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54 Cards in this Set
- Front
- Back
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How is heart failure staged?
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A, B, C, D
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What drugs should be avoided in Stage C heart failure patients?
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anti-dysrhythmics, CCBs, NSAIDs
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What are the 5 physiologic responses to CHF?
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increased sympathetic tone, HR, FOC, venous tone, arteriolar tone
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What are 5 s/s of CHF?
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decreased tissue perfusion, increased sympathetic tone, verntricular filling (causes myocardial hypertrophy), increased venous tone and blood volume, weight gain from fluid retention
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What are the 1st line drugs used to treat HF?
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diuretics
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What is an important consideration when administering diuretics to a HF patient?
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do not drop pressure to low because it is possible to decrease tissue perfusion
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What drug class is used for long-term HF treatment?
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thiazide diuretics
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What is the DOC for severe HF?
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loop diuretics (Lasix)
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Do drugs that inhibit the RAAS prolong life?
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yes
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What drug class should all HF patients take? What other meds should compliment the treatment?
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ACE inhibitors; beta blockers and a diuretic
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Name 3 AEs of ACE inhibitors.
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hypoTN, hyperkalemia, intractable cough
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Do ARBs prolong life in HF patients?
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yes
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When are ARBs preferred over ACE inhibitors when treating HF?
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when ACE inhibitors cause an intolerable cough
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Do aldosterone antagonists in HF prolong life?
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yes
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Which 3 beta blockers in HF prolong life?
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carvedilol, bisoprolol, metoprolol SR
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When using beta blockers to treat HF, how should the Rxs be dosed (general)?
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start dose low and gradually increase
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Does digoxin prolong life in HF patients?
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no, but it does reduce symptoms of HF; may actually shorten women’s life
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What is a serious problem with digoxin?
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causes dysrhythmias
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What values should be monitored when administering digoxin? Why?
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potassium; digoxin competes with potassium for binding to the Na⁺/K⁺ ATPase so if potassium levels are too high, response to digoxin is reduced; also if potassium levels are too low, digoxin can become toxic
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What range MUST potassium levels be kept between when giving digoxin?
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3.5-5 mEq/L
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What 3 positive inotropic effects result from digoxin?
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decreased HR, afterload, venous pressure
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Name 2 ways to treat digoxin toxicity.
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withdraw digoxin and potassium-sparing diuretic, give anti-dysrhythmic
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Name 2 s/s of digoxin toxicity.
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dysrhythmias, CNS disturbances
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What are normal dosage ranges for digoxin?
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0.5-0.8 ng/ml; narrow therapeutic index!!
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Name 3 AEs of digoxin.
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dysrhythmias, hypokalemia, heart disease
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How does digoxin interact with diuretics?
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potassium loss related to diuretics increases the likelihood of digoxin toxicity
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How do ACE inhibitors and ARBs interact with digoxin?
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the increased level of potassium decreases response to digoxin
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What is the half-life of digoxin?
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1.5 days
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What are the digoxin routes? Which route should be avoided?
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PO, IV, IM; IM should be avoided due to possible tissue damage
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What are the 4 classes of anti-dysrhythmics?
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Class I - Na⁺ Channel Blockers, Class II - Beta Blockers, Class III - K⁺ Channel Blockers, Class IV - CCBs
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What is an important characteristic of all anti-dysrhythmics?
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they can cause dysrhythmias
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What is a common complication of atrial fibrillation?
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stroke
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What do cardioconversions treat?
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Afib and Vfib
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What condition is described as “atypical, rapid, undulating, ventriclular tachycardia that can evolve into fatal ventricular fibrillation”?
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Torsades de Pointes
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What class of sodium channel blockers is only used for ventricular dysrhythmias? Route?
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Class IB; IV
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What class of sodium channel blockers is reserved for life-threatening ventricular dysrhythmias?
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Class IC
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What is an AE caused by amiodarone? What class is amiodarone in?
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profound hypoTN; potassium channel blocker
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What are 3 drug classes used to treat thromboembolic disorder?
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anticoagulants, antiplateles, thrombolytics
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What drug class are heparin and warfarin?
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anticoagulants
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What drug class are aspirin and tirofiban?
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antiplatelet
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Does heparin cross the placenta or enter breast milk?
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no
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What is an important AE of heparin?
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fatal hemorrhaging
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What blood value applies to heparin?
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aPTT (activate partial thromboplastin time)
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What is the normal aPTT?
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40s
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How does heparin affect aPTT?
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increased by a factor of 1.5-2 making the aPTT 60-80s
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What is the common suffix of anticoagulants I?
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“-parin” or “-farin”
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What are 2 benefits of low-molecular weight heparin?
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fixed dosing and does not require aPTT monitoring
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What is the 1st line treatment for DVTs?
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low-molecular weight heparins (“-parins”)
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Is warfarin used for emergencies?
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no
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What blood value is affected by warfarin? What is the more reliable indicator?
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PT (prothrombin time); INR (international normalized ratio)
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What is a normal INR range?
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2-4.5
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Which of these is a Category X drug: heparin, wafarin, enoxaparin
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warfarin
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What is aspirin used to prevent?
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MI, stroke
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What drug class is clopidogrel (Plavix) and ticlopidine (Ticlid)?
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adenosine diphosphate receptor antagonist
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