Drugs for Heart Failure
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44 terms
Terms | Definitions |
|---|---|
 Angiotensin-Converting Enzyme Inhibitors | -aka ACE Inhibitors -Large group of safe and effective drugs -First line agents for HF -Secondary agents for HTN -Can be combined with a thiazide diuretic or Ca++ channel blocker -Drug suffix "-pril" |
| Why are ACE inhibitors safer/better? | Can be combined with other drugs (diuretics, Ca++ channel blockers) and still be as effective |
| ACE Inhibitors are the first-line agents for what? | For pts with Heart Failure |
| ACE Inhibitors are the secondary agents for what? | Hypertension |
| ACE Inhibitors are used primarily for HF now instead of which drug? | Digoxin |
| What is the action of ACE inhibitors? | -Decrease the demands on the heart -Interferes with the RAAS -Prevents breakdown of the vasodilating substance Bradykinin |
| How do ACE inhibitors interfere with the RAAS? | -prevents conversion of Angiotensin I to II which -prevents Na+ and water resorption in the kidneys |
| What is the effect of bradykinin breakdown? | -decreased systemic vascular resistance (afterload) -decreased vasodilation, and ultimately -decreased BP |
| What are ACE inhibitors used for? | -Hypertensive pts -CHF: used either alone or in combo with other agents -Slows progression of LV hypertrophy after an MI -Renal protective effects in pts w/ diabetes |
| How are ACE inhibitors used after an MI? | decreases demands on the heart which ultimately slows down the hypertrophy- heart is not working as hard |
| What is a characteristic SE of a pt on ACE inhibitors? | Dry, non-productive cough; will stop when therapy is stopped |
| What are some SE of ACE inhibitor use? | -Fatigue -HA, Dizziness -Impaired taste -Blood disorders -Rash, Pruritus -Angioedema -Initially hypotensive |
| What is the concern with ACE inhibitors regarding angioedema? | -Occurs in face, mucous membranes (can occur in gut- visceral angioedema) -If not treated, will keep swelling until airway is obstructed & will need a trach -Once you've had it, increased risk of having it again -Higher risk in blacks than whites |
| What is the concern with ACE inhibitors regarding hypotension? | -First dose may cause hypotension -Take their BP 30-45 min after first dose |
| What do you teach a pt about ACE inhibitors and BP? | -When you first take med, sit down for a while then get up slowly -If you feel light headed/dizzy, call your doctor |
| Drug interactions with ACE inhibitors | -NSAIDS -Diuretics -Other antihypertensives |
| Examples of ACE inhibitors | -Captopril (Capoten) -Enalapril (Vasotec) -Ramipril (Altace) -Fosinopril (Monopril) -Lisinopril (Zestril) -Benazepril (Lotensin) |
| How is Ramipril (Altace) related to DM? | -Study looked at pts destined to get DM -Put them on Altace -Delayed onset of DM |
| Which ACE inhibitor is a prodrug? | Enalapril (Vasotec); so it works after it has been metabolized |
| Nursing Implications for pts on ACE inhibitors | -Get baseline VS -Monitor for hypotension -Monitor labs -Check for angioedema |
| Why do we monitor labs for pts on ACE inhibitors? | -Monitor renal fx, liver fx, and potassium levels -Must do this every month for the first 3 months |
| Beta Blockers | -Reduce cardiac remodeling -Reduce admissions -Reduce deaths -Block catecholamine/SNS actions |
| Why are elderly not likely to be placed on beta blockers? | ... |
| Vasodilators | Given as an adjunct to other treatments for HF |
| Examples of vasodilators | -BiDil -Nesiritide (Natrecor) |
| What is significant of BiDils? | -Vasodilator that is proven to work for black pts -Other don't seem to work as well |
| What is significant of Nesiritide (Natrecor)? | -Synthetic natriuretic peptide -Causes decreased preload and afterload |
| Cardiac Glycosides | -Inhibit the sodium potassium ATPase pump -Allows more calcium to be available for contraction |
| What is a prime example of a cardiac glycoside? | Digoxin |
| What are the "tropic" characteristics of Digoxin? | -Positive inotrope -Negative chronotropic -Negative dromotropic |
| What does it mean to be a positive/negative inotrope? | -Increases/decreases strength of cardiac contraction |
| What does it mean to be a positive/negative chronotrope? | -Increases/decreases heart RATE |
| What does it mean to be a positive/negative dromotrope? | -Decreases/increases refractory period |
| How is digoxin a negative chronotrope? | -Stimulates the PNS which decreases the HR |
| What are Cardiac Glycosides used for? | -HF -Supraventricular dysrhythmias -Atrial fib/flutter |
| How do cardiac glycosides help with dysrhythmias/atrial fib/flutter? | -Negative chronotropic -Slows down the heart rate so it can get into a somewhat normal rhythm |
| What are some SE of cardiac glycoside use? | -Dysrhythmias -N/V -Fatigue, Malaise -Confusion, convulsions, depression -Colored vision |
| What pt population is most likely to get depression SE? | Elderly pts |
| What are the GI complications associated with Dig Toxicity? | -N/V -Diarrhea -Abd pain |
| What are the cardiac complications associated with Dig Toxicity? | -Dysrhythmias -SA arrest -Heart block |
| What are the neurologic complications associated with Dig Toxicity? | -HA -Irritability, confusion -Depression -Insomnia, Psychosis -Seizures -Blue-yellow color blindness/shading -Blurred vision -Flickering lights |
| How do you treat a pt experiencing Dig Toxicity? | -D/C dig -Give digoxin immune Fab, K+ -Will bind with free dig molecules, inactivate it -Dig will then get excreted |
| Nursing Implications for Cardiac Glycosides | -Monitor pulse: if below 60, don't give med -Monitor electrolytes -Serum dig levels (normal=0.5-2.0 ng/ml) -Do NOT give IM -IV: slow push -Teach pt about high K+ foods |
| Examples of Other Inotropics | -Beta-adrenergic agonists -Phosphodiesterase III inhibitors |
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