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CHF- nursing pharmacology
heart failure
51
Pharmacology
Undergraduate 2
01/30/2011

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Term
heart failure
Definition
The inability of the heart to maintain adequate CO to meet the metabolit demands of the body.
Term
usually asymptomatic with low CO, and possible exercise intolerance
Definition
symptoms associated with early stages of heart failure are:
Term
can't breathe
Definition
what is the main symptom of decompensated heart failure
Term
baroreceptor reflex
Definition
When the body senses a decrease in CO and BP it tries to maintain homeostasis by using the ______ to raise BP.
Term
constricts them
Definition
The baroreceptor does what to the blood vessels?
Term
vasoconstrict; increases afterload
Definition
What does renin do to blood vessels?? and what does this do to the heart?
Term
increased water retention and edema
Definition
What does alodosterone from the RAS cause in heart failure pts?
Term
catecholamines
Definition
these have recently been discovered to be cardiac growth factors.
Term

decrease cardiac work, o2 consumption, decrease preload and afterload, increase CO

control Na and water

Definition
What are the overall goals of heart failure treatment?
Term
thiazides
Definition
these diuretics inhibit the active exchange of Cl/Na in the distal convoluted tubule
Term
in the distal convoluted tuble, and cortical collecting ducts
Definition
where do K sparing diuretics work?
Term
ascending loop of henle
Definition
where do the loop diuretics work?
Term
diuretics
Definition
these are the primary therapy for the majority of heart failure patients with pulmonary congestion
Term
loop diuretics
Definition
These diuretics are used to reduce vascular volume, edema, pulmonary congestion.  They are administered IV for decompensated HF
Term
names of loop diuretics
Definition
furosemde
bumetanide
torsemide
Term
Thiazide diuretics
(hydrochlodothiazide)
Definition
these are used when pts are resistant to loop diuretics, or they may be combined with loops to produce synergistic natriuresis
Term
K sparing (spironolactone)
Definition
these diuretics are actually shown to decrease the amount of cardiac remodeling, and in combination with ACE (-) increase survival.
Term
decrease afterload
Definition
Treatment goal of vasodilators in heart failure
Term
ACE inhibitors
Definition
what is the drug of choice to treat heart failure?
Term
vasoconstriction
Definition
What do AT1 receptors cause?
Term
cough
Definition
side effect of ACE inhibitors
Term
ACe inhibitors
Definition
captopril
enalapril,
lisinopril
Term
↓ peripheral resistance → ↓afterload and preload → ↑CO↓ aldosterone release  ↓ Na and H2O absorption;↓ cardiac hypertrophy and remodeling
Definition
Mechanism of action for ACE inhibitors
Term

block AT1 receptors,  effects similar to ACE(-)

Definition
what is the mechanism of action for type I angiotensin II receptor antagonists?
Term
Angiotensin II Receptor antagonists
Definition
Potential Advantages of __________  ↓ side effects  -bradykinin metabolism unaffected receptors not blocked
Term
NA-nitroprusside
Definition
This drug is for i.v administration only. its converted to NO and is a preload and afterload reducer
Term
Nitroglycerin
Definition
This drug is thought primarily to be a venodilator, it's converted to NO
Term
nitroglycerin (vasodilator) side effects
Definition

Term
Hydralazine and Isosorbide dinitrite (vasodilators)
Definition
These two drugs were used in combination a lot before the advent of ACE inhibitor.  They have to be taken every four to six hours and compliance is a huge issue
Term
unknown  ↓ afterload dilating arteries almost exclusively
Definition
mechanism of action for the vasodilator hydralazine
Term
↓preload, venodilator
Definition
Mechanism of action for the vasodilator isosorbide dinitrite
Term
Nesiritide
Definition
this vasodilator is a recombinant form of human brain natriuretic peptide, and can only be administered through i.v. for the acute treatment of dyspnea
Term
nesiritide
Definition
Mechanism of this vasodilator is to< ↑ cyclic GMP, diuretic and vasodilator responses         (↓ preload and afterload)
Term
increase ventricular performance →   ↑ CO
Definition
What is the treatment goal of positive inotropic drugs?
Term
Cardiac Glycosides (digoxin, digotoxin)
Definition
These drugs are also called digitalis drugs. They have oral absorption and renal excretion
Term
1-2, kidneys
Definition
Digoxin has a half-life of ____ days, and is eliminated by the ______
Term
7; liver
Definition
digitoxin has a half life of ____ days and is eliminated by the _____
Term
major effect  is to inhibit Na→ 
(digoxin, digitoxin)
Definition
Mechanism of action of the cardiac glycosides
Term

 

Side effects:

  very narrow therapeutic index.  Side effects are ↑ by low K+. 

  GI effects,  cardiac arrhythmia

 

Definition
What are some side effects of Digoxin?
Term
Lidocaine, potassium , Beta blockers
Definition
What drugs are good treatments for the side effects of Digoxin?
Term
Fab fragments- and IGg antibody
Definition
what can be administered in an overdose of digoxin?
Term
digoxin
Definition
_________ is used for pts in HF with atrial arrythmia, or if symptoms persist after ace inhibitor and beta blockers
Term
dopamine (D1, beta1, and alpha1 agonist)
Definition
This drug is a positive inotropic that is administered IV in er treatment for decompensated pts.  It dilates the renal artery so that a diuretic may be administered
Term
Dobutamine (B1 agonist)
Definition
This drug increases FC without increasing HR. it was often used in combo with low dose dopamine
Term
tachycardia, tolerance
Definition
Side effects of dopamine and dobutamine
Term
Phosphodiesterase inhibitors: (inamrinone and milrinone)
Definition

these were developed to replace digitalis. they work by increasing intracellular levels of cAMP by inhibiting its breakdown ↑cAMP → phosphorylation of Ca++ channels →  ↑ intracellular Ca++ →  ↑ FC and  CO increases 

 

Term
phosphodiesterase inhibitors
Definition
inamrinone and milrinone are _______
Term
short term severe failure, or right-sided failure
Definition
Phosphodiesterase inhibitors should only be given in what circumstances
Term

carvedilol

metroolol

bisprolol

Definition
Name the beta blockers used to treat heart failure
Term
beta blockers
Definition


_________   decrease SNA to heart  decrease HR + O2 consumption  decrease deleterious effects of catecholamines (decrease hypertrophy and remodeling  ↑ ventricular function (↑ EF)

 

 

Term
ace inhibitor/ beta blocker/ diuretic
Definition
what combo of drugs increases the survival rate of heart failure pts the most?
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