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NUR516 Final Exam > Medications for Heart Failure > Flashcards

Medications for Heart Failure Flashcards

(90 cards)

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1
Q

List examples of vasodilators

A

ACE inhibitors
Nitrates
Hydralazine

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2
Q

How do loop diuretics work?

A

Decrease BV → which decreases venous return & BP

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3
Q

How do beta-adrenergic antagonists (beta blockers) work?

A

Block beta receptors in the SNS → decreasing Ca++ flow into myocardial cells, & causing decreased contraction & workload

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4
Q

ACE inhibitors have a ____ improvement that reduces ____ & improves survival

A

Symptomatic improvement; reduces hospitalizations

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5
Q

What type of HF patients should be on ACE inhibitors if they can tolerate?

A

ALL patients with systolic HF

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6
Q

ACE inhibitors decrease what two things?

A

Preload & afterload

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7
Q

ACE inhibitors work by…

A

Vasodilation & by blocking RAAS/ aldosterone

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8
Q

ACE inhibitors help prevent…

A

Cardiovascular remodeling

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9
Q

What ethnic groups do ACE inhibitors not work as well in?

A

African Americans & Asians

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10
Q

If someone cannot tolerate an ACE inhibitor what should they be prescribed?

A

ARB → angiotensin receptor blocker

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11
Q

What is entresto?

A

Combo drug
Sacubitril (neprilysin inhibitor) plus valsartan (ARB)

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12
Q

Entresto is used for…

A

Systolic HF to improve Sx & reduce remodeling

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13
Q

What 3 things does entresto increase?

A
  1. Natriuretic peptides (ex. BNP)
  2. Bradykinin (vasodilation)
  3. Other mediators which increase vasodilation
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14
Q

List 5 side effects of Entresto

A

1) Angioedema
2) Hypotension
3) Hyperkalemia
4) Renal failure
5) Can cause cough

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15
Q

Entresto is contraindicated for what patients?

A

Pregnancy → can cause fetal harm

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16
Q

Why should patients avoid NSAIDs while on Entresto?

A

NSAIDs vasoconstrict & Entresto vasodilates (contraindicate each other)

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17
Q

What two things does Entresto inhibit?

A

Inhibits RAAS as well as angiotensin II

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18
Q

Loop diuretics inhibit…

A

Reabsorption of Na or Cl at the loop of henle

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19
Q

What do loop diuretics decrease? (Hint: 4)

A

1) Workload on heart
2) Preload
3) Stroke volume
4) Cardiac output

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20
Q

Which type of HF med can help decrease pulmonary congestion?

A

Loop diuretics

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21
Q

Explain admin of loop diuretics

A

Initially given IV then switched to oral

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22
Q

List 3 examples of loop diuretics

A

1) Bumetanide
2) Furosemide (Lasix)
3) Torsemide

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23
Q

List 6 side effects of loop diuretics

A

1) Hyponatremia
2) Hypokalemia
3) Hypovolemia
4) Hypomagnesemia
5) Hyperglycemia
6) Ototoxicity

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24
Q

List 3 nursing considerations for loop diuretics

A

1) Monitor potassium levels
2) Monitor I&O
3) Monitor blood sugar in diabetics

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25
What 2 meds are mineralcorticoid receptor antagonists?
Spironolactone & Eplerenone
26
What med class are Spironolactone & Eplerenone?
Aldosterone receptor blockers
27
List 2 indications for taking Spironolactone or Eplerenone
1) HTN 2) HF
28
When are aldosterone receptor blockers used?
When one drug is NOT enough to Tx Sx
29
How do aldosterone receptor blockers work?
Block exchange of Na for potassium in distal tubules
30
How would you instruct a patient to take aldosterone receptor blockers?
With meals
31
List three things to monitor in patient taking aldosterone receptor blockers
1) Potassium levels (can ↑) 2) LFTs 3) BUN/ Cr
32
Aldosterone receptor blockers are contraindicated in what kind of patients?
Patients with renal insufficiency
33
Aldosterone receptor blockers (specifically spironolactone) can cause _____ in males
Gynecomastia
34
Patients taking aldosterone receptor blockers should be instructed to avoid taking what meds?
1) ACE inhibitors/ ARBs 2) Heparin 3) NSAIDs
35
Beta blockers are ONLY used if
Patient has stable HF
36
Beta blockers help to improve _____ , reduces _____, & enhances survival in patients with ______
improves Sx; reduces hospitalizations; HFrEF (heart failure w/ reduced ejection fraction)
37
List the things Beta blockers slow down: (**Hint: 6**)
1. Slows HR 2. Decreases afterload 3. Decreases catecholamine stimulation 4. decreases myocardial energy demands 5. reduces remodeling due to cardiac myocyte hypertrophy & death 6. arrhythmia promotion
38
Do beta blockers affect preload?
NO
39
Beta blockers stimulate other detrimental systems such as _____
RAAS
40
List 3 drugs in beta blocker class
1) Carvedilol 2) Metoprolol succinate 3) Bisoprolol
41
Suffix for beta blockers
"olol"
42
Beta blockers should always be started at very ____ doses
low doses → can make HF worse
43
Are you able to stop taking beta blockers abruptly?
NO → need to taper off **if stopped it will cause a sympathetic surge & go from one extreme to another**
44
What must always be checked for patients taking beta blockers?
Apical HR
45
If apical HR is < _____ patient should call the doctor
< 60
46
List adverse effects of beta blockers: (**Hint: 4**)
1. worsening HF 2. Hypotension, bradycardia 3. bronchospasm (COPD & asthma → cause more bronchoconstriction) 4. Exacerbation of PVD
47
Nitrates fall under what class of drugs?
Vasodilators
48
When are nitrates indicated?
Preventions & Tx of attacks of angina pectoris & HF
49
What are the actions/ functions of nitrates? (**Hint: 4**)
1. arterial & venous dilator 2. decreases preload & afterload 3. increase O2 to heart 4. decrease myocardial O2 demand
50
Pharmacokinetics of Nitrates: (**Hint: 3**)
1. very rapidly absorbed 2. tolerance develops easily, must have drug-free periods 3. drug-drug interaction w/ sildenafil
51
What kind of drug is Sildenafil & why should nitrates not be given with use of this?
Sildenafil → viagra → can cause abrupt drop in BP
52
List all the administration routes for nitroglycerin (**Hint: 7**)
1. sublingual (common) 2. translingual spray 3. transmucosal tablet 4. oral, SR tablet 5. intravenous 6. topical ointment 7. transdermal
53
How do the transdermal nitroglycercin patches work?
it's a 24 hr patch; but stops working few hrs before that so that the patient has a break before the next patch is applied (↓ ability of developing drug tolerance)
54
What are the dosing guidelines for sublingual nitroglycerin?
every 5 minutes for a max of 3 doses **if no relief, then call 911**
55
What happens if nitroglycerin pill bottle is stored in light?
Light will degrade the med
56
How should the patient be instructed to position themselves when taking NTG sublingual tabs?
Must be sitting or laying
57
List side effects of NTG sublingual tabs (**Hint: 2**)
1. tingles or burns under tongue 2. H/A; dizziness
58
What VS should be monitored before & after taking NTG sublingual tabs?
Blood pressure
59
What type of med is isosorbide?
Oral nitrate
60
About how long does isosorbide work for?
~18 hours **Has drug free period in delivery system**
61
What two forms does isosorbide come in?
1) Short acting 2) Sustained release
62
Side effects of isosorbide are similar to what other med?
Nitroglycerin
63
What is the first drug regimen to improve Sx of HF?
Hydralazine & nitrates → isosorbide
64
Isosorbide decreases both preload & afterload by ...
achieving venous & arterial vasodilation
65
Isosorbide decreases ____ & ____ vascular resistance
Systemic & pulmonic
66
Isosorbide has a ______ effect on the heart
Positive
67
Isosorbide (hydralazine/ nitrates) are used in patients who:
1. have Sx despite ACEI, BB, diuretic therapy 2. those who CANNOT tolerate routine therapy
68
List an example of a cardiac glycoside
Digoxin
69
Indications for using digoxin (**Hint: 2**)
1) HF 2) A-fib
70
Is digoxin a first line treatment?
NO
71
Actions of cardiac glycosides (digoxin) **Hint: 5**
1. ↑ intracellular Ca 2. allows more Ca to enter myocardial cells during depolarization 3. (+) iontropic effect (↑ contraction) 4. ↑ renal perfusion with a diuretic effect → ↓ in renin release 6. slowed conduction through the AV node (↓ HR)
72
Describe the therapeutic margin of digoxin
Narrow therapeutic margin → normal level: 0.5-2.0 → desired level: 0.8
73
What is required due to narrow therapeutic margin with digoxin use?
Monitoring of drug levels (peak & trough levels)
74
What two routes can digoxin be administered?
Oral or IV
75
Pharmacokinetics of digoxin **Hint: 2**
1) Rapid onset & absorption 2) Excreted by the kidneys
76
what VS must be checked when taking digoxin?
Apical HR (call MD if < 60)
77
What 2 labs should be monitored for a pt taking digoxin?
BUN/ Cr & potassium
78
What can digoxin toxicity cause? **Hint: 4**
1. vision changes 2. N/V 3. dizziness 4. increased risk of hypokalemia
79
What is the antidote for digoxin?
Digibind
80
Digoxin should be used with caution in what patients? **Hint: 3**
1. pregnant & lactating 2. pediatric & geriatric 3. renal insufficiency
81
Summary of HF: Right sided
**Blood returns from the body (deoxygenated)** 1. ascites 2. edema
82
Summary of HF: Left sided
**Blood returns from lungs (oxygenated)** 1. crackles in lungs 2. expect SOB
83
List some nursing interventions for those with HF? **Hint: 6**
1. monitor lungs 2. monitor HR & BP 3. Monitor BUN/ Cr & potassium 4. Monitor weight daily 5. Question any orders for IV fluids 6. patient education
84
Why should the nurse question any orders for IV fluids?
Sx can get way worse → b/c patient is holding onto fluid & not urinating
85
What should be included in patient education? **Hint: 4**
1. NO sodium 2. No OTC medications 3. When to report S/S to provider 4. Weight gain of 3lbs in 2 days
86
How do we know as the nurse if the Tx was successful? **Hint: 2**
1. Lungs sound clearer 2. Decreased HR/ decreased workload
87
How do vasodilators work?
Decrease the workload of overworked cardiac muscle
88
ACE inhibitors prevent conversion of _____ to _____
Angiotensin I to angiotensin II
89
Three medication classes for Tx of HF:
1. Vasodilators 2. Loop diruetics 3. Beta-adrenergic antagonists
90
Classification fo HF: Worsening HF:
Worsening S/S or functional capacity

NUR516 Final Exam (21 decks)

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