HF

Question 1

During heart failure, cardiac output is reduced which leads to a series of responses by body:

Answer 1

Increased sympathetic activity
Increases heart rate and force of contraction but also increases vascular resistance
Combined, cardiac workload is increased, and failure gets worse
Activation of renin-angiotensin-aldosterone system (RAAS)
Promotes vasoconstriction and volume retention which both raise blood pressure

Question 2

What med blocks Activation of renin-angiotensin-aldosterone system (RAAS)

Answer 2

Angiotensin Receoptor Blockers

Question 3

Drugs that increase the force of contraction are positive intropes for ex ___________ Drugs that decrease

Answer 3

Epinephrine

Question 4

Drugs that decrease the force of contraction are negative intropes for ex.________ _________

Answer 4

Beta Blocker

Decrease HR

Question 5

Optimizing breathing during HF

Answer 5

Supplemental O2
HOB increase
Diuretics

Question 6

Nutriotonal therapy

Answer 6

Due to edema the patient should be on a ___________ and _________ __________.

Sodium and fluid

Fluid restriction 1.5-2 liters per day.

Question 7

What is vital to monitor in a patient is at risk fluid retention?

Answer 7

Wt Gain

Question 8

Wt gain indicative of fluid overload

Answer 8

2kgs in 3 days

Question 9

When thinking of the symptoms of heart failure what drugs do you think could be used with this condition?

Answer 9

ACE inhibitors, angiotensin receptor blockers
Adrenergic agents, cardiac glycosides
Vasodilators, diuretics,

Question 10

Pharm management goals

Answer 10

Reduction of preload
Reduction of systemic vascular resistance (reduction of afterload)
Inhibition of RAAS and vasoconstrictor mechanisms of sympathetic nervous system

Question 11

Ace Inhibs does what for HF

Answer 11

Decrease vascular resistance by dilating the veins that return blood to the heart

Decrease secretion of aldosterone
Less Na+ retention, less fluid retention
Less cardiac remodeling

Decrease secretion of ADH

Captopril and lisinopril have been determined to improve survival rate of an MI if given 1 to 2 days following the onset of symptoms.

Question 12

Ace inhib adverse effects

Answer 12

Cough
Angioedema
Hyperkalmic

Question 13

Angioedem

Answer 13

Swelling in the deep layer of skin and other tissues

Question 14

Treatment for angioedema

Answer 14

Epinephrine, benidryl

Question 15

Pisinopril is

Answer 15

Ace Inhib

Binds ACE, preventing formation of Angiotensin II
Decreases aldosterone, ADH production causing increased fluid output, decreased thirst
Angiotensin II is a ___________thus blocking production promots vasodialation

Can cause head ache, neutropenia

Question 16

Angiotensin 2 recebtor Blockers iondicated for

Answer 16

Hypertension and heart failure
MI
Prophylaxis against stroke (CVA)

Question 17

Mechanism of ARB action

Answer 17

Block angiotensin II from activating their target receptors in smooth muscle
Promote _____________ _ decreases blood pressure, afterload, preload
Decrease secretion of aldosterone and ADH

Question 18

Adverse effects of ARBS

Answer 18

More mild than Ace inhib

Question 19

Beta adrenergic Blockers

Answer 19

Used to decrease heart rate and force of contraction ( negative Inotrope and negative chronotropic effect)
Some promote vasodilation as well by blocking alpha1 receptors
Prevent MI and remodeling of ventricles

Question 20

Carevdiolol

Answer 20

Beta blocker

Blocks beta1 receptors
Decreases heart rate, force of contraction, O2 demand
Blocks alpha1 receptors
Reduces vascular resistance contributing to decreased blood pressure

Question 21

Adverse effects of Beta Adrenergic blockers

Answer 21

Mask hypoglycemia
Weight gain
Fatigue

Question 22

Vasodialators

Answer 22

Relax blood vessels causing vasodilation

Never a first choice because they have more adverse effects

Question 23

WHy areen’t vadsodialators first choice

Answer 23

More adverse effects

Question 24

Isosorbide Dinitrate

Answer 24

Vasodialotor

Angina pectoris
Heart failure

Donates NO molecules which promote relaxation of vascular smooth muscle cells leading to vasodialotrs

HOTN, headache, dizziness, reflex tachycardia .

Question 25

Cardiac Glycosides

Answer 25

Used in HF Can stablize some dysrhythmiads Cardiac glycosides are negative chronotropes and positive inotropes Improve symptoms by _________ heart rate while _________ force of contraction Require digitalizstion to be effective (becomes effective once a suitable concentration of drug has built up in tissues)

Question 26

What to do before giving digoxin

Answer 26

Take apical for full minute before giving, if less than 60 - hold

Question 27

Digoxin mech of action

Answer 27

Blocks Na+ / K+ ATPase the critical enzyme responsible for pumping sodium out of the myocardial cell in exchange for potassium. As Na+ accumulates in myocytes calcium ions are released from their storage areas in the cell which produces a more forceful contraction. Suppresses the SA node and slows electrical conduction through the AV node.

Question 28

Thereapeutic index of Cardiac Glycosides

Answer 28

Narrow

Question 29

Adverses effects of digoxin (digital toxicity)

Answer 29

Nausea, vomiting Visual disturbances Atrial dysrythmias Bradycardia Heart block Vent dysrythmias

Question 30

Assessment

Answer 30

Obtain complete health history including allergies and drug history

Question 31

Nursing Considerations for Clients Receiving Cardiac Glycoside Therapy (2 of 3)

Answer 31

Monitor ECG for changes to rate and rhythm Monitor for adverse effects including GI effects, vision changes, leg muscle cramps, shortness of breath Note if pt reports adverse effects or HR below 50 BPM

Question 32

Interventions for clients recieving cardiac glycoside thereapy

Answer 32

Monitor patient weight Ensure that dose is taken regularly to avoid toxicity related to overdose Monitor serum drug levels and report significant elevations Monitor electrolyte levels especially ________, and renal function tests, fluid input and output Monitor patient for signs of toxicity GI effects, lack of energy Visual disturbances, confusion

Question 33

What nursing measure is always taken before administering digoxin?

Answer 33

Apical pulse, one full minute

Question 34

What is digitalis toxicity?

Answer 34

Build up in blood

Question 35

Assessing for digitalis otxicity

Answer 35

Assess for levels in the blood

Question 36

Health conditions putting a person at ris for digitalis toxicity

Answer 36

CKD Hypothryoidism

Question 37

What are some signs and symptoms of it?

Answer 37

Decreased LOC Visiual disturbances N/V

Question 38

How do you treat it digitalis toxicity

Answer 38

Antidote Activated Charco (Stomach pump)

Question 39

Diuretics work by

Answer 39

Lowering BP decreasing the work-load of the heart. Used for fluid overload Prevents the reabsorption of sodium and chloride particularly in the loop of Henle region in the nephron. - Most Na is absorbed, therefore most effective place to stop it

Question 40

When you think of massive diuresis what is your main concern?_______________

Answer 40

Electrolyte loss (K+ specifically)

Question 41

Lasix pts need to be

Answer 41

Mobile Given in the morning

Question 42

Drugs for Heart Failure - Phosphodiesterase III Inhibitors

Answer 42

Block the enzyme phosphodiesterase in cardiac and smooth which increases the amount of calcium available for myocardial contraction Used with patients with heart failure who have not responded to other therapiesIncreased force of myocardial contraction increasing cardiac output. Only given IV

Question 43

Main concernes with Phosphodiesterase III Inhibitors

Answer 43

This inhibition results in two main actions; 1. a positive inotropic action which is? 2. Vasodilation

Question 44

Are calcium channel blockers useful in HF?

Answer 44

NO because they decrease heart rate and contractility