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Glossary of Drugs for Treating Heart Failure

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Define Heart Failure
Heart is unable to pump sufficient blood to meet the metabolic demands of the tissues
Not every patient has signs of systemic or pulmonary congestion
Why people have Heart Failure
Progressive
Ventricular dysfunction
Reduced CO
Insufficient tissue perfusion
Signs of fluid retention
Causes of Heart Failure
Chronic HTN
MI
CAD
Valvular disease
Congenital heart disease
Dysrhythmias
Aging myocardium
Define Cardiac Remodeling
genome expression resulting in molecular, cellular and interstitial changes and manifested clinically as changes in size, shape and function of the heart resulting from cardiac load or injury, cardiac remodeling is influenced by hemodynamic load, neurohormonal activation and other factors still under investigation.
What are physiologic adaptations to reduced cardiac output
Cardiac dilation
↑ sympathetic tone
↑ HR, ↑ contractility, ↑ venous tone, ↑ arteriolar tone
H20 retention and ↑ blood volume
Natriuretic peptides
Signs and symptoms of heart failure
↓ exercise tolerance
Fatigue
SOB
Tachycardia
Cardiomegaly
Pulmonary edema
Peripheral edema hepatomegaly
JVD
Weight gain – fluid retention
ACC/AHA Stages of Heart Failure
Stage A, Stage B, Stage C, Stage D
Treatment Overview of Heart Failure
Vasodilators
Diuretics
Beta blockers
Inotropic agents
What are the actions of Ace inhibitors and Vasodilators
Dilate arterioles and veins
Decrease release of aldosterone
What is the adverse effect of Ace inhibitors and Vasodilators?
Can caouse renal failure in patients with bilat renal artery stenosis
What Angiotensin II Receptor Blockers (ARB) is approved for treating HF?
Diovan
What is used in the acute care setting to treat heart failure?
Nitroglycerine IV - reduce preload & afterload
Sodium nitroprusside IV
Nesiritide IV - Opens up renals; works as diuretic. Short-term therapy only.
What diuretics are used to treat heart failure?
Thiazide diuretics
Loop diuretics
Potssium sparing diuretics
What beta blockers are used to treat heart failure?
Carvedilol, metoprolol
What are the actions of Carvedilol, metoprolol in treating heart failure?
Improve LV ejection fraction
protect the heart from excessive sympathetic stimulation
protect the heart from dysrhythmias
Start doses low
What are the Adverse effects of Beta Blockers?
Fluid retention and worsening heart failure
Fatigue
Hypotension
Bradycardia or heart block
What Inotropic Agents are used for heart failure?
Cardiac glycosides
Sympathomietics
Phosphodiesterase inhibitors
What cardiac glycoside is used for heart failure?
Digoxin
What are the actions of Digoxin?
Positive inotrope (increase contractability)
Inhibits sodium, potassium-ATPase → promotes calcium acculmulation → augmentationof contractile force
Potassium competes with dig for binding to sodium, potassium-ATPase → when potassium is low ↑dig binding → toxicity
↑ potassium ↓ therapeutic response
What precautions do you need to take with Digoxin?
Narrow therapeutic window (.5-1 mg IV)
Renal excretion
Need normal K+ serum levels to prevent toxicity (K+ binds to the same receptor of Digoxin)
What are the adverse effects of digoxin?
Dysrhythmias
Noncardiac adverse effects
Anorexia, nausea and vomiting
Fatigue
Visual disturbances
What nursing interventions do you need to take with digoxin?
Routes
po, SLOW IV
Apical rate prior to administration
Hold for <60 beats/minute
Hold for change in rhythm
Compliance is essential!
What nursing teaching do you need to do with digoxin?
Teach patients signs of toxicity
Teach patients to monitor for rate and rhythm
Teach patients to monitor for signs of hypokalemia
What Sympathomimetic drugs are used for heart failure?
Dopamine - used in telemonitoring. Increase renal perfusion.
Dobutamine - positive inotrope
What phosphodiesterase inhibitors are used for heart failure?
Inamrinone (Inocor) - dilates veins & arteries. Used IV in acute setting.

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