Chapter 24: Heart Failure Drugs

Question 1

What are the drug therapies for heart failure?

Answer 1

• ACE inhibitors
• Angiotensin II receptor blockers
• Beta blockers
• aldosterone antagonists
• B-type natriuretic peptides
• phosphodiesterase inhibitors
• cardiac glycoside (digoxin)

Question 2

Aldosterone antagonist

Answer 2

indicated for severe CHF

Question 3

Spironolactone

Answer 3

potassium-sparing diuretic that has been shown to reduce CHF symptoms

Question 4

What drugs are considered aldosterone antagonists?

Answer 4

spironolactone and eplerenone

Question 5

What are the miscellaneous drugs to treat heart failure?

Answer 5

• hydralazine/isosorbide dinitrate

- dobutamine

Question 6

hydralazine/isosorbide dinitrate

Answer 6

first drug approved for a specific ethnic group, namely african americans

Question 7

dobutamine

Answer 7

• beta1-selective vasoactive adrenergic drug

- structurally similar to dopamine

Question 8

B-Type Natriuretic Peptides includes

Answer 8

Nesiritide (Natrecor)

Question 9

nesiritide (natrecor)

Answer 9

used in the intensive care setting as a final effort to treat severe, life-threatening heart failure, often in combination with several other cardiostimulatory medications

Question 10

Mechanism of action for B-Type Natriuretic Peptides

Answer 10

• effects include diuresis (urinary fluid loss), natriuresis (urinary sodium loss) and vasodilation
• vasodilating effects on both arteries and veins
• indirectly increases cardiac output
• suppresses renin-angiotensin system

Question 11

Phosphodiesterase Inhibitors

Answer 11

work by inhibiting the enzyme phosphodiesterase

Question 12

Use of phosphodiesterase inhibitors results in

Answer 12

positive inotropic response and vasodilation

Question 13

Name a phosphodiesterase inhibitor

Answer 13

milrinone (primacor)

Question 14

What are the indications of phosphodiesterase inhibitors?

Answer 14

• short-term management of heart failure
• given when patient does not respond to treatment with digoxin, diuretics and/or vasodilators
• American Heart Associations and American College of Cardiology advise against long term infusions

Question 15

Adverse Effects of the Phosphodiesterase inhibitor, Milrinone

Answer 15

• dysrhythmia
• hypotension
• angina
• hypokalemia
• tremor
• thrombocytopenia

Question 16

Cardiac Glycosides

Answer 16

• from digitalis plant, foxglove
• for heart failure and control ventricular response to atrial fibrillation or flutter
• prototype is digoxin

Question 17

What is the mechanism of action for cardiac glycosides?

Answer 17

• increase myocardial contractility
• change electrical conduction properties of the heart: decrease rate of electrical conduction, prolong the refractory period (area between SA node and AV node)

Question 18

What are the drug effects of cardiac glycosides?

Answer 18

• positive inotropic effect
• negative chronotropic effect
• negative dromotropic effect

Question 19

positive inotropic effect

Answer 19

increased force of myocardial contraction (without an increase in oxygen consumption)

Question 20

Negative chronotropic effect

Answer 20

reduces heart rate

Question 21

Negative dromotropic effect

Answer 21

decreases electrical conduction of heart

Question 22

What are indications for cardiac glycosides?

Answer 22

• heart failure

- supraventricular dysrhythmias: atrial fibrillation and atrial flutter

Question 23

What are the cardiac glycosides?

Answer 23

digoxin and lanoxin

Question 24

Cardiac Glycosides: Digoxin and Lanoxin

Answer 24

• very narrow therapeutic window
• drug levels must be monitored: 0.5-2 ng/mL
• electrolyte levels must be monitored

Question 25

What do low potassium levels do to the cardiac glycosides: digoxin and lanoxin?

Answer 25

low potassium levels increase its toxicity

Question 26

What are the adverse effects of cardiac glycosides?

Answer 26

1. CV 2. CNS 3. Eyes 4. GI

Question 27

What are the adverse effects on the cardiovascular system due to cardiac glycosides?

Answer 27

dysrhythmias, including bradycardia or tachycardia

Question 28

What are the adverse effects on the CNS due to cardiac glycosides?

Answer 28

headaches, fatigue, malaise, confusion, convulsions

Question 29

What are the adverse effects on the eyes due to cardiac glycosides?

Answer 29

colored vision (seeing green, yellow, purple), halo vision, flickering lights

Question 30

What are the adverse effects on the GI system due to cardiac glycosides?

Answer 30

Anorexia, nausea, vomiting and diarrhea

Question 31

Digoxin Toxicity

Answer 31

- hyperkalemia (serum potassium greater than 5 mEq/L) in a digitalis toxic patient - life-threatening cardiac dysrhythmias - life-threatening digoxin overdose

Question 32

What is the antidote for digoxin toxicity?

Answer 32

digoxin immune Fab

Question 33

What are conditions that predispose digoxin toxicity?

Answer 33

- hypokalemia, use of a pacemaker, liver disease, hypercalcemia - dysrhythmias, hypothyroid, respiratory, or renal disease, advanced age

Question 34

Nursing Diagnosis

Answer 34

discuss nursing diagnosis and patient-centered care pg 383-387

Question 35

inotropic

Answer 35

drugs that influence the force of muscular contractions, particularly contractions of the heart muscle

Question 36

chronotropic

Answer 36

drugs that influence the rate of the heartbeat

Question 37

dromotropic

Answer 37

drugs that influence the conduction of electrical impulses within the tissues