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
Insufficient tissue perfusion
Signs of fluid retention
- Causes of Heart Failure
- Chronic HTN
Congenital heart disease
- 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
- Signs and symptoms of heart failure
- ↓ exercise tolerance
Peripheral edema hepatomegaly
Weight gain – fluid retention
- ACC/AHA Stages of Heart Failure
- Stage A, Stage B, Stage C, Stage D
- Treatment Overview of Heart Failure
- 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?
- 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
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
Bradycardia or heart block
- What Inotropic Agents are used for heart failure?
- Cardiac glycosides
- What cardiac glycoside is used for heart failure?
- 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)
Need normal K+ serum levels to prevent toxicity (K+ binds to the same receptor of Digoxin)
- What are the adverse effects of digoxin?
Noncardiac adverse effects
Anorexia, nausea and vomiting
- What nursing interventions do you need to take with digoxin?
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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