Cardiovascular Drugs For Heart Failure

Front 1

What so chronotropic drugs do?

Back 1

Influence heart rate

Front 2

What do inotropic drugs do?

Back 2

(+) Increases force of myocardial contraction
(-) decreases

Front 3

What do dromotropic drugs do?

Back 3

Influence the conduction of electrical impulses within cardiac tissues

Front 4

What happens to the heart during heart failure?

Back 4

- The heart is unable to pump enough blood from the ventricles to meet the body;s metabolic needs
- Ventricles inability to eject the blood from the heart and causes the blood to backup

Front 5

What are the signs and symptoms for Left ventricular heart failure?

Back 5

Pulmonary edema, coughing, SOB, dyspnea

Front 6

What are the signs and symptoms for Right ventricular heart failure?

Back 6

Systemic venous congestion, pedal edema, JVD, ascites, hepatic congestion

Front 7

What are the first line of drugs for heart failure?

Back 7

-ACE inhibitors
-Angiotensin II receptor blockers (ARB's)
-Beta Adrenergic Blockers
-Diuretics

Front 8

What is the next line of drugs for heart failure?

Back 8

-Cardiac glycosides - digoxin
-Phosphodiesterase inhibitors
-B-type naturiuretic peptide (BNP)

Front 9

What is cardiac glycoside?

Back 9

- Positive intotropic effect
- Increases force and strength of mycardial contraction
- (-)chronotropic and dromotropic effects
- does NOT reduce mortality

Front 10

When are cardiac glycosides used?

Back 10

-advanced stages of heart failure
-arterial fib.

Front 11

Cardiac glycosides improves what symptoms?

Back 11

-Decreases Dyspnea on excertion (DOE), PND, cough and cyanosis
- improves sympotoms, QOL and excerise tolerance

Front 12

What is digoxin indicated for?

Back 12

-Systolic heart failure and atrial fibrillation
-Along with other drugs

Front 13

What are digoxin interactions?

Back 13

-Amiodarone, quinidine, and verapmil can increase digoxin levels up to 50%
Herbal supplements - Ginseng, hawthorne, licorice, and johns wart

Front 14

What are safe digoxin dosages?

Back 14

-Digitalizing (adults): 1-1.5mg/ dayPO or IV
Maintenance: 0.125mg to 0.25mg PO

Front 15

What is digitalizing?

Back 15

-Bolus
-Large dose at first and then return to regualr maintenance dose

Front 16

What are contraindications of Digoxin?

Back 16

-Ventricular tachycardia
-Heart block
-idiotropic, hypertropic, subaortic, stenosis
-Acute MI
-Renal insufficiency
-Hypothyroidism
-Electrolyte imbalance
-Potassium will increase
-Calcium and magnesium will make patient more prone to toxcity

Front 17

What are adverse effects of digoxin?

Back 17

-Headache
-Weakness
-Drowsiness
-Vision Changes
-colored vision
-halos around lights or flickering
-GI upset
-Dysrhythmias

Front 18

What are the theraputic levels, the toxic levels, and the signs of toxcity in digoxin?

Back 18

Therapeutic levels
-0.5-2.0 ng/mL
Toxic levels
- >2.2 ng/mL
-Yellow halo around lights
-Vomitting
-Dysrhythmias
-Heart block

Front 19

What are treatments for Digoxin toxcity?

Back 19

-Digoxin antidote: Digoxin immune fab (Digifab/Digibind)
- Given IV
-Hypersensitivity reaction
-no digoxin for up to one week after
-can only recieve it once because it will start forming antibodies

Front 20

Indications for digoxin immune fab?

Back 20

-overdose of >10mg digoxin (adults) or >4mg (children)
-Serum digoxin level of >10ng/ml
- Potassium level >5 MEq/L
-Life threatening cardiac dysrhythmias

Front 21

What should the nurse watch closey for with giving immuneFab?

Back 21

anaphalyaxis

Front 22

What are some nursing considerations for cardiac glycosides?

Back 22

- Check dose carefully
- Know digoxin level prior to giving
- Check apical pulse for 1 full minute and hold if it is less than 60bpm
-Administer digoxin IV over 5 minutes
-2nd nurse to clarify dose prior to giving
-Avoid administering oral medication with food or antacids
-Monitor I and O and daily weight

Front 23

What are the 2 phosphdiasterase inhibitors (PDI)?

Back 23

inamrinone (inocor) and milrinone (primacor)

Front 24

What kind of response do PDI's have?

Back 24

- (+)inotropic effect - increases calcium levels in the cell resulting in an increase force of contraction
- may increase heart rate (positive chronotropic)
- vasodilation - decrease the force against which the heart muscle must pump to eject blood

Front 25

PDI's are used when?

Back 25

- Short term management of acute heart failure
- given in ICU (requires 24 hr monitoring)

Front 26

B- Type Natriuretic Peptide (BNP)

Back 26

Nesiritide (Natrecor)
-B-type natiuretic peptide (hormone)
-increases cardiac output and suppressess renin angiotensis system
-treats, severe, life threatening heart failure
- given in ICU (IV drip, continuous monitoring)