Nursing Pharmacology: Chf

Front 1

Describe the clinical syndrome seen in Congestive heart failure

Back 1

1. weight gain
2. edema
3. SOB
4. pulmonary congestion
5. and a variety of other symptoms.

Front 2

pharmacological Management of CHF includes:

Back 2

A. Cardiac Glycosides
B. Diuretics
C. Vasodilators (ACE inhibitors, Nitrates)
D. Beta Adrenergic Blockers

Front 3

Drug Management objectives for CHF:

Back 3

A. Correction of NA, water retention and volume overload.
B. Reduction of cardiac workload.
C. Improvement of myocardial contractility.
D. Control of precipitating and complicating factors.

Front 4

Cardiac glycoside class includes the drugs:

Back 4

1. digoxin* (Lanoxin)
2. digitoxin (Purodigin)

Front 5

Cardiac glycoside mechanism:

Back 5

Act by inhibit sodium-potassium pump there by increase intracellular calcium making cardiac muscle fibers contract more efficiently

Front 6

Cardiac glycoside provide effective treatment of CHF by:

Back 6

1. Exerting a positive inotropic action on the heart.
- Increase the force of myocardial contraction.
- Reduction of heart size.
- Increase blood flow to the kidneys.
2. Exerting a negative chronotropic and dromotropic action on the heart.
3. Increase stroke volume.

Front 7

Cardiac glycoside Results:

Back 7

1. Increase myocardial contractility
2. Increase cardiac output
i. increase cardiac, peripheral, kidney function
ii. decrease preload
3. Improve blood flow to periphery and kidneys
4. decrease edema and increase fluid excretion.

Front 8

What is the Digitalizing dose of Cardiac Glycoside?

Back 8

loading dose to bring serum level of the drug up to a desirable therapeutic level (2 mg IV).

Front 9

What is the Daily maintenance dose of Cardiac Glycoside?

Back 9

dose intend to replace medication that has been metabolized or eliminated by the body.
normal range: 0.125 - 0.5 mg daily.

Front 10

What is the Conventional dose of Cardiac Glycoside?

Back 10

dose in place of digitalizing dose, used from the very onset of therapy, particularly when a relatively short-acting cardiac glycoside, such as digoxin is used. Plateau at 7 days. Have narrow therapeutic range: 0.5 - 2 ng/ml in blood.

Front 11

Identify signs of toxicity which may result from cardiac glycosides.

Back 11

1. Nausea
2. vomiting
3. anorexia
4. Visual disturbances (green and yellow vision)
5. diplopia
6. bradycardia
7. headaches
8. dizziness
9. fatique

Hint 11

9

Front 12

What is the antidote for digitalis glycosides?

Back 12

digoxin immune fab (Digibind).
Works by binding to digoxin then excreted in urine.

Front 13

Discuss nursing implications for the care of person taking cardiac glycosides

Back 13

1. Always check apical rate for 1 full minute.
2. Withhold these drugs if the apical pulse rate is
<60 bpm
3. Check for signs of peripheral and pulmonary edema.
4. Report bigeminy or significant deviation in the heart rate and rhythm.
5. Assess for toxicity by checking serum level (0.5-2 ng/ml), heart rate and rhythm and observing for neurological signs, such as headache, visual disturbances and changes in color vision and gastrointestinal symptoms such as nausea, vomiting, and anorexia.
6. Monitor mental status.
7. Monitor potassium level and report level less than 4 ml.
8. To minimize pain and possible tissue damage, IM must be given deep into a large muscle mass.
9. Teach client and family members how to recognize signs of toxicity and assess heart rate.

Front 14

What is the action of diuretics?

Back 14

Increase urine flow resulted in:
1. Reduced blood volume
2. Reduced cardiac workload
3. Metabilize edematous fluid.

Front 15

What are the 3 categories of Diuretics?

Back 15

1. Thiazide
2. Loop
3. Potassium-sparing

Front 16

Mechanism of:
Thiazide Diuretics

Back 16

act by inhibiting sodium and chloride reabsorption in the early portion of the distal tubule, although they may block chloride reabsorption in the ascending Loop of Henle.

Front 17

Adverse effects of:
Thiazide Diuretics

Back 17

1. potassium depletion and hypokalemia which leads to:
cardiac arrhythmias and
muscle weakness.
2. Chloride depletion
3. metabolic alkalosis.

Front 18

Uses of:
Thiazide Diuretics

Back 18

1. Hypertension
2. Peripheral edema

Front 19

Adverse effects of:
Thiazide Diuretics

Back 19

a. electrolytes imbalances:
Hypokalemia
hypercalcemia
hypomagnesemia
bicarbonate loss
b. Hyperglycemia
c. Hyperuricemia
d. hyperlipidemia
e. Sensitivity-skin rashes

Front 20

example of short acting Thiazide diuretic

Back 20

1. Chlorothiazide (Diuril)
2. hydrochlorothizide (HydroDiuril, HCTZ)

Front 21

example of immediate acting Thiazide diuretic

Back 21

metolazone (Zaroxolyn)

Front 22

example of Long acting Thiazide diuretic

Back 22

indapamide (Lozol)

Front 23

Drug Class:
Chlorothiazide (Diuril)

Back 23

Thiazide diuretic

Front 24

Therapeutic action:
Chlorothiazide (Diuril)

Back 24

Inhibits reabsorption of sodium and chloride in distal tubule, increasing the excretion of sodium, chloride, and water by the kidney.

Front 25

Indication of:
Chlorothiazide (Diuril)

Back 25

i) Adjunctive therapy in edema associated with CHF, cirrhosis, corticosteroid, and estrogen therapy, renal dysfunction.
ii) Treatment of hypertension, alone or with other antihypertensive.

Front 26

Dosage of:
Chlorothiazide (Diuril)

Back 26

Adult:
Edema: 0.5 - 2 g PO or IV qid or bid.
hypertension: 0.5-2 g/d PO as a single or divided dose.

Front 27

Adverse effects of:
Chlorothiazide (Diuril)

Back 27

Dizziness, vertigo, nausea, anorexia, vomiting, dry mouth, diarrhea, constipation, polyuria, nocturia, impotence.

Front 28

Nursing implications for:
Chlorothiazide (Diuril)

Back 28

i) take drug early in the day
ii) weigh yourself daily and record weights.
iii) protect skin from exposure of the sun or bright light.
iv) Report: rapid weight change,
swelling in ankles or fingers,
oral bleeding or bruising,
muscle cramps.

Front 29

Mechanism of:
Loop diuretics

Back 29

act by inhibiting the reabsorption of sodium and chloride in the ascending loop of Henle, thereby reducing the ability of the kidneys to concentrate Urine.

Front 30

Uses of:
Loop diuretics

Back 30

1. HF
2. Hepatic cirrhosis
3. chronic renal failure

Front 31

example of:
Loop diuretics

Back 31

*all ending with "ide"*
1. furosemide (Lasix, Novo-Semide)
2. bumetanide (Bumex)
3. toremide (Demadet)

Front 32

Main adverse effects of:
Loop diuretics

Back 32

dehydration
electrolyte imbalances

Front 33

Drug class of:
Furosemide (Lasix, Novo-Semide)

Back 33

Loop diuretics

Front 34

Therapeutic actions of:
Furosemide (Lasix, Novo-Semide)

Back 34

Inhibits the reabsorption of sodium and chloride from the proximal and distal renal tubules and the loop of Henle, leading to a sodium-rich diuresis.

Front 35

Uses of:
Furosemide (Lasix, Novo-Semide)

Back 35

· Edema associated with CHF, cirrhosis, renal disease (oral, IV)
· Acute pulmonary edema (IV)
· Hypertension (oral)

Front 36

Contraindications/cautions of:
Furosemide (Lasix, Novo-Semide)

Back 36

Contraindications:
allergy to furosemide, sulfonamides;
allergy to tartrazine (in oral solution);
electrolyte depletion;
anuria, severe renal failure;
hepatic coma;
pregnancy;
lactation.
Use cautiously with SLE, gout, diabetes mellitus.

Front 37

Adverse effects of:
Furosemide (Lasix, Novo-Semide)

Back 37

electrolytes imbalances

Front 38

Nursing implementation for
Furosemide (Lasix, Novo-Semide)

Back 38

1. Administer with food or milk to prevent GI upset.
2. Reduce dosage if given with other antihypertensives
3. Give early in the day.
4. Avoid IV use if possible.
5. Do not mix parenteral solution with highly acidic solutions with pH below 3.5.
6. Do not expose to light, Discard diluted solution after 24 h.
7. Refrigerate oral solution.
8. Measure and record weight to monitor fluid changes.
9. Arrange to monitor serum electrolytes, hydration, liver function.
10. Arrange for potassium-rich diet or supplemental potassium as needed.

Front 39

Mechanism of:
Potassium-sparing diuretics

Back 39

exert action on the distal tubule.

Front 40

Uses of:
Potassium-sparing diuretics

Back 40

1. CHF
2. Hepatic cirrhosis
3. Nephrotic syndrome

Front 41

example of:
Potassium-sparing diuretics

Back 41

1. Spironolactone (Aldactone)
2. Triamterene (Dyrenium)
3. amiloride HCl (Midamor)

Front 42

Main Adverse effects:
Potassium-sparing diuretics

Back 42

Hyperkalemia

Front 43

Drug class of
Triamterene (dyrenium)

Back 43

Potassium-sparing diuretic

Front 44

Therapeutic actions of
Triamterene (dyrenium)

Back 44

directly block sodium reabsorption in the distal tubule independently of aldosterone.

Front 45

Indications for
Triamterene (dyrenium)

Back 45

Edema associated with:
Congestive Heart F
nephrotic syndrome
hepatic cirrhosis;
steroid-induced
secondary hyperaldosteronism
(alone or with other diuretics for
added diuretic or antikaliuretic effects)

Front 46

Contraindications/cautions
Triamterene (dyrenium)

Back 46

□ Contraindications:
allergy to triamterene
hyperkalemia
renal disease
(except nephrosis)
liver disease
lactation.
□ Use cautiously with
diabetes mellitus
pregnancy.

Front 47

Adverse effects of
Triamterene (dyrenium)

Back 47

1. headache
2. drowsiness
3. weakness
4. Nausea
5. anorexia
6. vomiting
7. dry mouth
8. diarrhea
9. Hyperkalemia.

Front 48

Nursing Implementation for:
Triamterene (dyrenium)

Back 48

□ Administer with food
or milk if GI upset occurs.
□ Mark calendars or provide other
reminders of drug days for outpatients
if alternate-day or 3- to 5-d/wk
therapy is optimal for treating edema.
□ Administer early in the day so that
increased urination does not disturb sleep.
□ Measure and record regular weights
to monitor mobilization of edema fluid.
□ Arrange for regular evaluation of serum electrolytes, BUN.

Front 49

what are the two types of Vasodilators?

Back 49

1. ACE inhibitors
2. Nitrates

Front 50

List the 4 goals of vasodilators therapy.

Back 50

1. Increase venous capacity
2. Improve ventricular contraction
3. Decrease ventricular dysfunction
4. Decrease heart size

Front 51

List example of
Angiotensin Converting Enzyme (ACE) inhibitors drugs.

Back 51

generic name ends in "pril"
1. Captophil* (Capoten)
2. Enalapril* (Vasotec)
3. Fosinopril (Monopril)
4. Benazepril (Lotensin)
5. Lisinopril* (Prinivil, Zestril)

Front 52

Describe the MOA of
Angiotensin Converting Enzyme (ACE) inhibitors.

Back 52

The drugs interfere with the conversion of angiotensin I to angiotensin II by inhibiting the action of ACE, the enzyme that permits the conversion. This action results in the dilation of peripheral blood vessels and a reduction in BP

Front 53

List 4 systemic effects of
Angiotensin Converting Enzyme (ACE) inhibitors.

Back 53

1. Lower peripheral resistance
2. Reduce blood volume
3. Decrease after load
4. Increase cardiac output

Front 54

What should client taking
Angiotensin Converting Enzyme(ACE) inhibitors be monitor for.

Back 54

clients receiving ACE inhibitors should be monitored for
1. development of renal and
2. hematologic changes that may be caused by these drugs.

Front 55

Adverse effects of
Angiotensin Converting Enzyme (ACE) inhibitors

Back 55

1) Hypotension
2) Chronic cough
3) Renal insufficiency

Front 56

Nursing Implication for
Angiotensin Converting Enzyme (ACE) inhibitors

Back 56

1) Obtain CBC before starting therapy and every month for the first 3 to 6 months of treatment.
2) Monitor tests related to renal function and blood glucose levels.

Front 57

Patient education for
Angiotensin Converting Enzyme (ACE) inhibitors

Back 57

1) Not to abruptly discontinue use of captopril
2) Instruct how to monitor blood pressure
3) Inform not to take OTC drugs (cold or allergies meds) without first contacting provider.

Front 58

State 2 theories that may explain how nitrates reduce anginal pain.

Back 58

Theory 1: Nitrate improve the delivery of oxygen to ischemic tissue by increasing coronary blood flow and by causing favorable redistribution of blood flow to ischemic areas.

Theory 2: Nitrate reduces oxygen consumption by coronary blood vessels and thereby relieve the ischemic state.

Front 59

What is
Amyl nitrate

Back 59

- Is a volatile liquid package in a crushable glass capsules surrounded with cotton and gauze.
- Inhaled by client.

Front 60

Identify the common routes of nitroglycerin administrations.

Back 60

1. Sublingually
2. Transdermal patches
3. Extended release - buccal
4. Sustained release - oral tablets
5. Ointment
6. IV

Front 61

Example of Nitrate that are administered
Sublingually

Back 61

Nitrostat

Front 62

Example of Nitrate that are administered
Transdermal patches

Back 62

Transderm-Nitro
Nitro-Dur
Nitrodisc
Deponit.

Front 63

Example of Nitrate that are administered in
Extended release buccal form

Back 63

(Nitrogard SR)

Front 64

Example of Nitrate that are administered in Sustained release oral tablets form.

Back 64

Nitro-Bid
Nitroglyn

Front 65

What is the storage requirements necessary for nitroglycerin tablets to retain their potency?

Back 65

- Avoid extreme temperature and humidity.
- Should not be refrigerated

Front 66

Describe the effect of Nitrates on the heart.

Back 66

a. Dilates large myocardial arteries to increase blood supply to the heart.
b. Reduces cardiac preload by reducing venous tone thereby allows for blood pooling in the periphery.

Front 67

List major adverse effects associated with the use of nitrates.

Back 67

Main:
headaches, dizziness, nausea or vomiting
Others:
agitation, facial flushing, increase
PR, dry mouth, rash, blurred vision

Front 68

What are the contraindications with the use of nitrates?

Back 68

1. clients with head trauma
2. cerebral hemorrhage
3. hypertension
4. Glaucoma

Front 69

What are nursing implications for clients taking Nitrate by IV?

Back 69

Nitrate cannot be given directly by IV, must be diluted.

Front 70

What are the Nursing implications for clients taking Nitrate by transdermal route?

Back 70

- Do not use finger to spread
- Rotate site
- Do not massage or rub

Front 71

What are the Nursing implications for clients taking Nitrate by sublingual route?

Back 71

- Pt. should sit or lie down to take medication
- potency of drug usually noted by burning or stinging sensations under tongue (newer drugs may not do this).
- Dose repetition - q 5 min X 3 doses. Notify provider if pain not relieved in 15 minutes.

Front 72

What are some patient teaching regarding nitrate?

Back 72

1. Avoid ETOH - shock-like syndrome such as flushing, weakness, pallor, hypotension, syncope may occur.
2. Dizziness, lightheadedness and slight headache may occur with administration.
3. Recognize overdose symptoms.

Front 73

What are symptoms of nitrate overdose?

Back 73

1. blurred vision
2. dry mouth
3. severe headaches

Front 74

What is the only Beta-adrenergic blocker approved for the treatment of CHF?

Back 74

carvedilol (Coreg)