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85 Cards in this Set
- Front
- Back
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heart failure |
inability of heart to pump enough blood to meet body's need for O2 and nutrients |
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symptoms of right sided heart failure |
(cor pulmonale) ascites, enlarged liver/spleen, distended jugular veins, anorexia, weight gain, dependent edema |
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symptoms of left sided heart failure |
paroxysmal nocturnal dyspnea, pulmonary congestion, restlessness, confusion, fatigue, cyanosis |
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causes of heart failure |
CAD, HTN, hyperthyroidism, excessive IV fluids/blood, antidysrhythmic meds, Na/H2O retention from meds |
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meds that cause Na/H2O retention |
corticosteroids, estrogens, NSAIDs |
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inotropes (MOA) |
+inotropic, -chronotropic, inhibits Na/K pump, increasing Ca in cell, increasing cardiac contractility |
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inotropes (uses) |
heart failure, A-fib, A-flutter |
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inotrope |
digoxin (Lanoxin) |
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digoxin: contraindications |
myocarditis, V-tach, V-fib, caution with MI, heart block, electrolyte imbalance, renal impairment, use of other cardiac drugs (quinidine, verapamil, nifedipine) |
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digoxin: therapeutic range |
0.8-2.0 ng/mL toxicity can occur at any level but most commonly above 2.0 |
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signs/symptoms of dig toxicity |
n/v, tachycardia, bradycardia, blurred vision, mental changes, abdominal distention, anorexia |
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most common digoxin dose for older adults |
0.125mg/day |
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non-pharmacologic management of HF |
reduce Na intake, restrict fluid, promote weight loss, correct contributing factors, reduce physical activity when symptomatic, O2 therapy, prepare for heart transplant |
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cardiotonic inotropes (phosphodiesterase inhibitors) |
milrinone lactate (Primacor) |
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cardiotonic inotropes: MOA |
+ inotropic, vasodilation, increase cAMP |
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human B-type natriuretic peptides |
nesiritide (Natrecor) |
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human B-type natriuretic peptides: MOA |
decrease preload and after load, diuresis, vasodilation |
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loop diuretics: use |
reduce edema |
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loop diuretics |
furosemide (Lasix) |
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thiazide diuretics: use |
reduce edema, reduce plasma volume, increase CO, decrease preload |
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thiazide diuretics |
hydrochlorothiazide (HTZD) |
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ACEIs |
vasodilation, decrease aldosterone, enalopril (Vasotec) |
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ARBs |
block vasoconstriction from RAAS, losatan (Cozaar) |
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beta-adrenergic blockers |
prevent ventricular remodeling, propranolol (Inderal) |
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aldosterone antagonists |
decrease Na/H2O retention, spirinolactone (Aldactone) |
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which side of the heart usually fails first? |
left side |
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what two classes of medications can be given with diuretics to treat HF? |
ACEIs and ARBs |
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what is the antidote for digoxin? |
digiband |
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What parameter is on digoxin and why? |
heart rate, -chronotropic |
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PEFR |
peak expiratory flow rate |
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goals of therapy for asthma |
no chronic symptoms, no exacerbations, no limitations on activity, no adverse effects of medications |
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Drug classes for asthma |
adrenergics, SABAs, LABAs, anticholinergics, xanthines, corticosteroids, leukotriene modifiers, mast cell stabilizers, immunosuppressants |
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short acting beta agonists (SABAs) |
quick relief, short acting, "rescue" medications, albuterol (Proventil) |
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long acting beta agonists (LABAs) |
maintenance medications, formoterol (Foradil), salmeterol (Severvent), terbutaline (Brethine) |
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anticholinergics |
blocks acetylcholine to cause bronchodilation, decrease mucous production, ipratropium (Atrovent), tiotropium (Spiriva) |
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Xanthines |
bronchodilator, CNS stimulant, narrow therapeutic range, theophylline (aminophylline) |
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Xanthines: therapeutic range |
15-20 mcg/mL, toxic over 20 mcg/mL |
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corticosteroids |
decrease mucous, decrease edema, repair damage, long term, little systemic effect if inhaled, beclomethasone (QVAR), budesonide (Pulmocort), fluticasone (Flonase) |
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leukotriene modifiers |
decrease mucous, edema, and bronchoconstriction, long term, montelukast (Singular) |
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mast cell stabilizers |
prevent release of bronchoconstrictive and inflammatory substances, cromolyn (NasoCrom) |
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immunosuppressants |
decreases IgE, not given at home-risk of anaphylaxis, omalizumab (Xolair) |
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fluticasone/salmeterol |
Advair |
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budesonide/formoterol |
Symbicort |
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ipratropium/albuterol |
Duoneb |
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asthma stimuli |
URTIs, allergens, smoke, drugs (ASA, NSAIDs), foods, physical activity, stress, cold air, emotional factors, GERD |
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components of asthma control |
assessment/monitoring, pharmacologic therapy, control of triggers, education |
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characteristics of asthma |
bronchoconstriction, inflammation, hyperactivity to stimuli |
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asthma symptoms |
dyspnea, chest tightness, wheezing, cough, sputum |
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mild intermittent asthma |
< 2 days/week, <2 nights/month |
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mild persistent asthma |
>2 days/week, <1/day, >2 nights/month |
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moderate persistent asthma |
daily and >1 night/week |
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severe persistent asthma |
continual daytime, frequent at night |
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initial therapies for COPD |
anticholinergics (iprotropium, tiotropium), LABAs, SABAs, combos, inhaled glucocorticoids with other drugs, thoephylline (rare) |
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fluticasone furoate/vilanterol |
Breo Ellipta |
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Addison's disease |
inadequate production of cortisol and aldosterone |
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Cushing's disease |
excessive corticotropin, adrenal tumor |
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HPA axis |
hypothalamus, anterior pituitary, adrenal cortex, negative feedback, does not respond during fight or flight |
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types of endogenous corticosteroids |
glucodorticoids, mineralcorticoids, adrenal sex hormones |
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Why must corticosteroid drugs be tapered? |
HPA axis is suppressed when on drugs |
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When are the most glucocorticoids released? |
upon waking |
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What does inadequate secretion of mineralcorticoids cause? |
hpyerkalemia (+), hyponatremia (-), dehydration |
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Adverse effects of corticosteroids |
insufficiency/excess, cushing's features, vertigo, headache, insomnia, immunosuppression, fluid retention, amenorrhea |
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corticosteroids: contraindications |
systemic fungal infection, Hep B, severe immunosuppression,live viral vaccines, antibiotic-resistant infections, DM, Chron's, IBS, HTN, CHF, decreased kidney function |
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Major adverse effect of corticosteroids |
adrenal insufficiency |
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A patient is taking losartan potassium (Cozaar) for heart failure. Losartan potassium treats heart failure by... |
lowering the patient's blood pressure. It blocks the vasoconstrictive effects of renin. |
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What stimulus causes the HPA axis to increase production of corticosteroids? |
low serum levels of corticosteroids |
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To minimize adrenal suppression, administration instructions for prednisone should be... |
take your medication in the morning |
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A patient with renal failure is prescribed digoxin. What action should be anticipated based on the patient's history? |
Digoxin dose will be reduced |
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Spirilactone (Aldactone) has been added to a patient's medication regimen for heart failure. What effect will the patient experience? |
The patient will have decreased edema |
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A patient receiving corticosteroids following a liver transplant asks if she will take the medication for the rest of her life. What is your response? |
Drug therapy is continued as long as the organ is in place to prevent rejection. You will take the medication every day. |
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A patient with emphysema is taking tiotropium (Spiriva). The use of what medication is contraindicated? |
ipratropium: both medications are anticholinergics |
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Use of adrenergics to treat asthma and COPD is cautioned in patients with which conditions? |
DM, seizure disorders, hypertension, contraindicated in severe CAD |
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Dosage of corticosteroids for children is calculated by... |
severity of disease rather than weight |
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Combination therapy with corticosteroids and diuretics increases risk of.... |
hypokalemia |
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What teaching point should be made to a patient on digoxin? |
take your pulse for one minute every morning before taking your medication |
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A patient with acute onset pulmonary edema who has not experienced a response to digitalization will receive what medication? |
primacor (commonly used for patients who did not experience relief from digoxin, diuretics, or vastdilators) |
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What is a potential sign of Cushing's syndrome development in a patient on long term corticosteroid therapy? |
truncal obesity |
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The should anticipate administering what to a patient admitted to the ED with status asthmaticus? |
high doses of B2 agonists every 20 minutes for 1 to 2 hours |
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mast cells release substances that cause.... |
bronchoconstriction and inflammation |
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A patient's digoxin level is 2.2 ng/mL. This indicates... |
digitalis toxicity |
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A patient with COPD is prescribed corticosteroids. What routes will the medications be given? |
oral and parenteral. the effectiveness of inhaled corticosteroids in COPD has not been established |
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For what condition would a patient's dose of enalopril (Vaster) be held? |
Pt is volume depleted due to diarrhea |
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Patients with asthma commonly present with what chronic symptoms? |
damaged airway mucosa, airway inflammation |
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What is the corticosteroid of choice for cerebral edema? |
dexamethasone |
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What class of medications is not recommended for HF? |
beta blockers: they reduce contractility |
