Mod 6- HF Flashcards
What does inotropic mean?
It means contractility so a positive inotropic means an increase in contractility
What happens with right-sided heart failure
blood backs up into the periphery- signs are pitting edema, nocturia d/t increased renal perfusion when supine, elevated jugular venous pressure
What happens in Left-sided heart failure?
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
What drugs work to improve contractility?
Cardiotonic (inotropic) drugs
What HF drugs are not recommended for children?
Phosphodiesterase inhibitors and HCN blockers
What is Digoxin used for in children and what is important about dosing?
used for heart defects and related problems; dosage should be checked by another nurse and monitored closely for digitalis toxicity
What are considerations for adults taking cardiotonic agents?
take own pulse, daily weighs, stick w/ same brands & avoid in pregnancy/ lactation
T/F Dosage of cardiotonic agents needs to be adjusted for older adults with renal impairment
TRUE
What is a cardiac glycoside medication?
Digoxin
What is the action of a cardiac glycoside?
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
What are the indications for cardiac glycosides?
tx of HF and atrial fibrillation
ADE of cardiac glycosides
HA, weakness, drowsiness, vision changes- yellow halo indicate toxicity; GI upset and anorexia; arrhythmia development (brady arrhythmias)
Contraindications of Cardiac Glycosides
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
Cautions for cardiac glycosides
pregnancy/ lactation
pediatric and geriatric pts
Drug/Drug interactions of Cardiac Glycosides
Verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, cyclosporine
potassium losing diuretics- increase risk of arrhythmias and toxicity
cholestyramine, charcoal, colestipol, bleomycin, cyclophosphmide, methotrexate
What is an important physical assessment for someone taking cardiac glycosides?
LS- rhales or crackles can mean fluid build up in the lungs
When would you withhold a cardiac glycoside?
If the apical pulse is <60bpm after taking for 1 full minute
Should you give a Cardiac Glycoside w/ food?
No- avoid with food and antacids it will interfere with absorption
What is a therapeutic digoxin level?
0.5 - 2 ng/ml
What does a negative chronotrope do?
Decreases heart rate
When would you administer the Phosphodiesterase Inhibitor- Inamrinone?
When pt with HF has not responded to digoxin, diuretics, or vasodilators
When would you administer the Phosphodiesterase Inhibitor- Milrinone
Used for short-term management of HF in pts who are receiving digoxin and diuretics
How do Phosphodiesterase Inhibitor work?
increases the contractility of the heart and relaxes vascular smooth muscles to reduce heart workload
When are Phosphodiesterase Inhibitor indicated?
For the short term tx of HF in pts unresponsive to digitalis, diuretics, or vasodilators
Contraindications of Phosphodiesterase Inhibitors
Allergy or severe aortic or pulmonic disease, MI, fluid volume deficit and ventricular arrhythmias
Cautions for Phosphodiesterase Inhibitor
pregnany/ lactation
Elderly increases risk for ADE
ADE of Phosphodiesterase Inhibitors
Arrhythmias, hypotension, N/V, thrombocytopenia- low platelet count especially w. milrinone, pericarditis, pleuritis, fever, chest pain, burning at injection site
What would happen if Phosphodiesterase Inhibitor was mixed with furosemide?
If mixed together, will cause precipitate
Hyperpolarization-Activated Cyclic Nucleotide–Gated Channel Blockers is long for what medication?
HCN Blockers
HCN Blocker medication
Ivabradine
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
ADE of HCN Blockers
Bradycardia, hypertension, Afib, luminous phenomena
Drug-Drug interactions of HCN Blockers
CYP3A4 inhibitors b/c alters drug concentrations
Negative chronotropic drugs b/c both slow HR
What do you want to monitor for a pt taking Ivabradine?
Input/ output & daily weight
pulse, knowing when to withhold
