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heart failure meds
cardiac glycosides, diuretics
| Question | Answer |
|---|---|
| positive inotropic effect | cardiac glycoside |
| positive inotropic effect strengthen | myocardial contraction |
| negative chronotropic effect slows | the heart rate by decreasing impulse formation |
| negative dromotropic effect refers to drugs that affect | conduction velocity through specialized conducting tissues and delays conduction |
| twofold effect of digitalis glycosides | increase the strength of contraction; slows the heart rate and slowing conduction velocity |
| depressed myocardial contractility is primarily the underlying cause of | heart failure |
| treatment of HF does this | remove excess water and salt in the body, enhance myocardial contraction |
| clnicial signs of Right sided heart failure | JVD, hepatomegaly, ascites, and peripheral edema |
| clinical signs of Left sided heart failure | pulmonary edema, dyspnea, interference of o2 and co2 exchange |
| failing heart may show | increase in preload and afterload |
| decreased renal perfusion activates | RAAS |
| RAAS increases | sodium and water retention increasing blood volume increasing demand on the heart |
| prescribed to reduce the increase in blood volume and edema | diuretics |
| prescribed for left ventricular systolic dysfunction | ACE inhibitor |
| pool blood in the extremities reducing blood return and thus preload | nitrates or vasodilators |
| increase cardiac contractility with direct stimulation of beta1 adrenergic receptors | dobutamine |
| decrease peripheral vascular resistance (afterload, pulmonary capillary wedge pressure (preload), pulmonary vascular resistance, and secretion of aldosterone | key reasons to use ACE inhibitors for Heart Failure |
| digoxin effects cardiac ffxn by | + inotropic, -chronotropic, -dromotropic |
| for enlarged failing heart, the positive inotropic action of digitalis can cause | the myocardium to beat more forcefully, increasing CO and decreasing o2 use. |
| net effect of improved pumping of heart | reduce heart size and decrease venous pressure to relieve edema |
| positive inotropic mechanism | free calcium ions to result in more forceful contractions |
| low to moderate levels of digitalis slow heart rate because | the SA node depolarizes less frequently |
| dig toxicity can increase | rate of APs and spontaneous depolarizations causing dysrhythmia |
| AV conduction velocity is slowed by increased vagal action and | MOA of digitalis (Digoxin) |
| prolonged PR interval | slowed AV conduction by Digoxin |
| increased force of systolic contraction causes | the ventricles to empty more completely |
| slower heart rate permits more filling time resulting in: | 1. falling venous pressure 2. enhancement of coronary circulation 3. heart size decreased |
| mild diuretic effect | cardiac glycosides |
| digoxin slows the ventricular rate by increasing the refractory period at AV junction and slows conduction in this type of dysrhythmia | atrial fibrillation |
| reduces possibility of ventricular tachycardia in atrial fib | digoxin |
| more effective in low output heart failure | cardiac glycosides |
| s/e of glycosides | anorexia (first sign of dig tox), nausea, bradycardia, stomach pain, dysrhythmia |
| nausea, vomiting, and ab distress occurrs days after the first sign of dig tox | anorexia |
| maintenance dose of dig | 0.125mg or .25mg qd |
| saturation of the body tissues with enough digitalis to cause the signs and symptoms of HF to disappear | digitalization |
| dig is prescribed according to | client's body weight |
| two methods of digitalization | rapid method requiring hospitalization and monitoring, or slow method that can be done at home |
| rapid loading method given to | client in acute HF, divided doses over 24 hours |
| slower method may take this long for digitalization | 7 days |
| slow method advantages | safer, oral dose, no close monitoring |
| dysrhythmia may indicate | dig tox, which then needs to be stopped |
| progression of AV block means | that dig is not working |
| caution in older adults b/c | frequent renal impairment (can lead to tox), drug induced cognitive impairment |
| electronic pacemakers may require | special dosing |
| hypokalemia and hypomagnesia increases risks | for dig tox |
| hypercalcemia and hyperkalemia may lead to | dysrhythmia with digoxin |
| vantricular contractions or tachycardia may be ----with digoxin | exacerbated |
| acutre myocarditis, MI, or ischemic heart disease is highger risk for | digitalis induced dysrhythmia |
| sick sinus and wolf parkinson white may worsen with | digoxin |
| amiodarone | increases digoxin serum levels |
| antacids | decreases digitalis absorption |
| CCB | require reduced dig doses |
| spironolactone | may increase the half life of digoxin |
| measure this before administration of digoxin | apical rate for one minute, parameters to not give are <60 bpm, or >110bpm |
| take apical and radial for one minute when giving dig for this | atrial fibrillation |
| digoxin is working when s/s are these | improvement in rate and rhythm, improved respirations, diuresis, and feeling of well-being |
| watch this electrolyte carefully | potassium |
| s/s hypokalemia | drowsiness, hypoperistalsis, depression, paresthesia, weakness, anorexia, depressed reflexes, orthostatic hypotension, polyuria |
| monitor these for renal function | BUN and creatinine levels |
| dysrhythmia of dig tox include | atrial tachycardia with AV block, progressing AV blocks, accelerated junction rhythms, ventricular dysrhythmias |
| why digoxin is preferred in clients with impaired liver fxn... | does not need extensive hepatic metabolism |
| delayed or diminished renal excretion can lead to | dig tox |
| sudden weight gain early sign of | fluid retention |
| excess fluid volume signs include | dependent edema (pedal or sacral), basilar crackles in lungs, jugular distention |
| administer slowly to prevent | pulmonary edema |
| caution with hypertension d/t | temporary increase in BP |
| IM injection where and how? | in large muscle mass and then massage |
| do not give with high fiber b/c | digoxin binds to fiber reducing amount of medication |
| should not be skipped or doubled, must take when? | same time every day |
| cannot change brands d/t | difference in bioavailability |
| restrict sodium intake to this during dig therapy | 2 grams |
| report weight gain of this | 1-2 pounds per day |
| avoid this food, can induce sodium and water retention | licorice |
| teachings to client taking digoxin | take own pulse, carry med id, report s/s including visual disturbances |
| antidote for digoxin | digibind, binds with digoxin and then excreted by kidneys |
| less potent than loop diuretics | thiazide |
| max portion of sodium that thiazide affects | 10% |
| thiazides promote excretion of | water, Na, Cl, K, Mg |
| thiazides may increase serum levels of | calcium, glucose, uric acid |
| important feature of thiazide | impair free water clearance without effect on concentration ability |
| antihypertensive action | reduction in plasma, and ECF levels resulting in decrease CO |
| increase dieetary intake of this when taking thiazide | potassium |
| may add this to med regimen to stop potassium loss | potassium sparing diuretic |
| increase in serum uric acid may result from | thiazide |
| probenecid | counteract elevation in serum uric acid |
| hyperglycemia or impaired glucose tolerance may result with | thiazide and loop diuratics |
| hyperglycemia can be controlled | by diet alteration or increase dose of insulin |
| increasing serum lipid levels | result of thiazide and perhaps furosemide |
| check creatinine clearance of older adults | to ensure adequate renal function |
| caution in giving thiazides with | severe, renal impairment, hepatic impairment, DM, electrolyte imbalance, pregnant women (CI) |
| baselines of these to check client's underlying conditions | BP, extent of edema with CHF, baseline blood chemistry for glucose, electrolytes, BUN, serum uric acid, serum creatinine |
| side effects of thiazides | nausea, diarrhea, constipation, orthostatic hypotension, hypokalemia, hyponatremia, allergic rxn, agrnulocytosis, gout, hepatotox, and thrombocytopenia |
| BP should not show a client in this state before thiazide | hypotension |
| nursing considerations include | daily weights and fluid balance, monitoring with digitalis, latent diabetes or gout, monitor for hyperglycemia or hyperuricemia, hypovolemia, hyponatremia, hypokalemia, hypocalcemia, hypochloremia, hypomagnesemia |
| observe for signs of these electrolyte imbalances | hypovolemia, hyponatremia, hypokalemia, ypocalcemia, hypochloremia, hypomag |
| d/c thiazide diuretics before performing parathyroid fxn tests | they may alter serum calcium concentrations |
| anorexia, nausea, and vomiting are early signs of | digoxin toxicity to be aware of |
| dry mouth, constipation, and orthostatic hypotension | effects of thiazides |
| loop diuretics are similar to other diuretics but different b/c | the effect is greater than those reported with other diuretics |
| reported effects of loop includes | hypergylcemia, hyperuricemia, increase in ldl, decrease in hdl, increase excretion in mg and ca |
| loop indicated for | edema a/w CHF and hypertension |
| postural hypotension, blurred vision, headaches, ab distress, diarrhea, anorexia, anxiety, confusion, ototoxicity, photosensitivity | s/e of loops |
| blood chem for loops include | BUN, CO2, glucose, uric acid |
| clients with renal insufficiecy and dehydration may experience | reversible elevation of BUN and creatinine from loops |
| excessive dosing of loops can lead to | prolonged water loss, electrolyte depletion, dehydration, blood volume reduction, circulatory collapse |
| if loops ar added with other meds for hypertension, expect this | adjustment of meds to decrease potential for orthostatic hypotension |
| Administer furosemide IV injections over | 2 minutes |
| Spironolactone | Potassium sparing diuretic |
| spironolactone combined with this provides additive blockade on aldosterone | ACE inhibitors |
| ACE and spironolactone | protect the heart from too much aldosterone which reduce the capability of heart to pump |
| s/e of spironolactone | gynecomastia, muscle cramps, decreased libido, hirsutism, flank pain, agranulocytosis, and thrombocytepenia |
| first sign of hyperkalemia | irregular heartbeat or peaked T waves |
| other signs of hyperkalemia | confusion, tingling in the extremities, breathing difficulties, anxiety, fatigue, physical weakness |
| reverse hyperkalemia of 6-6.5 or more with | sodium bicarbonate, glucose, and regular insulin |
| give loops with these to decrease GI symptoms | milk or food |
| vasodilators include | nitropress, nitroglycerin, natrecor |
| Acute pulmonary Edema trx | morphine |
| reduciton of anxiety and causes vasodilatory effect | morphine |
| vasodilatory effects by | promotes venous pooling, therefore lowers systemic vascular resistance, lowering cardiac workload = enhanced cardiac function |
| adverse effects of morphine | respiratory depression, decreased LOC, hypotension, constipation, n/v |
| n/c of morphine | with patients with COPD |
| narcan | antidote of morphine |
| s/e of diuretics | electrolyte imbalance, worsening renal function, metabolic alkalosis |
| natrecor | mimics BNP, vasodilates, promotes natriuresis, decreased fluid volume, preload, neurohormones, increased cardiac muscle relaxation |
| do not draw BNP while this is running | natrecor |
| vasodilators that are both arteriodilators and venodilators | nitropress |
| vasodilator that is a venodilators | nitroglycerin |
| venous dilators | reduce preload |
| arterial dilators | reduce afterload |
| beta agonists | dopamine and dobutamine |
| PDE III inhibitors | Milirone, Amrinone (watch for renal functions and increased contractility) |
| vasoactive adrenergics | digoxin increase force of contractions |
| do not draw BNP while this is running | natrecor |
| vasodilators that are both arteriodilators and venodilators | nitropress |
| vasodilator that is a venodilators | nitroglycerin |
| venous dilators | reduce preload |
| arterial dilators | reduce afterload |
| beta agonists | dopamine and dobutamine |
| PDE III inhibitors | Milirone, Amrinone (watch for renal functions and increased contractility) |
| vasoactive adrenergics | increase force of contractions, IV admin. for hemodynamically unstable patients, some increase BP |
| digoxin | used as maintenance positive inotrope |
| maintenance therapy for HF | ABCD-A, ACE inhibitors, beta blockers, cardiac glycosides, diuretics, aldosterone Antagonists |
| Cornerstone of treament | ACE inhibitors |
| ACE inhibitors | promotes reverse remodelling, decreases afterload, decreases preload, cardioprotective |
| s/e ACE | hypotension, hyperkalemia, cough, angioedema |
| Life Long Drug Therapy | Beta Blockers (never stop suddenly) |
| Coreg | nonselective B1B2 and alpha blocker |
| Metoprolol | selective B1 |
| s/e BB | hypotension, volume overload, bradycardia, AV blockade, fatigue |
| number one s/e of BB | FATIGUE |
| Aldosterone aldactone Antagonists | decreases preload and has protective effects when combined with ACEI and BB |
| Spironolactone s/e | hyperkalemia and gynecomastia |
| 3 ways to REDUCE PRELOAD | diuretics, ACE, Natrecor |
| 3 ways to IMPROVE CONTRACTILITY | digoxin, bi-ventricular pacing, research drugs (calcium sensitizers) |
| 6 ways to REDUCE AFTERLOAD | ACE, BB, Nitrates, Hydralazine, Natrecor, Aldosterone Antagonists |
| what to avoid while on maintenance therapy | NSAIDS, Advil, Motrin |
Created by:
hong204
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