Heart Failure Drugs Flashcards Preview

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Flashcards in Heart Failure Drugs Deck (46):
0

Digoxin (Lanoxin)
(Functional Classification)

Cardiac glycoside, inotropic, antidysrhythmic

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Digoxin (Lanoxin)
(Chemical Classification)

Digoxin preparation

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Digoxin (Lanoxin)
(Mechanism of Action)

Inhibits the sodium-potassium ATPase pump, which makes more calcium available for contractile proteins, thereby resulting in increased cardiac output (positive inotropic effect); increases force of contractions; decreases heart rate (negative chronotropic effect); decreases AV conduction speed

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Digoxin (Lanoxin)
(Uses)

Heart failure, atrial fibrillation, atrial flutter, atrial tachycardia, cardiogenic shock, paroxysmal atrial tachycardia, rapid digitalization in these disorders

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Digoxin (Lanoxin)
(Contraindications)

Hypersensitivity to digoxin, ventricular fibrillation, ventricular tachycardia, carotid sinus syndrome, 2nd- or 3rd-degree heart block

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Digoxin (Lanoxin)
(Side Effects)

CNS: Headache, drowsiness, apathy, confusion, disorientation, fatigue, depression, hallucinations
CV: DYSRHYTHMIAS, Hypotension, bradycardia, AV BLOCK
EENT: blurred vision, yellow-green halos, photophobia, diplopia
GI: nausea, vomiting, anorexia, abdominal pain, diarrhea

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Digoxin (Lanoxin)
(Nursing Considerations)

ASSESS:
-Apical pulse for 1 min before giving product; if pulse <60 in adult, call prescriber; note rate, rhythm, character; monitor ECG continuously during parenteral loading dose
-Electrolytes: K , Na, Cl, Mg, Ca; renal function studies: BUN, creatinine; blood studies: ALT, AST, bilirubin, Hct, Hgb before initiating treatment and periodically therafter
-I&O ratio, daily weights; monitor turgor, lung sounds, edema
-Monitor product levels: therapeutic level 0.5-2ng/ml
-Cardiac status: apical pulse, character, rate, rhythm

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Digoxin (Lanoxin)
(Overdose Treatment)

Discontinue product; give potassium; monitor ECG; give adrenergic-blocking agent, digoxin immune FAB

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Dobutamine
(Functional Classification)

Adrenergic direct-acting Beta1-agonist, cardiac stimulant

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Dobutamine
(Chemical Classification)

Catecholamine

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Dobutamine
(Mechanism of Action)

Causes increased contractility, increased cardiac output without marked increased in heart rate by acting on Beta1-receptors in heart; minor alpha and beta2 effects

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Dobutamine
(Uses)

Cardiac decompensation due to organic heart disease or cardiac surgery

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Dobutamine
(Contraindications)

Hypersensitivity, idiopathic hypertrophic subaortic stenosis

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Dobutamine
(Side Effects)

CNS: Anxiety, headache, dizziness, fatigue
CV: palpitations, tachycardia, hyper/hypotension, PVCs, angina
ENDO: hypokalemia
GI: heartburn, nausea, vomiting
MS: muscle cramps (leg)
RESP: dyspnea

14

Dobutamine
(Nursing Considerations)

ASSESS:
-HYPOVOLEMIA; if present, correct first; administer cardiac glycoside before DOBUTamine
-OXYGENATION/PERFUSION DEFICIT: check BP, chest pain, dizziness, loss of consciousness
-HEART FAILURE: S3 gallop, dyspnea, neck venous distention, bibasilar crackles in patients with CHF, cardiomyopathy, palpate peripheral pulses; report if extremities become cold or mottled or if peripheral pulses decrease
-ECG during administration continuously; if BP increases, product is decreased; CVP or PCWP, cardiac output during inf; report changes
-Serum electrolytes, urine output
-SULFITE SENSITIVITY, which may be life threatening

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Dobutamine
(Overdose Treatment)

Administer a Beta1-adrenergic blocker; reduce IV or discontinue, ensure oxygenation/ventilation; for severe tachydysrhythmias (ventricular), give lidocaine or propranolol

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Lisinopril
(Functional Classification)

Antihypertensive, Angiotensin-Converting Enzyme 1 (ACE) inhibitor

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Lisinopril
(Chemical Classification)

Enalaprilat lysine analog

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Lisinopril
(Mechanism of Action)

Selectively suppresses renin-angiotensin-aldosterone system; inhibits ACE, thereby preventing conversion of angiotensin I to angiotensin II

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Lisinopril
(Uses)

Mild to moderate hypertension, adjunctive therapy of systolic CHF, acute MI

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Lisinopril
(Contraindications)

Hyper-sensitivity, angioedema

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Lisinopril
(Side Effects)

CNS: Vertigo, depression, stroke, insomnia, paresthesias, headache, Fatigue, asthenia, dizziness
CV: chest pain, hypotension, sinus tachycardia
EENT: blurred vision, nasal congestion
GI: nausea, vomiting, anorexia, constipation, flatulence, GI irritation, diarrhea, HEPATIC FAILURE, HEPATIC NECROSIS
GU: PROTEINURIA, RENAL INSUFFICIENCY, sexual dysfunction, impotence
INTEG: rash, pruritus
MISC: muscle cramps, hyperkalemia
RESP: dry cough, dyspnea
SYST: ANGIOEDEMA, ANAPHYLAXIS, TOXIC EPIDERMAL NECROLYSIS

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Lisinopril
(Nursing Considerations)

ASSESS:
-Blood studies, platelets; WBC with differential at baseline, periodically q3mo; if neutrophils <1000/mm3, discontinue treatment (recommended with collagen-vascular disease)
-Baselines of renal, hepatic studies before therapy begins, periodically; LFTs, uric acid, glucose may be increased
-ANGIOEDEMA: ANAPHYLAXIS, TOXIC EPIDERMAL NECROLYSIS, facia swelling, dyspnea, tongue swelling (rare)
-Pregnancy before starting treatment; pregnancy (D)
-HYPERTENSION: BP, pulse q4hr during beginning treatment and periodically thereafter; note rate, rhythm, quality; apical/pedal pulse before administration; notify prescriber of any significant changes
-Electrolytes: K, Na, Cl
-CHF: edema in feet, legs daily; weight daily; dyspnea, wet crackles
-Skin turgor, dryness, of mucous membranes for hydration status

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Lisinopril
(Overdose Treatment)

Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure

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Milrinone
(Functional Classification)

Inotropic/vasodilator agent with phosphodiesterase activity

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Milrinone
(Chemical Classification)

Bipyridine derivative

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Milrinone
(Mechanism of Action)

Positive inotropic agent; increases contractility of cardiac muscle with vasodilator properties; reduces preload and afterload by direct relaxation on vascular smooth muscle

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Milrinone
(Uses)

Short-term management of advanced heart failure that has not responded to other medication

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Milrinone
(Contraindications)

Hypersensitivity to this product, severe aortic disease, severe pulmonic valvular disease, acute MI

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Milrinone
(Side Effects)

CV: DYSRHYTHMIAS, hypotension, chest pain, PVCs
GI: nausea, vomiting, anorexia, abdominal pain, HEPATOTOXICITY, JAUNDICE
HEMA: THROMBOCYTOPENIA
MISC: headache, hypokalemia, tremor, inj site reactions

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Milrinone
(Nursing Considerations)

ASSESS:
-ECG continuously during IV; ventricular dysrhythmia can occur
-BP, pulse q5min during inf; if BP drops 30mmHg, stop inf, call prescriber
-Electrolytes: potassium, sodium, chloride, calcium; renal studies: BUN, creatinine; blood studies: platelet count
-ALT, AST, bilirubin daily
-I&O ratio, weight daily; diuresis should increase with continuing therapy
-If platelets are <150,000/mm3, product is usually discontinued and another product started
-Extravasation; change site q48hr

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Milrinone
(Overdose Treatment)

Discontinue product, support circulation

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Nesiritide
(Functional Classification)

Vasodilator

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Nesiritide
(Chemical Classification)

Human B-type natriuretic peptide

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Nesiritide
(Mechanism of Action)

Uses DNA technology; human B-type natriuretic peptide binds to the receptor in vascular smooth muscle and endothelial cells, thereby leading to smooth muscle relaxation

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Nesiritide
(Uses)

Acutely decompensated CHF

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Nesiritide
(Contraindications)

Hypersensitivity to this product or Escherichia coli protein; cardiogenic shock or BP <90mmHg as primary therapy

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Nesiritide
(Side Effects)

CNS: headache, insomnia, dizziness, anxiety, confusion, paresthesia, tremor
CV: Hypotension, TACHYCARDIA, dysrhythmias, bradycardia, VENTRICULAR TACHYCARDIA, VENTRICULAR EXTRASYSTOLES, ATRIAL FIBRILLATION
GI: vomiting, nausea
INTEG: rash, sweating, pruritus, inj site reaction
MISC: abdominal pain, back pain
RESP: increased cough, hemoptysis, APNEA

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Nesiritide
(Nursing Considerations)

ASSESS:
-PCWP, RAP, cardiac index, MPAP, BP, pulse during treatment until stable
-Daily serum creatinine, BUN
CHF: weight gain, dyspnea, crackles, I&O ratios, peripheral edema

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Valsartan
(Functional Classification)

Antihypertensive

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Valsartan
(Chemical Classification)

Angiotensin II receptor antagonist (Type AT1)

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Valsartan
(Mechanism of Action)

Blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II; selectively blocks the binding of angiotensin II to the AT1 receptor found in tissues

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Valsartan
(Uses)

Hypertension, alone or in combination in patients >6yr, CHF, post MI with left ventricular dysfunction/failure in stable patients

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Valsartan
(Contraindications)

Hypersensitivity, severe hepatic disease, bilateral renal artery stenosis

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Valsartan
(Side Effects)

CNS: Dizziness, Insomnia, drowsiness, vertigo, headache, fatigue
CV: angina pectoris, 2nd-degree AV block, CEREBROVASCULAR ACCIDENT, hypotension, MI, Dysrhythmias
EENT: conjunctivitis
GI: Diarrhea, abdominal pain, nausea, HEPATOTOXICITY
GU: impotence, NEPHROTOXICITY
HEMA: Anemia, neutropenia
META: hyperkalemia
MISC: vasculitis
MS: cramps, myalgia, pain, stiffness
RESP: Cough

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Valsartan
(Nursing Considerations)

ASSESS:
-BP, pulse, q4hr lying, siting, standing; note rate, rhythm, quality periodically
-Blood studies; BUN, creatinine, LFTs, total/direct bilirubin before treatment
-Angioedema: facial swelling; SOB; edema in feet, legs daily
-Skin turgor, dryness of mucous membranes for hydration status; correct volume depletion before initiating therapy