Lewis 38 - Heart Failure

Question 1

MOA/Class

furosemide, bumetanide

Answer 1

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

Loop diuretic

Tucker 51

Question 2

Side Effects

furosemide, bumetanide

Answer 2

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

Tucker 51

Question 3

Nursing Considerations

furosemide, bumetanide

Answer 3

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

Question 4

Indications

furosemide, bumetanide

Answer 4

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

Tucker 51

Question 5

MOA/Class

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

Answer 5

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

Nitrate

Tucker 46

Question 6

Side Effects

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

Answer 6

Hypotension, orthostatic hypotension, reflex tachycardia, headache.

Tucker 46

Question 7

Nursing Considerations

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

Answer 7

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

Question 8

Indications

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

Answer 8

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

Tucker 46

Question 9

MOA/Class

hydralazine, nitroprusside

Answer 9

Acts directly on vascular smooth muscle causing vasodilation

Vasodilator

Tucker 43

Question 10

Side Effects

hydralazine, nitroprusside

Answer 10

Hypotension, dizziness, reflex tachycardia

Tucker 43

Question 11

Nursing Considerations

hydralazine, nitroprusside

Answer 11

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

Question 12

Indications

hydralazine, nitroprusside

Answer 12

Significant hypertension
Increased SVR/afterload

Tucker 43

Question 13

MOA/Class

nestiritide

Answer 13

Venous and arterial vasodilator

Recombinant BNP

Question 14

Side Effects

nestiritide

Answer 14

Hypotension

Question 15

Nursing Considerations

nestiritide

Answer 15

Monitor BP carefully.

Question 16

Indications

nestiritide

Answer 16

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

Question 17

MOA/Class

morphine

Answer 17

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

Tucker 26

Question 18

Side Effects

morphine

Answer 18

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

Tucker 26

Question 19

Nursing Considerations

morphine

Answer 19

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

Tucker 26

Question 20

Indications

morphine

Answer 20

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

Tucker 26

Question 21

MOA/Class

dopamine, dobutamine, norepinephrine

Answer 21

Binds to adrenergic receptors stimulating SNS response;
Positive inotrope

Adrenergic agonist

Tucker 30

Question 22

Side Effects

dopamine, dobutamine, norepinephrine

Answer 22

dysrhythmias

Tucker 30

Question 23

Nursing Considerations

dopamine, dobutamine, norepinephrine

Answer 23

Monitor IV site for extravasation (phentolamine)

Tucker 30

Question 24

Indications

dopamine, dobutamine, norepinephrine

Answer 24

Significant hypotension; shock

Tucker 30

Question 25

# MOA/Class milrinone

Answer 25

Inodilator (positive inotrope/vasodilator) | Phosphodiesterase inhibitor ## Footnote Tucker 44

Question 26

# Side Effects milrinone

Answer 26

dysrhythmias, thrmobocytopenia, liver toxicity ## Footnote Tucker 44

Question 27

# Nursing Considerations milrinone

Answer 27

Precipitates when given in the same IV line as furosemide. ## Footnote Tucker 44

Question 28

# Indications milrinone

Answer 28

HF that is unresponsive to other therapies ## Footnote Tucker 44

Question 29

# MOA/Class digoxin

Answer 29

Increases intracellular calcium - positive inotrope, negative chronotrope, negative dromotrope | Digitalis/cardiac glycoside ## Footnote Tucker 44

Question 30

# Side Effects digoxin

Answer 30

Bradycardiac, hypotension ## Footnote Tucker 44

Question 31

# Nursing Considerations digoxin

Answer 31

* 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 ## Footnote Tucker 44

Question 32

# Indications digoxin

Answer 32

HF A-fib/A-flutter (for rate control) ## Footnote Tucker 44

Question 33

# MOA/Class lisinopril, enalapril, captopril, etc.

Answer 33

Prevents conversion of angiotensin 1 to angiotensin 2 (causing vasodilation) | Angiotensin-Converting Enzyme (ACE) Inhibitor ## Footnote Tucker 43

Question 34

# Side Effects lisinopril, enalapril, captopril, etc.

Answer 34

Dry cough Hyperkalemia First-dose hypotension, orthostatic hypotension Angioedema ## Footnote Tucker 43

Question 35

# Nursing Considerations lisinopril, enalapril, captopril, etc.

Answer 35

* 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. ## Footnote Tucker 43

Question 36

# Indications lisinopril, enalapril, captopril, etc.

Answer 36

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling ## Footnote Tucker 43

Question 37

# MOA/Class losartan, valsartan, etc.

Answer 37

Blocks the binding of A2 to receptors | Angiotensin II Receptor Blocker (ARB) ## Footnote Tucker 43

Question 38

# Side Effects losartan, valsartan, etc.

Answer 38

Hypotension Hyperkalemia (less common than ACEIs, but still need to monitor) Less dry cough than ACEIs ## Footnote Tucker 43

Question 39

# Nursing Considerations losartan, valsartan, etc.

Answer 39

Avoid potassium supplements Like ACEIs, most important to monitor BP ## Footnote Tucker 43

Question 40

# Indications losartan, valsartan, etc.

Answer 40

Hypertension; Decrease cardiac workload; Prevent/limit ventricular remodeling ## Footnote Tucker 43

Question 41

# MOA/Class sacubitril-valsartan

Answer 41

Promotes diuresis Vasodilates | Neprilysin-angiotensin receptor inhibitor ## Footnote Tucker 44

Question 42

# Side Effects sacubitril-valsartan

Answer 42

Hypotension Angioedema ## Footnote Tucker 44

Question 43

# Nursing Considerations sacubitril-valsartan

Answer 43

Monitor BP, renal function ## Footnote Tucker 44

Question 44

# Indications sacubitril-valsartan

Answer 44

Heart failure ## Footnote Tucker 44

Question 45

# MOA/Class spironolactone

Answer 45

Blocks the action of aldosterone in the renal tubule; creates loss of sodium (and water) while retaining potassium | Aldosterone antagonist/ K+ sparing diuretic ## Footnote Tucker 51

Question 46

# Side effects spironolactone

Answer 46

Hyperkalemia, hirsutism, gynecomastia, voice deepening, irregular menses ## Footnote Tucker 51

Question 47

# Nursing Considerations spironolactone

Answer 47

May be used in combination with loop diuretics to help offset potassium loss ## Footnote Tucker 51

Question 48

# Indications spironolactone

Answer 48

Ascites, HTN, nephrotic syndrome, HF, hyperaldosteronism ## Footnote Tucker 51

Question 49

# MOA/Class atenolol, esmolol, metoprolol

Answer 49

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 ## Footnote Tucker 31

Question 50

# Side Effects atenolol, esmolol, metoprolol

Answer 50

fatigue, dizziness, bradycardia, impotence ## Footnote Tucker 31

Question 51

# Nursing Considerations atenolol, esmolol, metoprolol

Answer 51

Monitor BP and heart rate. B1 selectivity decreases with higher doses. Teach safety interventions for postural hypotension. Decreased effect when given with NSAIDs ## Footnote Tucker 31

Question 52

# Indications atenolol, esmolol, metoprolol

Answer 52

MI/chronic angina (decreased workload/increased supply), HTN, tachycardia (SVT, A-fib, A-flutter), heart failure (decreased workload) ## Footnote Tucker 31

Question 53

# MOA/Class Hydralazine-isosorbide dinitrate

Answer 53

Vasodilation - increasing myocardial perfusion and decreasing cardiac workload | Vasodilator-Nitrate

Question 54

# Side Effects Hydralazine-isosorbide dinitrate

Answer 54

Hypotension

Question 55

# Nursing Considerations Hydralazine-isosorbide dinitrate

Answer 55

Teach safety interventions to avoid postural hypotension

Question 56

# Indications Hydralazine-isosorbide dinitrate

Answer 56

Heart failure (works particularly well in African-Americans)

Question 57

# MOA/Class azathioprine cyclosporine

Answer 57

Suppresses cell-mediated immunity | Immunosuppressant ## Footnote Tucker 17

Question 58

# Side Effects azathioprine, cyclosporine, tacrolimus

Answer 58

Bone marrow suppression. Hepatotoxicity. ## Footnote Tucker 17

Question 59

# Nursing Considerations azathioprine, cyclosporine, tacrolimus

Answer 59

Increased risk for infection and cancers. Avoid live-virus vaccines. Good infection control implementation. Avoid grapefruit juice. ## Footnote Tucker 17

Question 60

# Indications azathioprine, cyclosporine, tacrolimus

Answer 60

Crohn's disease/UC, transplant rejection, RA ## Footnote Tucker 17

Question 61

# MOA/Class mycophenolate

Answer 61

Inhibits proliferation of B and T lymphocytes ## Footnote Tucker 17

Question 62

# Side Effects mycophenolate

Answer 62

Hypertension, GI upset ## Footnote Tucker 17

Question 63

# Nursing Considerations mycophenolate

Answer 63

Increased risk for infection and cancers. Avoid live-virus vaccines. Good infection control implementation. Avoid grapefruit juice. ## Footnote Tucker 17

Question 64

# Indications mycophenolate

Answer 64

Prevent transplant rejection ## Footnote Tucker 17