Term
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Definition
Defined: when the heart can't pump enough blood to meet the tissue needs for oxygen & nutrients
Symptoms: dyspnea (shortness of breath) / fatigue / ankle edema / JVD / pulmonary edema / Ejection Fracture < 40%
Left side HF: Respiratory symptoms (crackles, dyspnea, pulm. edema)
Right side HF: Systemic symptoms (jugular venous distension, ankle edema, fatigue)
Preload Vs. Afterload: Almost all meds for CHF will affect preload, afterload, or both
Inotropic: force or energy of muscular contractions of the heart (inotropic agent increases myocardial contractility)
Drugs to treat:
ACE inhibitors / angiotensin II receptor blockers / diuretics / beta blockers (dif from first ones) |
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Term
Angiotensin-Converting Enzyme (ACE) Inhibitors
"-pril" |
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Definition
ACE: responsible for the conversion from angiotensin I to angiotensin II --> leads to aldosterone release, increasing vasoconstriction & sodium & H20 retention (increases BP & afterload)
Drug:
- lisinopril (Prinivil, Zestril)
- captopil (Capoten)
Action: Inhibits conversion of angiotensin I to angiotensin II / decrease BP & afterload
Use: heart failure / HTN / MI / 1st line of treatment for HTN associated with CKD
Adverse: severe hypotension / renal tubular damage / cough (common)
Contraindications: ARBs / pregnant / renal disorder (caution)
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Term
Angiotensin II Receptor Blockers (ARBs)
"-sartan" |
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Definition
ARBs: blocks vasoconstriction, aldosterone secretion, lowering BP & afterload
*If patient can't tolerate ACE inhibitor, s/he is moved over to an ARB
Drug:
- losartan (Cozaar)
- valsartan (Diovan)
Action: compete w/ angiotensin II for tissue binding sites
Use: HTN / heart failure
Adverse: severe hypotension / less cough problems
Contraindications: ACE / pregnant / liver failure
Nursing Implications:
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Term
Phosphodiesterase Inhibitor |
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Definition
Drug:
Action: Inhibits action of phosphodiesterase enzyme
Use: short term treatment of acute heart failure
Adverse: severe hypotension / dysrhythmia
*ICU care only, use after other treatments fail |
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Term
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Definition
Drug:
Action: Slows rate, inc. force of contractions, inc. CO
Use: heart failure / tachyarrhythmias (over 100 bpm)
Adverse: bradycardia (bpm less than 60) / heart block
Toxicity:
- anorexia, upset stomach, hypokalemia, vision changes
- normal digoxin blood level (0.5 - 2. 0 ng/mL)
- Elderly, impaired renal function, electrolyte imbalances
- Digibind = reversal agent for digoxin (forms An-Ab complex)
Contraindications: heart block / bradycardia
Nursing Implications:
- Start w/ loading doses, followed by maintenance dose
- Hold if HR < 60
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Term
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Definition
Diuretics: used heavily with treatment of heart failure for fluid overload
*loop diuretics for fluid overload
*K+ sparing for heart failure progress
Drug:
- hydralazine/isosorbide (BiDil)
Use: treatment of heart failure in African American population |
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Term
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Definition
Defined: disturbance in electrical conduction
- can be in many areas:
- Sinus
- Atrial
- Nodal
- Ventricular
- Heart block
- can be benign or life threatening
- classified in different categories depending on their action: I, II, III, IV
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Term
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Definition
Drug:
- quinidine (Quinidex)
- procainamide (Pronestyl)
- disopyramide (Norpace)
Action: Na+ channel blockers
Use: (life threatening dysrhythmias) supraventricular/ventricular arrhythmias
Adverse: blood disorders & Lupis-Like syndrome (Pronestyl) / tinnitus (quinidine) / diarrhea / N/V / hypotension / dizziness / dysrhythmias
Contraindications: kidney & liver disorders
Nursing Implications:
- take AHR
- Monitor BP
- Take on time & on schedule
- Many drug interactions
*these drugs have side effects of another dysrhythmia
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Term
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Definition
Drug:
Action: decrease automaticity in ventricles (the ability of the cell to make it self contract--> rhythms should occur in atria not ventricle)
Use: serious ventricular dysrhythmias
Adverse: bradycardia / heart block / hypotension / confusion
Precautions: pregnancy / elderly / acute MI
Nursing Implications:
- lidocain IV only
- monitor rate/rhythm/ BP
- Safety
** lidocaine has large 1st Pass Effect PO
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Term
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Definition
Drug:
- propafenone (Rythmol)
- flecainide (Tambocor)
Action: decreases conduction to ventricles by supressing premature ventricular contractions
Use: life threatening ventricular arrhythmias
Adverse: dysrhythmias / dizziness / fatigue
Caution: heart failure / liver disease / K+ imbalances
Nursing Implications:
- monitor serum K+
- Monitor rate
- Monitor rhythm
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Term
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Definition
Drug:
Beta blockers - given IV push (different from first Beta blockers)
- propanolol (Inderal)
- esmolol (Breviblock)
- sotalol (Betapace)
Action: block the SNS
Use: supraventricular tachycardia
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Term
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Definition
Drug:
Action: prolong duration of the action potention, slow repolarization, prolong refractory period in atria and ventricles / prevents heart from being irritable (slows everything down)
Use: ventricular dysrhythmias
Adverse: hypotension / N/V / visual disturbances
Precautions: liver diseases / pulmonary diseases
Nursing Implications:
- monitor HR , dysrhythmias, BP, & thyroid function
*very long half life (2-3 months)
*interacts w/ coumadin & dogoxin (those drugs need to have their dose decreased when starting this drug)
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Term
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Definition
Drug:
- verapamil (Calan)
- diltiazem (Cardizem)
Action: calcium channel blockers , slow inward flow of Ca+ / help make cardiac tissues not so irritable
Use: prevent/control supraventricular arrhythmias / HTN
Adverse: nausea / leg cramps / hypotension / bradycardia / heart block
Precautions: pregnancy / heart block / hypotension / elderly
Nursing Implications:
- monitor BP & Hr
- give w/ food
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Term
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Definition
Drug:
Action: slows conduction time through the AV node
Use: conversion of PSVT (very occasional rapid heart rate) to sinus rhythm (normal HR = 60 - 100 bpm)
** causes asystole for period of seconds then returns
heart to regular rhythm
**10 sec half life, given IV push
** used after failure of other treatments
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