Mod 6- HF Flashcards

1
Q

What does inotropic mean?

A

It means contractility so a positive inotropic means an increase in contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens with right-sided heart failure

A

blood backs up into the periphery- signs are pitting edema, nocturia d/t increased renal perfusion when supine, elevated jugular venous pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What happens in Left-sided heart failure?

A

Blood is coming in from the lungs and as it backs up, it can cause anxiety r/t respiratory problems; crackles in the lungs, decreased peripheral pulses/ hypoxia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What drugs work to improve contractility?

A

Cardiotonic (inotropic) drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What HF drugs are not recommended for children?

A

Phosphodiesterase inhibitors and HCN blockers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Digoxin used for in children and what is important about dosing?

A

used for heart defects and related problems; dosage should be checked by another nurse and monitored closely for digitalis toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are considerations for adults taking cardiotonic agents?

A

take own pulse, daily weighs, stick w/ same brands & avoid in pregnancy/ lactation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

T/F Dosage of cardiotonic agents needs to be adjusted for older adults with renal impairment

A

TRUE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a cardiac glycoside medication?

A

Digoxin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the action of a cardiac glycoside?

A

improve the squeeze of the heart which leads to increased perfusion to the kidneys and stop RAAS system to decrease BP and blood volume; also slows conduction through AV node to SLOW HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the indications for cardiac glycosides?

A

tx of HF and atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

ADE of cardiac glycosides

A

HA, weakness, drowsiness, vision changes- yellow halo indicate toxicity; GI upset and anorexia; arrhythmia development (brady arrhythmias)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Contraindications of Cardiac Glycosides

A

Allergy, ventricular tachycardia or fibrillation, heart block or sick sinus syndrome (slow HR)
idiopathic hypertrophic subaortic stenosis
acute MI, renal insufficiency, and electrolyte abnormalities- high calcium, low potassium or low magnesium can lead to arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Cautions for cardiac glycosides

A

pregnancy/ lactation

pediatric and geriatric pts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drug/Drug interactions of Cardiac Glycosides

A

Verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, cyclosporine
potassium losing diuretics- increase risk of arrhythmias and toxicity
cholestyramine, charcoal, colestipol, bleomycin, cyclophosphmide, methotrexate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is an important physical assessment for someone taking cardiac glycosides?

A

LS- rhales or crackles can mean fluid build up in the lungs

17
Q

When would you withhold a cardiac glycoside?

A

If the apical pulse is <60bpm after taking for 1 full minute

18
Q

Should you give a Cardiac Glycoside w/ food?

A

No- avoid with food and antacids it will interfere with absorption

19
Q

What is a therapeutic digoxin level?

A

0.5 - 2 ng/ml

20
Q

What does a negative chronotrope do?

A

Decreases heart rate

21
Q

When would you administer the Phosphodiesterase Inhibitor- Inamrinone?

A

When pt with HF has not responded to digoxin, diuretics, or vasodilators

22
Q

When would you administer the Phosphodiesterase Inhibitor- Milrinone

A

Used for short-term management of HF in pts who are receiving digoxin and diuretics

23
Q

How do Phosphodiesterase Inhibitor work?

A

increases the contractility of the heart and relaxes vascular smooth muscles to reduce heart workload

24
Q

When are Phosphodiesterase Inhibitor indicated?

A

For the short term tx of HF in pts unresponsive to digitalis, diuretics, or vasodilators

25
Contraindications of Phosphodiesterase Inhibitors
Allergy or severe aortic or pulmonic disease, MI, fluid volume deficit and ventricular arrhythmias
26
Cautions for Phosphodiesterase Inhibitor
pregnany/ lactation | Elderly increases risk for ADE
27
ADE of Phosphodiesterase Inhibitors
Arrhythmias, hypotension, N/V, thrombocytopenia- low platelet count especially w. milrinone, pericarditis, pleuritis, fever, chest pain, burning at injection site
28
What would happen if Phosphodiesterase Inhibitor was mixed with furosemide?
If mixed together, will cause precipitate
29
Hyperpolarization-Activated Cyclic
Nucleotide–Gated Channel Blockers is long for what medication?
HCN Blockers
30
HCN Blocker medication
Ivabradine
31
Actions and indications of HCN Blockers
Blocking the HCN slows the pacemaker of Sinus node, in the repolarizing phase of the action potential slows SA node to decrease the work load of the heart
32
ADE of HCN Blockers
Bradycardia, hypertension, Afib, luminous phenomena
33
Drug-Drug interactions of HCN Blockers
CYP3A4 inhibitors b/c alters drug concentrations | Negative chronotropic drugs b/c both slow HR
34
What do you want to monitor for a pt taking Ivabradine?
Input/ output & daily weight | pulse, knowing when to withhold