23.

Heart Failure Agents 4 – 6 Questions

a. Pharmacology Overview
i. Inotropic- drugs that influence the force or energy of muscular
contractions, particularly contraction of the heart muscle
ii. Chronotropic- drugs that influence the rate of the heart beat
iii. Dromotropic- drugs that influence the conduction of electrical impulses
within tissues
b. Ace Inhibitors
i. Mechanism of Action
Prevent sodium and water resorption by inhibiting aldosterone secretion
c. Phosphodiesterase Inhibitors
i. Mechanism of Action
Inhibit phosphodiesterase; which increases intracellular cAMP –produce
a positive inotropic response and vasodilation
d. Cardiac Glycosides
i. Indications
Systolic heart failure, to control ventricular response to afib or flutter –
also can be used in adjunct to drugs of other classes, beta blockers,
diuretics, ACE inhibitors, and ARBs.
ii. Adverse Effects
Associated with cardiovascular, CNS, ocular, and GI effects -- Low
therapeutic index, dysrhythmias, headaches, fatigue, malaise, confusion,
convulsions, colored vision, halo vision, flickering lights, anorexia,
nausea, vomiting, diarrhea,
iii. Toxicity and Management of Overdose
Digibind therapy; conditions that predispose toxicity- hypokalemia, use
of cardiac pacemaker, hepatic dysfunction, hypercalcemia, dysrhythmias,
hypothyroid, respiratory, or renal disease, advanced age
iv. Normal Electrolyte Lab Values
Calcium- 8.8-10.3 mg/dl
Chloride- 95-107meq/l
Magnesium- 1.6-2.4meq/l
Phosphate- 2.5-4.5 mg/dl
Potassium- 3.5-5.3 meq/l
Sodium- 135-147meq/l
v. Drug Interactions
Antidysrhythmics, calcium, amohotericin B, chlorthalidone, loop
diuretics, laxatives, adrenal steroids, thiazide diuretics, antacids,
antidiarrheals, cholestyramine, colestipol, sucralfate, anticholinergics,
barbituates, beta blockers, calcium channel blockers, quinidine,
verapamil, amiodarone-* most serious
vi. Digitalis Toxicity
Conditions predisposing DT: use of pace maker, hypokalemia,
hypercalcemia, atrioventricular block, dysrhythmias, hyperthyroidism,
respiratory/renal disease, advanced age, ventricular fibrillation.
e. Nursing Process
i. Implementation: First Line Drugs
Give cautiously, intensive care setting, close monitoring, monitor for
severe effects, concern of syncope, peripheral neuritis, monitor VS
ii. Patient Teaching Tips
 Radial pulse before administration, daily weight, report adverse effects
or abnormal VS immediately, keep journal, wear medical alert bracelet,
take at same time every morning, don’t stop abruptly, consume foods
high in potassium if diuretic ordered as well, avoid using antacids or
eating milk products or bran 2 hours before or 2 hours after taking med
f. Digoxin (lanoxin)
i. Indication for Use
Heart failure, a fib, flutter
ii. Digitalis Toxicity
From long duration of action and long half life
iii. Therapeutic Levels
0.5-2 ng/ml