension
Nursing Considerations
nestiritide
Monitor BP carefully.
Indications
nestiritide
Short-term treatment of ADHF after a failed response to IV diuretics
MOA/Class
morphine
Binds to opioid receptors producing analgesia and sedation. Dilates pulmonary and systemic blood vessels. Decreases anxiety.
Tucker 26
Side Effects
morphine
respiratory depression, itching (from histamine release), orthostatic hypotension, CNS depression, constipation (with long-term use)
Tucker 26
Nursing Considerations
morphine
Antidote - naloxone
Monitor respiratory status, BP, neuro status, and oxygenation.
Tucker 26
Indications
morphine
pain
(adjunct management of anxiety, angina/HF, and air hunger)
Tucker 26
MOA/Class
dopamine, dobutamine, norepinephrine
Binds to adrenergic receptors stimulating SNS response;
Positive inotrope
Adrenergic agonist
Tucker 30
Side Effects
dopamine, dobutamine, norepinephrine
dysrhythmias
Tucker 30
Nursing Considerations
dopamine, dobutamine, norepinephrine
Monitor IV site for extravasation (phentolamine)
Tucker 30
Indications
dopamine, dobutamine, norepinephrine
Significant hypotension; shock
Tucker 30
MOA/Class
milrinone
Inodilator (positive inotrope/vasodilator)
Phosphodiesterase inhibitor
Tucker 44
Side Effects
milrinone
dysrhythmias, thrmobocytopenia, liver toxicity
Tucker 44
Nursing Considerations
milrinone
Precipitates when given in the same IV line as furosemide.
Tucker 44
Indications
milrinone
HF that is unresponsive to other therapies
Tucker 44
MOA/Class
digoxin
Increases intracellular calcium - positive inotrope, negative chronotrope, negative dromotrope
Digitalis/cardiac glycoside
Tucker 44
Side Effects
digoxin
Bradycardiac, hypotension
Tucker 44
Nursing Considerations
digoxin
- 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
Indications
digoxin
HF
A-fib/A-flutter (for rate control)
Tucker 44
MOA/Class
lisinopril, enalapril, captopril, etc.
Prevents conversion of angiotensin 1 to angiotensin 2 (causing vasodilation)
Angiotensin-Converting Enzyme (ACE) Inhibitor
Tucker 43
Side Effects
lisinopril, enalapril, captopril, etc.
Dry cough
Hyperkalemia
First-dose hypotension, orthostatic hypotension
Angioedema
Tucker 43
Nursing Considerations
lisinopril, enalapril, captopril, etc.
- 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
Indications
lisinopril, enalapril, captopril, etc.
Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling
Tucker 43
MOA/Class
losartan, valsartan, etc.
Blocks the binding of A2 to receptors
Angiotensin II Receptor Blocker (ARB)
Tucker 43
Side Effects
losartan, valsartan, etc.
Hypotension
Hyperkalemia (less common than ACEIs, but still need to monitor)
Less dry cough than ACEIs
Tucker 43
Nursing Considerations
losartan, valsartan, etc.
Avoid potassium supplements
Like ACEIs, most important to monitor BP
Tucker 43
Indications
losartan, valsartan, etc.
Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling
Tucker 43
MOA/Class
sacubitril-valsartan
Promotes diuresis
Vasodilates
Neprilysin-angiotensin receptor inhibitor
Tucker 44
Side Effects
sacubitril-valsartan
Hypotension
Angioedema
Tucker 44
Nursing Considerations
sacubitril-valsartan
Monitor BP, renal function
Tucker 44
Indications
sacubitril-valsartan
Heart failure
Tucker 44
MOA/Class
spironolactone
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
Side effects
spironolactone
Hyperkalemia, hirsutism, gynecomastia, voice deepening, irregular menses
Tucker 51
Nursing Considerations
spironolactone
May be used in combination with loop diuretics to help offset potassium loss
Tucker 51
Indications
spironolactone
Ascites, HTN, nephrotic syndrome, HF, hyperaldosteronism
Tucker 51
MOA/Class
atenolol, esmolol, metoprolol
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
Side Effects
atenolol, esmolol, metoprolol
fatigue, dizziness, bradycardia, impotence
Tucker 31
Nursing Considerations
atenolol, esmolol, metoprolol
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
Indications
atenolol, esmolol, metoprolol
MI/chronic angina (decreased workload/increased supply), HTN, tachycardia (SVT, A-fib, A-flutter), heart failure (decreased workload)
Tucker 31
MOA/Class
Hydralazine-isosorbide dinitrate
Vasodilation - increasing myocardial perfusion and decreasing cardiac workload
Vasodilator-Nitrate
Side Effects
Hydralazine-isosorbide dinitrate
Hypotension
Nursing Considerations
Hydralazine-isosorbide dinitrate
Teach safety interventions to avoid postural hypotension
Indications
Hydralazine-isosorbide dinitrate
Heart failure (works particularly well in African-Americans)
MOA/Class
azathioprine
cyclosporine
Suppresses cell-mediated immunity
Immunosuppressant
Tucker 17
Side Effects
azathioprine, cyclosporine, tacrolimus
Bone marrow suppression. Hepatotoxicity.
Tucker 17
Nursing Considerations
azathioprine, cyclosporine, tacrolimus
Increased risk for infection and cancers. Avoid live-virus vaccines. Good infection control implementation. Avoid grapefruit juice.
Tucker 17
Indications
azathioprine, cyclosporine, tacrolimus
Crohn’s disease/UC, transplant rejection, RA
Tucker 17
MOA/Class
mycophenolate
Inhibits proliferation of B and T lymphocytes
Tucker 17
Side Effects
mycophenolate
Hypertension, GI upset
Tucker 17
Nursing Considerations
mycophenolate
Increased risk for infection and cancers. Avoid live-virus vaccines. Good infection control implementation. Avoid grapefruit juice.
Tucker 17
Indications
mycophenolate
Prevent transplant rejection
Tucker 17
