Mod 6- HF

Question 1

What does inotropic mean?

Answer 1

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

Question 2

What happens with right-sided heart failure

Answer 2

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

Question 3

What happens in Left-sided heart failure?

Answer 3

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

Question 4

What drugs work to improve contractility?

Answer 4

Cardiotonic (inotropic) drugs

Question 5

What HF drugs are not recommended for children?

Answer 5

Phosphodiesterase inhibitors and HCN blockers

Question 6

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

Answer 6

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

Question 7

What are considerations for adults taking cardiotonic agents?

Answer 7

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

Question 8

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

Answer 8

TRUE

Question 9

What is a cardiac glycoside medication?

Answer 9

Digoxin

Question 10

What is the action of a cardiac glycoside?

Answer 10

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

Question 11

What are the indications for cardiac glycosides?

Answer 11

tx of HF and atrial fibrillation

Question 12

ADE of cardiac glycosides

Answer 12

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

Question 13

Contraindications of Cardiac Glycosides

Answer 13

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

Question 14

Cautions for cardiac glycosides

Answer 14

pregnancy/ lactation

pediatric and geriatric pts

Question 15

Drug/Drug interactions of Cardiac Glycosides

Answer 15

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

Question 16

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

Answer 16

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

Question 17

When would you withhold a cardiac glycoside?

Answer 17

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

Question 18

Should you give a Cardiac Glycoside w/ food?

Answer 18

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

Question 19

What is a therapeutic digoxin level?

Answer 19

0.5 - 2 ng/ml

Question 20

What does a negative chronotrope do?

Answer 20

Decreases heart rate

Question 21

When would you administer the Phosphodiesterase Inhibitor- Inamrinone?

Answer 21

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

Question 22

When would you administer the Phosphodiesterase Inhibitor- Milrinone

Answer 22

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

Question 23

How do Phosphodiesterase Inhibitor work?

Answer 23

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

Question 24

When are Phosphodiesterase Inhibitor indicated?

Answer 24

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

Question 25

Contraindications of Phosphodiesterase Inhibitors

Answer 25

Allergy or severe aortic or pulmonic disease, MI, fluid volume deficit and ventricular arrhythmias

Question 26

Cautions for Phosphodiesterase Inhibitor

Answer 26

pregnany/ lactation

Elderly increases risk for ADE

Question 27

ADE of Phosphodiesterase Inhibitors

Answer 27

Arrhythmias, hypotension, N/V, thrombocytopenia- low platelet count especially w. milrinone, pericarditis, pleuritis, fever, chest pain, burning at injection site

Question 28

What would happen if Phosphodiesterase Inhibitor was mixed with furosemide?

Answer 28

If mixed together, will cause precipitate

Question 29

Hyperpolarization-Activated Cyclic
Nucleotide–Gated Channel Blockers is long for what medication?

Answer 29

HCN Blockers

Question 30

HCN Blocker medication

Answer 30

Ivabradine

Question 31

Actions and indications of HCN Blockers

Answer 31

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

Question 32

ADE of HCN Blockers

Answer 32

Bradycardia, hypertension, Afib, luminous phenomena

Question 33

Drug-Drug interactions of HCN Blockers

Answer 33

CYP3A4 inhibitors b/c alters drug concentrations

Negative chronotropic drugs b/c both slow HR

Question 34

What do you want to monitor for a pt taking Ivabradine?

Answer 34

Input/ output & daily weight

pulse, knowing when to withhold