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NURS 572 Pharm Ch 47
Pharm Ch 47 Heart failure
| Question | Answer |
|---|---|
| 2 major causes of HF | CAD---HTN |
| HF compensations result in long-term cardiac remodeling bwo 2 systems | SNS---RAAS contribute to remodeling that result in fibrous, non-contractile scar tissue |
| How does heart compensate to HF | ventricles dilate and hypertrophy--> become shperical in an attempt to compensate for decreased CO. Only works short term, then leads to viscous cycle |
| what is viscous cycle in HF | compensatory SNS/RAAS ---inc HR/venous pressure/arterial pressure ---remodeling occurs---heart continues with compensatory mechs but heart can no longer respond |
| S/S CHF | dec exercise tol---fatigue--tachy---tachypnea/sob/doe/pnd/orthopenea----peripheral edema---venous JVD/HJR, HSM---cardiomegaly/tachy/LVH strain |
| class of drugs used to tx HF - 4 | diuretics---ACEIs----BB---Inotropic agents (subclasses sympathomimetics and glycosides-digoxin) |
| Most common diuretics are thiazides ---if RF, then loop diuretics. MOA in HF | MOA to decrease preload---decrease peripheral/pulmonary edema----cardiac dilation |
| what are the thiazide diuretics again? | hydrochlorothiazide---chlorothiazide---chlorothalidone---metolazone |
| what are the loop diuretics again | furosemide---bumetadine---torsemide |
| what are benefits to selecting K-sparing diuretics spironolactone or eplerenone (if you can afford it!) | benefit is that this class inhibits aldosterone effect in RAAS that contributes to both cardiac remodeling ----and SNS activation ---and baroreceptor dysfunction |
| ACEIs are used to tx HF, MOA is | block Angio-2 which minimizes remodeling ---vasoDIL arteries and veins so DECREASES pre/after loads---aldosterone decreases intravascular volume/remodeling |
| ACEIs are prils, but let's review their ADRs | cough---angioedema---first dose effect---category D |
| There are ONLY 3 BBs approved for HF. MOA in HF is | counterintuitive MOA - expect they would slow heart down, which is what we're treating for. HOWEVER for some reason they work at very precise doses - start low, go slow - so just go with it |
| what are the 3 BBs approved for HF | caverdilol---bisoprolol---metoprolol------- ONLY IN SUSTAINED RELEASE FOR METOPROLOL |
| ADRs of BBs if dose too high | ADRs of brady---heart block---dec bp---fluid retention---fatigue |
| Inotropic agents - sympathomimetics - their use | only used temporary, IV ---last line/Stage D drugs due to SEs |
| Name 2 sympathomimetics for ST/IV only use | dopamine---dobutamine (both B-1 agonists, remember dopa steps up the stairs in terms of what receptors it hits) |
| Now, in cardiac glycosides class we have | digoxin is in this class |
| Effects of digoxin in terms of inotropy | positive inotrophy---inc contractility/force---inc CO---DECREASED sympathetic tone which dec tachy, pre/after load----increased urine production leads to decreased Na/H20 retention |
| MOA digoxin | poisons Na/K/ATP pump which re-sets the cell after depol/repol as it tries to restore Na in ECF and K ICF---REMEMBER---Ca goes wherever Na goes (see next slide) |
| MOA digoxin as affects Ca | like I was saying, if pump is poisoned, then Na/Ca can't leave cell as fast---when Ca in cell longer, heart has longer contraction time--->positive inotrophy! |
| what state of serum K predisposes to cardiac toxicity | HYPOkalemia----digoxin competes with K ---if K is low, then more digoxin can bind to render its effects. too much of a good thing |
| what types of cardiac ADR for digoxin | ALMOST ANY!!! dysrhythmia, so monitor closely |
| what are non-cardiac ADRs digoxin | a/n/v---crosses BBB so CNS distrurbances |
| what is effect of K-WASTING diuretics such as loop or thiazides | hypokalemia possible, which may lead to digoxin toxicity |
| what is effect of K-SPARING diuretics | hyperkalemia ---now too much K competing with digoxin---could decrease efficacy |
| In a 3 drug regiment, what drugs to we use - in order of adding them sequentially | Stage A = ACEIs-----Stage B = ACEI+ BB----Stage 3 = ACEI +BB + diuretic |
| so when do we add digoxin? | Digoxin is only considered if first 3 drug lines not effected then you ADD digoxin----as in add it to ACEI+BB+diuretic |
| What other drug classes MIGHT be considered at time digoxin is considered (stage C if first 3 not effective) | may consider ARB+ACEI combo or spiractolone |
Created by:
lorrelaws
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