Medications for heart failure Flashcards
1
Q
Is the incidence of heart failure increasing or decreasing in the US?
A
increasing
2
Q
What are large portions of the U.S. population at risk for?
A
HF or stage A
3
Q
What are risk factors for heart failure? (10)
A
- HTN
- obesity
- pre-diabetes
- diabetes
- cardiac disease (esp. MI)
- familial or genetic cardiomyopathy
- cardiotoxicity r/t cancer
- substance abuse
- autoimmune disease
- iron overload
- inflammatory disorders (covid)
4
Q
What races/ethnicities have greater incidence of heart failure?
A
- african americans
- hispanics
5
Q
What are the 4 etiologies of heart failure?
A
- ischemic heart disease
- chronic HTN
- COPD
- cardiomyopathies
6
Q
How does ischemic heart disease cause heart failure?
A
r/t ischemic insults to myocardium, weakens the strength of ventricular contraction
7
Q
How does COPD lead to heart failure?
A
- leading cause of right ventricular failure
- can cause RV changes & HF called cor pulmonale
- development of pulmonary HTN due to constriction of arterial vessels & increased workload & exhaustion of RV
8
Q
What kind of cardiomyopathies can lead to HF?
A
- restrictive
- hypertrophic
9
Q
What are the underlying problems in HF related to muscle damage?
A
artherosclerosis or cardiomyopathy
10
Q
What may cause the heart to increase workload to maintain an efficient output?
A
- HTN
- alcoholism
- MI
- A-fib
- valvular disease
11
Q
____________ ____________ are an underlying problem in HF resulting from congenital cardiac defects.
A
structural abnormalities
12
Q
What is left-sided heart failure?
A
when lt ventricles are unable to pump re-oxygenated blood from the lungs to the heart’s left atrium; ventricles are too stiff and not contracting properly
13
Q
What does left-sided heart failure lead to?
A
- decreased cardiac output
- pulmonary congestion
14
Q
what is a common cause of right-sided heart failure?
A
left-sided heart failure
15
Q
What are the two types of left-sided heart failure?
A
systolic heart failure
diastolic heart failure
16
Q
What is happening in systolic HF?
A
LV cannot contract forcefully enough to keep blood circulating normally throughout the body
17
Q
What is happening in diastolic HF?
A
LV has grown stiff or thick & is unable to fill the heart properly, which reduces the amount of blood pumped out of the body
18
Q
Left-sided systolic HF deals with __________ of the heart
A
contraction
19
Q
What is ejection fraction in left- sided systolic HF?
A
low (<40%)
20
Q
What are the 9 symptoms of left-sided systolic heart failure?
A
- fatigue
- decreased urine production
- increased HR; may be irregular
- elevated BP
- enlarged heart
- pulmonary “congestion” - SOB
- coughing (often worse at night)
- weight gain
- decreased blood flow to extremities
21
Q
left-sided HF is an issue with ventricles being ____ _____ to properly _____ heart; able to contract (ventricular _____________)
A
too stiff; fill; hypertrophy
22
Q
What is ejection fraction in left-sided diastolic HF?
A
typically normal (>50%)
23
Q
What does lef-sided diastolic HF often result from?
A
HTN
24
Q
Is there medication available to help with diastolic dysfunction?
A
no
25
What are sx of left-sided HF? (picture;10)
- paroxymal nocturnal dyspnea
- elevated pulmonary capillary wedge pressure
- pulmonary congestion
- restlessness
- confusion
- orthopnea
- tachycardia
- exertional dyspnea
- fatigue
- cyanosis
26
What are sx of pulmonary congestion?
- cough
- crackles
- wheezes
- blood-tinged frothy sputum
- tachypnea
27
What is the vicious cycle of LV failure?
LVF leads to decreased renal perfusion which causes renin production and triggers persistent cycling RAAS which causes futher deterioration of heart function
28
Is left-sided or right-sided HF more common?
left-sided HF
29
What is the problem in right-sided Heart failure?
deoxygenated blood is coming from the body but the rt-side of the heart is not pumping as well as it should leading to "back-up of blood in the body
30
What are the 8 sx of right-sided HF? (on slide; 7)
- fatigue
- vein distension
- weight gain
- increased urination
- hepatomegaly
- increased abdominal girth
- peripheral swelling
31
What are the 9 sx of right-sided HF? (picture)
- fatigue
- increased peripheral venous pressure
- ascites
- enlarged liver & spleen
- may be secondary to chronic pulmonary problems
- distended jugular veins
- anorexia & complaints of GI distress
- weight gain
- dependent edema
32
What 7 things does activation of the sympathetic nervous system cause?
- increased HR & contractility tachycardia
- vasoconstriction
- activates the renin-angiotensin system (RAS)
- direct cardiotoxicity
- increased myocardial O2 demand
- increase wall stress
- decreased preload & increases afterload
33
About ____ of pts with HF have three or more comorbidities
50%
34
The average HF pt is taking ___ medications
6
35
___ of HF pts had at least two admissions per year
78%
36
only ___ completed their annual prescription regimen
10%
37
____ of HF pt never refilled any HF prescriptions
1/3`
38
What should HF treatment address?
the effects of HF on airway, breathing & circulation
39
What are the 3 main goals of HF treatment?
- treatment of the existing sx of the crisis situation
- prevention of further or expanding complications
- treatment of underlying cause
40
What are the 4 stages of HF?
stage A: at-risk for HF
stage B: pre-heart failure
Stage C: symptomatic HF
stage D: advanced HF
41
What is happening during stage A of HF?
pt is at risk for HF but w/o current of previous S/S of HF & w/o structural/ functional heart disease or abnormal biomarkers; pt has other disease process/ family hx related to HF
42
What are the risk factors for those in Stage A of HF?
- HTN
- CVD
- diabetes
- abesity
- exposure to cardiotoxic agents
- genetic variant doe cardiomyopathy
- family hx of cardiomyopathy
43
What is happening in Stage B of HF?
pt w/o currect or previous S/S of HF but has evidence of:
- structural heart disease
-evidence of increased filling pressures
- increased natriuretic peptide levels
- persistently elevated cardiac troponin
44
What is happening in Stage C of HF?
pt with current or previous S/S of HF
45
What is happening in stage D of HF?
marked HF sx that interfere with daily life with recurrent hospitalizations despite attempts to optimize GDMT (treatment)
46
what are the 4 classifications of HF?
new onset/ de novo HF
resolution of sx
persistent HF
worsening HF
47
What is new onset/ de novo HF?
- newly dx HF
- no previous hx of HF
48
What is happening if Hf is classified as resolution of sx?
resolution of S/S of HF
- HF in remission w/ resolution of previous structural and/or functional heart disease
49
What is persistent HF?
persistent HF w/ ongoing S/S and/or limited functional capacity
50
What is worsening HF?
worsening S/S or functional capacity
51
What are the three classes of medication used to treat Hf?
- vasodilators
- loop diuretics
- beta- adrenergic antagonists (beta blockers)
52
What are the three types of vasodilators that can be used?
- ACE inhbitors
- nitrates
- hydralazine
53
How to vasodilators help with HF?
decrease the workload of overworked cardiac muscle
54
How do loop diuretics help with HF?
decrease blood volume, which decreases venous return & BP
55
How do beta blockers help with HF?
block the beta-receptors in the SNS, decreasingn calcum flow into the myocardial cells, & causing decreased contraction & workload
56
How do ACE inhibitors work?
prevent the conversion of angiotensin I to angiotensin II; blocking RAAS & causing vasodilation
57
What do ACE inhibitors help prevent?
cardiac remodeling
58
ACE inhibitors allow for symptomatic improvement, reduced _______________ and _________ survival
hospitalization; improved
59
if tolerated; all pts with _________ heart failure should be on an ACE inhibitor
systolic
60
What affect do ACE inhibitors have on preload & afterload?
ACE inhibitors decrease preload & afterload
61
In what ethnic groups do ACE inhibitors tend to not be as effective?
black & asian people
62
What can be used as an alternative to ACE inhibitors for those ethnicities or in case of ACE intolerance?
angiotensin receptor blockers (ARBs)
63
What is entresto?
sacubitril (neprilysin inhibitor) plus valsartan (ARB)
64
What is entresto used for?
used for systolic heart failure to improve sx and reduce remodeling
65
What does entresto do?
- increases naturetic peptides (like BNP)
- bradykinin (vasodilation)
- increases other mediators which increase vasodilation
66
What are the side effects of entresto?
- angioedema
- hypotension
- hyperkalemia
- renal failure
67
What can entresto cause?
a cough
68
is entresto safe for pregnancy?
no; contraindicated
69
What type of medications cannot be taken with entresto?
NSAIDS
70
How do loop diuretics work?
inhibit reabsorption of sodium or chloride at the loop of henle
71
How do look diuretics help the heart?
- decrease workload on heart
- decrease preload
- decrease stroke volume
- decrease cardiac output
72
How are loop diuretics typically given?
initially given Iv then changed to oral
73
What are three examples of loop diuretics?
bumetanide
furosemide
torsemide
74
What are possible side effects of loop diuretics?
- hyponatremia
- hypokalemia
- hypovolemia
- hypomagnesemia
- hyperglycemia
- ototoxicity
75
What should you monitor with pts on loop diuretics?
- potassium
- I & Os
76
What are spironolactone & eplerenone considered to be?
mineralocorticoid receptor antagonists(AKA: aldosterone receptor blockers)
77
What are spironolactone & eplerenone taken for?
hypertension & HF
78
When are spironolactone & eplerenone taken as opposed to other medications?
used when one drug is not enough to treat sx
79
How do spironolactone & eplerenone work?
block the exchange of sodium for potassium in the distal tubules
80
Should spironolactone & eplerenone be taken with or without food?
should be taken with meals
81
What should be monitored in pts taking spironolactone & eplerenone?
- potassium
- LFTs
- BUN & creatinine
82
When should a pt not recieve spironolactone or eplerenone?
when they have renal insufficiency
83
What can spironolactone & eplerenone cause?
gynecomastia
84
With what medications should spironolactone & eplerenone not be taken?
ACE inhibitors
ARBs
heparin
NSAIDS
85
what do beta blockers help with?
help to improve sx, reduce hospitalization & enhance survival in pts with HF with reduced ejection fraction
86
how do beta blockers help the heart?
- decrease catecholamine stimulation
- decrease myocardial energy demands
- reduce remodeling due to cardiac myocyte hypertrophy & death
- stimulation of other detrimental systems such as the renin-angiotensin-aldosterone syestem
- anti-arrhythmia promotion
87
What are the drugs in the beta blocker class?
- carvedilol
- metoprolol Succinate
- bisprolol
88
how should a beta blocker be started?
at a very low dose, as it can worsen HF
89
What should you never do when taking a beta blocker?
never stop abruptly, need to taper off
90
What are adverse effects of beta blockers?
- worsening HF especially when first started
- hypotension
- bradycardia
- bronchospasm (COPD,asthma)
- exacerbation of peripheral vascular disease
91
What should a nurse always do before giving a beta blocker?
take an apical HR, call MD if less than 60
92
When are nitrates indicated?
prevention & treatment of attacks of angina pectoris & HF
93
how do nitrates work on the body?
- arterial & venous dilator
- decrease preload & afterload
- increase oxygen to the heart; decrease myocardial oxygen demands
94
how quickly are nitrates absorbed?
very rapidly
95
Can people develop tolerance to nitrates?
yes; tolerance develops easily, must have drug-free periods
96
What drug-drug interaction with nitrates causes hypotension?
sildenafil (viagra)
97
What are the routes of administration for nitroglycerin?
- sublingual
- translingual spray
- transmucosal tablet
- oral, SR tablet
- intravenous
- topical ointment
- transdermal
98
what should you do when administering any type of nitrate to a pt?
always wear gloves
99
How long do nitroglycerin patches work?
patch is placed for 24 hrs but stops working before that to prevent tolerance
100
how often can sublingual NTG be given?
every 5 minutes for a max 3 doses; if no relief, call 911
101
How must a pt be positioned before taking NTG
sitting or laying
102
where should NTG be stored?
in its original bottle & protected from sunlight
103
What are some side effects that may be experienced with NTG?
- tingles or burns under tongue
- dizziness
- headache
104
What should the nurse do before and after giving NTG?
take a BP
105
What is the name for oral nitrate?
isosorbide
106
What are the forms of oral isosorbide?
short acting or sustained release
107
how long does isosorbide work?
works for about 18 hrs; has a drug free period in the delivery system
108
What was the first drug regimen shown to improve the sx of HF?
hydralazine & nitrate (isosorbide)
109
how does the combination of hydralazine & nitrate (isosorbide) affect the body?
- decreases preload & aferload by achieving both venous & arterial vasodilation
- decreases systemic & pulmonic vascular resistance
- positive inotropic effect on heart
110
With what pts is hydralazine & nitrate typically used?
- pt who have sx despite ACE inhibitors, beta blockers, & diuretic therapy
- those who cannot tolerate routine therapy
111
When is digoxin indicated?
heart failure
atrial fibrilation
112
is digoxin a first-line tx for HF?
no
113
What does digoxin do?
- increases intracellular calcium
- allows more calcium to enter the myocardial cell during depolarization
- positive inotropic effect (increase contraction)
- increased renal perfusion w/ a diuretic effect ( decrease in renin release)
- slowed conduction through the AV node (decrease HR)
114
is the therapeutic margin for digoxin narrow or broad?
very narrow
115
What is the normal and desired level for digoxin?
normal level: 0.5-2.0
desired level: 0.8
116
What should be drawn when taking digoxin?
peak & troughs
117
What are the risks with digoxin?
digoxin toxicity & increased risk of hypokalemia
118
How is digoxin given?
orally or IV (not the same dosing)
119
What is the onset & absorption of digoxin?
rapid
120
How is digoxin excreted?
renal excretion
121
What should be checked before giving digoxin?
always check apical HR, call MD if less than 60
122
What labs should be monitored when taking digoxin?
- BUN & creatinine
- potassium
123
What are sx of digoxin toxicity?
- vision changes
- N/V
- dizziness
124
What is the antidote to digoxin?
digibind
125
With what pt populations should digoxin be used with caution?
- pregnancy & lactation
- children
- geriatrics
- renal insufficiency
126
What are some nursing interventions for those with HF?
- monitor lungs
- monitor HR & BP
- monitor BUN & creatinine
- monitor potassium
- monitor weight daily
- question orders for IV fluids
- pt education: no sodium, no OTC meds
