#44: Drugs Treating Heart Failure

Question 1

Afterload

Answer 1

Resistance against which the heart has to beat

Question 2

Cardiac Output

Answer 2

Volume of blood being pumped by the heart

Question 3

Cardiomegaly

Answer 3

Enlargement of the heart, r/t HTN, Valvular Disease, and HF

Question 4

Cardiomyopathy

Answer 4

A disease of the heart muscle that leads to an enlarged heart and eventually a complete heart muscle failure and death

Question 5

Dyspnea

Answer 5

Difficulty breathing, seen with left-sided heart failure

Question 6

Heart Failure

Answer 6

A condition in which the heart muscle fails to adequately pump blood around the CV system, leading to a backup (congestion) of blood

Question 7

Hemoptysis

Answer 7

A blood-tinged sputum, seen in left-sided heart failure when blood backs up into lungs

Question 8

Positive Inotropic

Answer 8

Effect resulting in an increased contraction of the heart

Question 9

Preload

Answer 9

The amount of blood that is brought back to the heart to be pumped throughout the body

Question 10

Pulmonary Edema

Answer 10

Seen with severe left-sided heart failure

Question 11

Tachypnea

Answer 11

Rapid and shallow respirations, seen with left-sided heart failure

Question 12

Two Classes of Drugs Used to Tx HF

Answer 12

Cardiotonic

HCN - hyperpolarization-activated cyclic nucleotide-gated

Question 13

Effect of Cardiotonic Drugs

Answer 13

Increase cardiac contractility and increase perfusion to kidneys, decreasing RAAS and increasing urine output, decreasing BP

Question 14

Effect of HCN Drugs

Answer 14

Work in pacemaker, decrease heart rate, balance cardiac cycle

Question 15

Causes of Cardiomyopathy

Answer 15

Viral infection
Alcoholism
Anabolic Steroid Use
Collagen d/o
*Anything that alters contraction/pump

Question 16

Effects of HTN

Answer 16

Causes an enlarged heart muscle d/t increase stress

Increases cardiac O2 demands

Question 17

Effects of Right-Sided HF

Answer 17

Liver congestion
Spleen congestion
Elevated jugular venous pressure
Edema of legs
*Eventually leads to both sided HF

Question 18

Cardiomegaly Mechansim

Answer 18

Increase blood volume dilates chamber

Question 19

Causes of Right-Sided HF

Answer 19

COPD or elevated pulmonary pressure

Harder pushing blood into lungs

Question 20

Cardiac Output

Answer 20

The volume of blood that leaves the heart in 1 min

Question 21

Cardiac Output Components

Answer 21

Stroke Volume x Heart Rate

Question 22

Stroke Volume

Answer 22

Amount of blood that leaves the left ventricle with each contraction

Question 23

Average Stroke Volume

Answer 23

75mL

Question 24

Two Cardiotonic Agents

Answer 24

1. Cardiac Glycosides - Digoxin (Lanoxin)

2. Phosphodiesterase Inhibitors - Milrinone

Question 25

Two Cardiotonic Agents Patient Teaching

Answer 25

Monitor and track pulse Weigh in same clothing, same time daily Changes in diet, GI activity or meds

Question 26

Cardiotonics with Renal Impairment

Answer 26

Leads to accumulation of digoxin, reduce dosage

Question 27

Digoxin Mechanism

Answer 27

``` Increases intracellular Ca2+ Increases force Increase CO and Renal Perfusion (Decreases RAAS) Slows HR *Decreases cardiac workload ```

Question 28

Digoxin Therapeutic Margin

Answer 28

Very narrow between dose and overdose

Question 29

Digoxin Kinetics

Answer 29

Rapid IV onset (5-20min) | Metab unchanged in urine (potential for backup/OD)

Question 30

Digoxin Contraindications

Answer 30

``` Allergy V-Tach Heart Block (slows AV node further) MI (increases force/muscle damage) Renal Insufficiency (toxic) ```

Question 31

Digoxin Adverse Effects

Answer 31

Arryhthmias Anorexia N/V

Question 32

Digoxin Toxicity Effects

Answer 32

``` Shock Cardiac Arrest Ventricular Dysrhythmias Bradycardia Hypokalemia ```

Question 33

Digoxin Nursing Diagnoses

Answer 33

Decrease Cardiac Output | Risk for Injury (r/t Falls)

Question 34

Therapeutic Digoxin Level

Answer 34

0.5-2 ng/mL

Question 35

Natriuretic Peptide Function

Answer 35

To induce uresis by decreasing [Na+]

Question 36

Natriuretic Peptide Prototype

Answer 36

Nesiritide (Natrecor)

Question 37

Natriuretic Therapeautics

Answer 37

Use in adults with decompensated HF

Question 38

Nesiritide Maximizing Effects

Answer 38

Must be given w/ cECG