pee pee
this drug class is 1st line therapy for acute pulmonary edema from heart failure
diuretics
this med is a first line treatment for heart failure (class and prototype)
ACE inhibitor, Lisinopril
what 3 beta blockers are approved in heart failure
carvedilol
metoprolol
bisoprolol
name the 2 SGLT-2 inhibitor prototypes
describe the action of cardiac glycosides
slow the heart, increase force of contraction, increase CO, improved efficiency
this drug (name and class) can be used in combo with loop or thiazide diuretics to counteract low K levels
spironolactone, K-sparing diuretic
why do ACE inhibitors cause a dry cough?
because they cause an increase in bradykinin
explain how BBs are dosed different for patients with heart failure
start with small doses (1/10, 1/20) and double every 2 weeks
name some common side effects for SGLT-2 inhibitors
UTIs, polyuria, genital fungal infections, weight loss, dehydration risk
describe the MOA of isosorbide dinitrate
causes direct relaxation of venous smooth muscle
name 3 outcomes of using spironolactone in heart failure
blocks aldosterone, reducing Na+/fluid retention
prevent cardiac remodeling
suppress SNS
reduces symptoms, decrease hospitalizations and prolongs life
what is the difference in effect between ACE and ARB?
ACE inhibitors decrease cardiac remodeling while ARBs do not
name 3 benefits of beta blockers that are specific to heart failure
helps to improve EF
slows progression of HF
prevents cardiac remodeling
name some SGLT-2 nursing considerations/education (2)
monitor kidney function
educate on infection risks
your patient has nausea, vomiting, anorexia, and fatigue. They begin to complain they are seeing greenish yellow halos around the lights. What are you going to administer to them and why?
digibind because they have digoxin toxicity
name 1 possible side effect for each type of diuretic class
loop - hypokalemia, dehydration, hypotension, ototoxicity (IV)
thiazide - hypokalemia, hypercalcemia, hyperglycemia, hypotension
K-sparing - hyperkalemia, gynecomastia, menstrual irregularities
explain the ARNi mechanism of action and name the prototype
name 3 patient teachings for beta blockers
check if HR is < 60
teach patient not to stop suddenly
teach DM to monitor blood sugar
what was this drug class originally designed for? why?
diabetes, because it causes increased excretion of glucose in the urine
this med is specifically recommended for black patients with HFrEF who are already on standard therapy but still have symptoms
isosorbide dinitrate + hydralazine (BiDil)
this aldosterone antagonist is being used more frequently because it does not cause gynecomastia
eplerenone
A patient complains their new blood pressure medication is giving them hyperkalemia, orthostatic hypotension, and angioedema. What med are they likely on?
Valsartan
(Sacubitril/Valsartan also acceptable answer)
Which formulation would you give to your heart failure patient, and why?
Metoprolol succinate (XL) or metoprolol tartrate
Metoprolol succinate (XL) is designed specifically for heart failure management, while the immediate-release (tartrate) is more commonly used for high blood pressure or after heart attacks.
what effects do SGLT-2 inhibitors have on the heart? (2)
decreased LV mass
improved diastolic function
what is the therapeutic range of digoxin?
0.5-0.8 ng/mL