Quiz 7 Heart Failure Drugs Flashcards
Heart failure definition
Heart failure (HF) is a pathologic state in which the heart is unable to pump blood in sufficient amounts to meet the body’s metabolic needs (decreased CO)
Symptoms of left-sided heart failure
- Pulmonary edema
- Coughing
- Dyspnea
Symptoms of right-sided heart failure
- Jugular vein distention
- Ascites
- Pedal edema
Diagnostic studies for heart failure
- BNP
- Echocardiography to determine ejection fraction (EF)
Compensated v. decompensated heart failure
Compensated: under control mostly with meds
- clear lungs
- displaced cardiac apex
Decompensated: worsening/uncontrolled HF
- tachycardic
- tachypneic, with
- bilateral inspiratory rales
- jugular venous distention
- edema
- pale
- diaphoretic
Positive inotropic, chronotropic, and dromotropic
↑ Contraction, ↑ HR, ↑ Conduction
Goals of drug therapy for HF
- Improve symptoms
- Slow deterioration in myocardial function
- Reduce mortality
MOA/Drug effects Loop Diuretics
MOA: decreases Na, Cl, and K reabsorption in thick ascending limb of the loop of Henle in the nephron which results in profound diuresis.
Effect: reduced blood volume decreases venous pressure (preload) and arterial pressure (afterload). Reduced pulmonary and peripheral edema.
Ex. Furosemide (Lasix)
Indications Loop Diuretics
Acute and chronic HF
Adverse Effects Loop Diuretics
- Hypokalemia (↑ risk of digoxin toxicity)
- Severe hypotension
Nursing implications/patient education
Assess fluid volume status, lab values (K), advise patient to eat foods rich in Potassium (bananas, potatoes, dried fruit, tomatoes, spinach, citrus fruit)
MOA/Drug effects ACEI (Inhibit RAAS)
MOA: inhibits ACE which prevents the conversion of angiotensin I to angiotensin II (a powerful vasoconstrictor). Also reduces aldosterone secretion. Suppress degradation of kinins (vasodilator).
Effect: arteriolar and venous dilation results in reduced preload, afterload, ↓ pulmonary & pedal edema, and increased cardiac output. ↑ kinins reduces cardiac remodeling.
Ex. lisinopril (Prinvil), captopril (Capoten), enalapril (Vasotec)
Indications ACEI
Cornerstone of HF therapy
Adverse Effects ACEI
A: angioedema
C: cough
E: extra Potassium (hyperkalemia)
hypotension
MOA/Drug effects Beta-Blockers (Inhibit SNS)
MOA: protect heart from excessive sympathetic stimulation
Effect: Improve LV ejection fraction (1-3 months), slow the progression of HF, reduce need for hospitalization, and prolong survivial.
Ex. Carvedilol (Coreg), bisoprolol, sustained-release metoprolol (Toprol XL)
Contraindications Beta Blockers
Heart block
Adverse Effects Beta Blockers
- Fluid retention/ worsening HF
- Bradycardia/ heart block
- Hypotension
Dosages Beta Blockers
Start low and go slow
Things to know about Cardiac Glycosides
- Oldest group of cardiac drugs
- Comes from the foxglove plant
- Digoxin (Lanoxin) is the only cardiac glycoside available in the U.S.
- No longer used as first-line treatment
MOA/Drug effects
MOA: inhibits the sodium-potassium adenosine triphosphatase pump.
Effect: positive inotropic effect increases the force of ventricular contraction which increases cardiac output. Increased CO, can reverse all the overt manifestations of HF.
Indications Cardiac Glycosides
Second-line heart failure; atrial fibrillation
Precautions Cardiac Glycosides
Lasix (secondary to risk of hypokalemia)
Adverse effects Cardiac Glycosides
- Digoxin toxicity
- Cardiac dysrhythmia
Therapeutic window Cardiac Glycosides
0.5 to 0.8 ng/mL
