- chronic hypertension - coronary artery disease (leave the heart stiff and unable to pump_ - MI - diabetes - mitral stenosis
First line drugs
- angiotensin-converting enzyme inhibitors (ACE) - diuretics - sometimes cardiac glycosides (but have more SE)
second choice drugs
- used in acute HF or when ACE inhibitors and diuretics are ineffective - phosphodiesterase inhibitors - vasodilators - beta adrenergic drugs
how do ACE inhibitors work?
- vasodilator and reduces blood volume
what are cardiac glycosides
increase the force of myocardial contraction and were once the traditional drugs of choice for heart failure
what is a cardiac glycoside drug
- digoxin (lanoxin) only drug in this class available in the US.
what is the primary action of digoxin?
- increase in the force of contraction - positive inotropic affect - allows the weakened heart to eject more blood per beat - increased cardiac output
what is a second important action of digoxin?
- slow electrical conduction through the heart (SA and AV nodes) - fewer beats per minute - reduced heart rate, combined with more forceful contractions, allows for much greater efficiency of the heart
what are SE for digoxin
loss of appetite, vomiting, diarrhea, drowsiness, confusion, blurred vision - small margin of safety
what is the antidote for digoxin toxicity
digoxin immune fab (ovine) - binds directly to digoxin
the patient has been started on digoxin (lanoxin) therapy. which of the following should be monitored 1) BUN levels 2) amylase levels 3) sodium levels 4) potassium levels
4) potassium levels
which of the following should be expected with the use of digoxin (lanoxin)? 1) increased weight 2) decreased edema 3) increased blood volume 4) increased heart rate
2) decreased edema
two vasodilators that need to be taken together to work properly
a patient who is taking hydralazine for HF is also experiencing angina. which of the following drugs would be used in combination with hydralazine to help relieve this patients symptoms? 1) isosorbide dinitrate (isordil) 2) carvedilol (coreg) 3) chlorothiazide (diuril) 4) milrinone (primacor)
1) isosorbide dinitrate (isordil)
what do phosphodiesterase inhibitors do?
- are used for short-term therapy of advnaced heart failure -block the enzyme phosphodiesterase in cardiac and smooth muscle (increases the amount of clacium available for myocardial contration)
what are the two main actions that benefit patients with HF?
- an increased force of contraction (positive inotropic response) - vasodilation
what are phosphodiesterase inhibitors?
- inamrinone (inocor) - milrinone (primacor)
what are SE to milrinone?
ventricular dysrhythmia - monitor ECG continusouly during infusion
what kind of drug is nesiritide (natrecor)
vasodilator - small peptide hormone structurally identical to human beta-type nautriuretic peptide - decreases preload and afterload - SE: severe hypotension
the patient is admitted with HF. the physican orders IV milrinone (primacor). the most serious adverse effects of this drug is? 1) headache 2) dysrhythmias 3) confusion 4) drowsiness
the patient is complaining of a viselike pain in his cheast that subsides with rest. the patient is likely experiencing: 1) a stroke 2) a myocardial infarction 3) angina 4) a cerebral vascular accident
what is angina?
angina pectoris is characterized by severe chest pain caused by lack of sufficient oxygen flow to heart muscle
what is the most common cause of angina?
- atherosclerosis in the coronary arteries (a build up of fatty, fibrous material called plaque in the walls of arteries)
three classes of drugs for angina
- organic nitrates (drug of choice for terminating acute angina pain) - beta-adrenergic blockers (drugs of choice for preventing angina pain) - calcium channel blockers (used when beta blockers are not tolerated well)
two types of nitrates?
- short acting (nitroglycerin) long acting(isorobide dinitrate)
what are the SE effects for these nitrates?
dizziness, orthostatic hypotension - tolerance commonly occurs with long acting nitrates taken for an extended period
the patient should remove transdermal nitroglycerin patch at night to: 1) prevent overdose 2) prevent adverse reactions 3) ensure the dosage is appropriate 4) delay development of tolerance
4) delay development of tolerance
when treating angina, the nurse knows that the mechanism of action of a beta-adrenergic blocker is: 1) slowed heart rate and decreased contractility of the heart 2) relaxation of arterial and venous smooth muscle 3) increased contractility and heart rate 4) decreased peripheral resistance
1) slowed heart rate and decreased contractility of the heart
the patient taking calcium channel blockers should use extreme caution when taking which of the following medications? 1) acetaminophen (tylenol) 2) ibuprofen (motrin) 3) digoxin (lanoxin) 4) ranitidine (zantac)
3) digoxin (lanoxin)
what are the goals for pharmacologic treatment for MI?
- restore blood supply (perfusion) to the damaged myocardium as quickly as possible through the use of thrombolytics - reduce myocardial oxygen demand with organic nitrates, beta blockers or CCBs to prevent another MI - control or prevent MI-associated dysrhythmias with beta blockers or other antidysrhythmics
what are the goals for thrombolytics?
- dissolve clots that are obstructing the coronary arteries - restore circulation to the myocardium - thrombolytics are most effective when administered from 20 minutes to 12 hours after the onset of MI symptoms
once the clot is dissolved using thrombolytic therapy what is given?
- anticoagulant or antiplatelet therapy is initiated to prevent formation of additional thrombi - narrow margin of safety