Heart Failure Drugs & Antilipemics

Question 1

digoxin toxicity

Answer 1

HR below 60/new irregular rhythm, anorexia, nausea, confusion, blurred yellow tinged appearance of halos are symptoms. Discontinued by MD ONLY, takes about 1 wk for drug to be eliminated from body.

Question 2

What is digoxin overdose?

Answer 2

Antidote: digoxin immune Fab (Digibind)

- Therapeutic classification: antidotes
- Pharmacologic classification: antibody
- Indications: serious life-threatening overdose w/digoxin
- Action: antibody produced in sheep that binds to unbound digoxin serum
- Therapeutic effect: bind & subsequent removal of digoxin, preventing toxic effects

Question 3

What is LDL?

Answer 3

Low-density lipoproteins bad/lousy cholesterol

Question 4

What is HDL?

Answer 4

high-density lipoproteins good/healthy cholesterol

Question 5

What are recommended therapeutic lifestyle changes to ↓ cholesterol?

Answer 5

• Diet: ↓ cholesterol & saturated fat, ↑ soluble fiber & plant stanols & sterols
• Weight control
• Exercise: 30-60 min of activity
• Smoking cessation

Question 6

Statins adverse effects

Answer 6

hepatotoxicity (0.2-2%), myopathy (5-10%), Rhabdomyolysis (rare)

Question 7

What are S/S of hepatotoxicity?

Answer 7

anorexia, nausea, vomiting, yellow skin/sclera, dark urine

Question 8

Blood flow of heart?

Answer 8

Venus

Right
Atrium
Tricuspid > Right Ventricle > Pulmonary valve > Lungs

escaped the

Left
Atrium
Bicuspid > Left ventricle > Aortic valve > Body

and Pushed All the cheese in the VALVES on the way out!
PULMONARY AND AORTIC VALVE are points of exit from the ventricles.

Aorta= 5 letters= Right Vena Cava = 4 letters = Left

Question 9

S/S left HF

Answer 9

cough, pulmonary edema, dyspnea,

Question 10

S/S right HF

Answer 10

jugular vein distention, ascites, pedal edema

Question 11

(RAAS) ACE Inhibitors

MOA

Answer 11

↓ Na, Cl, K reabsorption in ascending loop of henle results in diuresis

Question 12

ACE Inhibitors

Drug Effects

Answer 12

↓ blood volume, ↓venous pressure (preload) & arterial pressure (afterload). ↓pulmonary & peripheral edema

Question 13

ACE Inhibitors

Indications

Answer 13

Acute & chronic HF

Question 14

ACE Inhibitors

Adverse Effects

Answer 14

hypokalemia (↑ risk of digoxin toxicity), severe hypotension

Question 15

ACE Inhibitors

Nursing Implications

Answer 15

Assess pt.’s fluid volume, VS, labs

Question 16

Theraputic window for digoxin?

Answer 16

0.5-0.8 ng/mL

Question 17

How long does it take digoxin to leave the body?

Answer 17

1 wk

Question 18

Difference between Statin & Nicotinic Acid

Answer 18

Nicotinic: ↓ triglycerides mainly 20-50%, ↓ LDL to lesser extent 5-25%, Raise HDL cholesterol 15-35%

Statin: Drug Effects: ↓ LDL cholesterol by 25-63%

Question 19

Statin contradindication

Answer 19

Avoid Crestor in Asian pt decent/prescribe smaller doses, grapefruit juice pregnancy category X

Question 20

Statin Nursing Implication

Answer 20

2 wks effect, max 4-6wks, reversal of effects upon withdrawal, monitor LFT & CK levels, assess for ℅ weakness, muscle aches

Question 21

Statin Pt Education

Answer 21

Most effective when taken @ bedtime, immediate report muscle pain/weakness or indications of liver dysfxn, avoid alcohol

Question 22

Nicotinic MOA

Answer 22

B vitamin known as niacin (B3). higher doses are needed than available in OTC vitamins.

Question 23

Nicotinic Drug Effects

Answer 23

↓ triglycerides mainly 20-50%, ↓ LDL to lesser extent 5-25%, Raise HDL cholesterol 15-35%

Question 24

Nicotinic Adverse Effects

Answer 24

intense facial flushing & pruritus, GI distress (self-limiting), hepatotoxicity

Question 25

Nicotinic Nursing Implications/Pt Education

Answer 25

instruct pt to take 325 mg of ASA 30 min prior to dose to ↓ decrease flushing

Question 26

Vasodilators MOA

Answer 26

Isorils belongs to same family w/nitroglycerin. Causes selective dilation of veins ↓ preload & ↓ congestive symptoms. Hydralize causes selective dilation of arterioles, improving CO ( ↓ afterload ) and renal blood flow (↑ urine output/ ↓ volume)

Question 27

Normal Potassium levels

Answer 27

3.5-5 mEq/L

Question 28

Cardiac glycosides MOA

Answer 28

inhibits sodium-potassium adenosine triphosphate pump, causing accumulation of calcium in cardiac myocytes. Calcium augments contractile force by facilitating interaction of myocardial actin and myosin

Question 29

Cardiac glycosides Drug Effects

Answer 29

Positive inotropic effect ↑ force of ventricular contract, thus ↑ CO, which reverse overt manifestation of HF Sodium-potassium adenosine triphosphate pump keeps K+ IN cell and keeps Na+ and Ca++ OUT of cell. Digoxin allows Na+ and Ca++ INTO cell and K+ OUT of cell.

Question 30

Cardiac glycosides Indications

Answer 30

seconline HF; atrial fibrillation

Question 31

Cardiac Adverse Effects

Answer 31

digoxin toxicity, cardiac dysrhythmia