Pharmacology Chapter 24 Heart Failure

Front 1

Define Heart Failure

Back 1

Inability of the ventricles to pump enough blood to meet metabolic demands.

Front 2

What are the 5 main causes of heart failure?

Back 2

1. Mitral stenosis
2. MI
3. Chronic to HTN
4. Coronary Artery Disease
5. Diabetes Mellitus

Front 3

Since there is no cure for heart failure, what are the three treatment goals for heart failure?

Back 3

1. Prevent
2. Treat
3. Remove the underlying cause

Front 4

Define cardiac output.

Back 4

The amount of blood pumped by each ventricle per minute.

Front 5

What are the two main factors that affect cardiac output?

Back 5

Preload and Afterload.

Front 6

When dealing with heart failure pharmacotherapy is targeted to words what two things?

Back 6

Prevention and slowing the progression of heart failure

Front 7

Define the Frank-Starling law.

Back 7

States that the more myocardial fibers are stretched prior to contraction, the more forcefully the heart will contract.
Example -the more a rubber band is stretched, the more forcefully it will snap back.

Front 8

Defin contractility.

Back 8

Strength of a heart's contraction.

Front 9

What do positive inotropic agents do?

List four examples.

Back 9

Inotropic agents increase contractility.

Examples include epinephrine, norepinephrine, thyroid hormone, and dopamine.

Front 10

What do negative Inotropic agents do?

What are two examples?

Back 10

If negative inotropic agents decrease contractility.

Examples include quinidine and beta-adrenergic antagonists.

Front 11

Define afterload.

Back 11

The degree of pressure in the aorta that must be overcome for blood to be ejected from the left ventricle.

Front 12

What is the most common cause for an increased after load?

Back 12

Peripheral resistance due to HTN

Front 13

Define cardiac remodeling.

Back 13

Occurs when the myocardial cells change size, shape, a and structure leading to hypertrophy.

Front 14

What happens when heart failure occurs on the left side of the heart?

Back 14

Blood backups and two the lungs, resulting in the classic symptoms of cough and DIB.

Front 15

What happens when heart failure occurs on the right side of the heart?

Back 15

Blood backs up into the veins, resulting in peripheral edema and engorgement of organs such as the liver.

Front 16

What are the classic symptoms of heart failure?

Back 16

Dyspnea on exertion, fatigue, pulmonary congestion, and peripheral edema.

Front 17

Define orthopnea.

Back 17

Difficulty breathing when recumbent.
Person feels like they are suffocating, and it often worsens at night.

Front 18

What are the two most common reasons why clients experience decompensation?

Back 18

1. Noncompliance with sodium and water restrictions.
2. Noncompliance with drug therapy.

Front 19

What two cardiac events may precipitate acute heart failure?

Back 19

1. MI
2. Myocardial ischemia

Front 20

What are the drugs of choice in the treatment of heart failure?

Back 20

Ace inhibitors.

Front 21

What does ACE inhibitors stand for?

Back 21

Angiotensin Converting Enzyme Inhibitors

Front 22

Who should receive ACE inhibitors?

Back 22

All clients with heart failure and many clients at high risk for heart failure should receive an ACE inhibitor unless specifically contraindicated.

Front 23

What are the two primary actions of ACE inhibitors?

What to do ACE inhibitors actually do you in the body?

Back 23

1. Lower peripheral resistance.
2. Inhibit Aldosterone secretion.

Reduce blood volume and dilate veins.

Front 24

By reducing blood volume and dilating the veins, ACE inhibitors do what in the body?

Back 24

Decrease pulmonary congestion and reduces perpheral edema.

Front 25

ACE inhibitors of have been shown to reduce mortality following a cute MI of when therapy is started soon after the onset of symptoms.

Back 25

No entry.

Front 26

What does ACE inhibitors stand for?

Back 26

Angiotensin Converting Enzyme Inhibitors

Front 27

Who should receive ACE inhibitors?

Back 27

All clients with heart failure and many clients at high risk for heart failure should receive an ACE inhibitor unless specifically contraindicated.

Front 28

What are the two primary actions of ACE inhibitors?

What to do ACE inhibitors actually do you in the body?

Back 28

1. Lower peripheral resistance.
2. Inhibit Aldosterone secretion.

Reduce blood volume and dilate veins.

Front 29

By reducing blood volume and dilating the veins, ACE inhibitors do what in the body?

Back 29

Decrease pulmonary congestion and reduces perpheral edema.

Front 30

ACE inhibitors of have been shown to reduce mortality following a cute MI of when therapy is started soon after the onset of symptoms.

Back 30

No entry.

Front 31

What should the nurse remember about ACE inhibitors and getting a CBC?

Back 31

A CBC should be drawn before starting therapy, and repeated every month for the first 3 to 6 months of treatment.

Front 32

When should ARB's be given to patients?

Back 32

ARB's are usually a reserved for clients unable to tolerate the side effects of ACE inhibitors.

Front 33

What are two examples of ARB's?

Back 33

1. valsartan
2. candesartan

Front 34

What are ARB's?

Back 34

Angiotensin-receptor blockers?

Front 35

Several ACE inhibitors have been shown to reduce mortality following acute MI when therapy is started soon after the onset of symptoms.

Back 35

No entry.

Front 36

What should the nurse to know about ACE inhibitors and pregnancy?

Back 36

ACE inhibitors are contraindicated during pregnancy, lactation, and history of angioedema.

Front 37

Why is a CBC important when taking an ACE inhibitor?

Back 37

ACE inhibitors should be held if the neutrophil count drops below 1000 due to the potential for neutropenia.

Front 38

What should be discontinued before the use of ECE inhibitors and why?

Back 38

Diuretics.

Prevent severe hypotension.

Front 39

Whites may occur with an initial doses of ACE inhibitors?

How long should the client be monitored?

Back 39

Severe hypotension.

Several hours.

Front 40

If severe hypotension occurs, what should the nurse do?

Back 40

Place the client in a supine position and notify the healthcare provider.

Front 41

A lower dose of an ACE inhibitor may be needed for what two clients?

Back 41

1. Elderly clients
2. Those with renal insufficiency.

Front 42

ACE inhibitors should be used with caution in clients with what three conditions?

Back 42

1. Impaired kidney function.
2. Hyperkalemia.
3. Autoimmune diseases, especially systemic lupus erythematosus (SLE)

Front 43

What five things should the client be taught about ACE inhibitors?

Back 43

1. Do not taking any other prescription or OTC drugs without notifying your physician.
2. It may take weeks or months for therapeutic response to be reached.
3. Followed dietary modifications of including sodium and potassium restrictions, two prevent side effects of of hyperkalemia and Hyponatermia.
4. Do not take salts or potassium supplements unless ordered by Physician.
5. Avoid driving until affects of drug are known.

Front 44

What two types of pharmacotherapy are used in the treatment of heart failure?

Back 44

1. ACE inhibitors.
2. Diuretics.

Front 45

How do diuretics work in the treatment of heart failure?

Back 45

Diuretics increase urine flow, there by reducing blood volume and cardiac workload.

Front 46

What is the prototype ACE inhibitor?

Back 46

lisinopril (Prinivil, Zestoretic, Zestril)

Front 47

What are the six types of ACE inhibitors?

Back 47

1. captopril (Capoten)
2. enalapril (Vasotec)
3. fosinopril (Monopril)
4. lisinopril (Prinivil, Zestoretic, Zestril)
5. quinapril (Accupril)
6. ramipril (Altace)

Front 48

What are the four most common non life threatening of adverse affects of ACE inhibitors?

Back 48

1. Headache
2. Dizziness
3. Orthostatic hypotension
4. Cough

Front 49

Whites are four life-threatening affects of ACE inhibitors?

Back 49

1. Severe hypotension
2. Syncope
3. Angioedema
4. Blood dyscrasias

Front 50

What is a blood dyscrasias?

Back 50

Any condition involving the blood or blood making organs?