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54 Cards in this Set
- Front
- Back
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What is Heart Failure (HF)? |
Heart failure is when the heart is unable to pump enough blood from the ventricles to meet the body's needs. |
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Which ventricular has the most problems from HF? |
The Left ventricular |
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What causes heart failure? |
-Cardiac defect -Defect outside the heart |
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What is a cardiac defect? |
MI or valve deficiency |
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What are defects that are outside the heart that can cause HF? |
Coronary artery disease Pulmonary hypertension Diabetes |
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What is the pace maker of the heart? |
SA node |
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The SA node beats how fast? |
60-100 bpm |
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The AV node beats how fast? |
40-60 bpm |
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The Bundle of HIS beats how fast? |
20-40 bpm |
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The Pukinje fibers beat how fast? |
10-20 bpm *cant live with! |
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When the conduction system shuts down whats the order that each system takes over?
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1. SA node
2. AV node 3. Bundle of HIS 4. Purkinje fiber |
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What are the classes of HF? |
Class I: Pt not limited to normal physical activities Class II: Activities result in fatigue, dyspnea Class III: Marked limitation in normal physical activity Class IV: Symptoms at rest or physical activity
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What are the three different drug therapies for HF? |
Inotropic drugs Chronotropic drugs Dromotropic drugs |
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What does positive or negative inotropic drugs do? |
Increase or decrease contraction |
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What does positive or negative chronotropic drugs do? |
Increase or decrease heart rate |
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What does positive or negative dromotropic drugs do? |
Increase or decrease conduction |
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What is the drug therapy for heart failure? |
-ACE Inhibitors -Angiotensin II receptor blockers (ARBs) -Beta Blockers -Aldosterone antagonists -B-type natriuretic peptides -Phosphodiesterase inhibitors -Cardiac glycosides |
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What does an ACE inhibitor do? |
-Prevent sodium and H20 resorption by inhibiting aldosterone secretion -Diuresis results, which decreases preload |
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What do ACE Inhibitors end in?
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"pril" is what Angiotensin-Converting enzymes (ACE) Inhibitors end in
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What are ACE inhibitors used for? |
They are used for HTN, HF, and acute MI |
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What are some side effects of ACE Inhibitors?
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-*Dry cough
-Decrease renal function -Hyperkalemia |
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What does an ARBs do? |
They are potent vasodilators; all ARBs are similar in action |
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Which heart failure drug causes an annoying cough? |
ACE inhibitor |
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What do Angiotensin II Receptor Blockers end in? |
"tan" |
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What are beta blockers?
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-Reduce SNS stimulation to the heart and the heart's conduction system
-Reduced HR, delayed AV node conduction, reduced myocardial contractility, and decreased myocardial automatically result |
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What do Beta Blockers end in? |
They end in "lol" |
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What do Aldosterone Antagonist do? |
-Decrease the levels of Na+ and H2O to reduce edema which can worsen HF |
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What does Aldosterone cause? |
-Increased levels of sodium and water, leads to edema and can worsen HF |
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What are Aldosterone Antagonist drugs?
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-Spironolactone (K+ sparing)
-Eplernone (selective aldosterone blockers) |
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What do Aldosterone Antagonist drugs end in? |
"one" |
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Miscellaneous drugs that treat HF |
-Hydralazine/isosorbide dinitrate (BiDil): 1st drug approved for a specific ethnic group - AAmerican -Dobutamine: Beta 1 selective vasoactive adrenergic drug |
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What do B-type Natriuretic Peptides do? |
-Gets ride of H20 (diuresis) & Na+ (natriuresis), and vasodilation -Vasodilation effects on both arteries and veins -Indirectly increase CO -Suppresses renin-angiotensin system |
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What are B-TYPE NATRIURETIC PEPTIDE drugs? |
Nesiritide: used in ICU setting to treat life threatening heart failure |
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What are B-type Natriuretic Peptide side effects? |
-Hypotension -Dysrhythmia -Headache -Abdominal pain |
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What are the results in using Phosphodiesterase inhibitors? |
-Positive inotropic responses: ^ contraction, works on failing heart -Vasodilation |
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What is a Phosphodiesterase inhibitor? |
Milrinone (Primacor) |
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What are the first line of drugs for hypertension? |
ACE inhibitors |
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When do you use Phosphodiesterase Inhibitors? |
-Short-term management of HF -When patient doesn't respond to digoxin, diuretics, and/ vasodilators |
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Phosphodiesterase side effects? |
-Dysrhythmia -Hypotension -Angina -Hypokalemia -Tremor -Thrombocytopenia |
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Can Lasix and Phosphodiesterase inhibitors be infused together? |
No, different lines bc they will crystalize when given together |
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Background on Cardia Glycosides?
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-Oldest group of cardia drugs
-Not used as first line treatment -Obtained from Digitalis plant foxglove |
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What is the prototype drug for Cardiac Glycosides? |
Digoxin |
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MOA of cardiac glycosides
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- ^ myocardial contractility
-Change electrical conduction properties of heart: decrease rate of electrical conduction, prolong refractory period |
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Drug effects with Cardia Glycosides? |
-Positive Inotropic effect -Negative Chronotropic effect -Negative Dromotropic effect |
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Other Cardia Glycosides drug effects |
- ^ stroke volume -reduction in heart size during diastole -decrease in venous BP and vein engorgement - ^ coronary circulation - Promotion of tissue perfusion & diuresis bc of improved blood circulation -Pain relief -Nocturnal dyspnea, cough, cyanosis |
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What is Cardiac Glycosides used for? |
-HF -Supraventricular dysrhythmias |
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What are the side effects of Cardiac Glycosides? |
-Very narrow therapeutic window* -Low K+ increase toxicity -Convulsions -Halo vision |
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What is the drug range for Digoxin? |
0.5 to 2 ng/ml |
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What is the antidote for digoxin toxicity? |
Digibind
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What consist of digoxin toxicity?
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-Life threatening digoxin overdoes of 10mg
-LT cardiac dysrhythmias sinus brady -Gold/green halos -Hyperkalemia (greater than 5 mEq/L) |
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What are conditions that predispose Digoxin Toxicity? |
-Hypokalemia: 3.5-5.0 (normal range) -Use of cardiac pacemaker -Hepatic dysfunction -Hypercalcemia: 8.5- 10.8 (normal range) -Dysrhythmias -Hypothyroid, respiratory,or renal disease -Advanced age |
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What should the nurse do?
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-Assess Apical pulse for 1 full minute
-Lab values -Apical pulse less than 60, greater than 100 hold dose and notify prescriber -Hold dose if s/s of toxicity |
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What foods should you avoid with Digoxin? |
High fiber foods |
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What drugs should be used on a pump? |
Nesiritide and Milrinone |
