Chapter 51

Question 1

MAJOR CLASSES FOR HF
-What are the 5 types?

Answer 1

1. ACE-I
2. Angiotensin II receptor blockers (ARBs)
3. Aldosterone antagonists
4. Cardiac glycosides (Digoxin)
5. Angiotensin receptor neprilysin inhibitors (ARNIs)

Question 2

ACE-I
-What are some examples? (3)

Answer 2

-Enalapril, lisinopril, captopril

Question 3

ACE-I: Therapeutic Use
-What is this the first line therapy for?
-Long term use is better for what?

Answer 3

-HF
-Heart function & preventing further damage to the heart

Question 4

ACE-I: Hemodynamic Benefits
-What are the 4 benefits?

Answer 4

1. Arteriolar dilation
2. Venous dilation
3. Suppression of aldosterone release
4. Cardiac remodeling

Question 5

ACE-I: Hemodynamic Benefits
-What does arteriolar dilation do?

Answer 5

It improves blood flow in the kidneys & other tissues

Question 6

ACE-I: Hemodynamic Benefits
-What does venous dilation do?

Answer 6

It reduces venous pressure = reduced pulmonary congestion, peripheral edema, preload, & cardiac dilation

Question 7

ACE-I: Hemodynamic Benefits
-what does suppression of aldosterone release cause?

Answer 7

Enhanced excretion of sodium & water WHILE retaining potassium

Question 8

ACE-I: Hemodynamic Benefits
-What does cardiac remodeling help do?

Answer 8

Improve heart structure over time, reversing harmful changes in size & shape

Question 9

ACE-I: Mechanism of Action
-What does this inhibit?

Answer 9

-Conversion of angiotensin I to angiotensin II

Question 10

ACE-I: Mechanism of Action
-What does this reduce? (2)

Answer 10

1. Vasoconstriction & sodium retention caused by angiotensin II
2. Cardiac remodeling, which slows disease progression

Question 11

ACE-I: Adverse Effects
-What are they? (HHAIR)

Answer 11

-Hypotension
-Hyperkalemia
-Angioedema
-Intractable cough
-Renal failure

Question 12

ACE-I: Adverse Effects
-When does this cause renal failure?

Answer 12

If the patient has bilateral renal artery stenosis

Question 13

ACE-I: Adverse Effects
-Most seriously, this can cause what?

Answer 13

A fetal injury

Question 14

ARBS
-What do these end in?
-What are 2 examples?

Answer 14

-sartan
-Losartan & valsartan

Question 15

ARBS: Therapeutic Uses
-When is this going to be used?

Answer 15

When patients CANNOT tolerate ACE-I due to cough or angioedema

Question 16

ARBS: Therapeutic Uses
-How are the benefits, in relation to ACE-I

Answer 16

They are similar –> reduces mortality & symptoms BUT less cough

Question 17

ARBS: Mechanism of Action*
-What does this block?

Answer 17

Angiotensin II receptors

Question 18

ARBS: Effects
-What are the 3 effects?

Answer 18

1. Vasodilation
2. Reduced aldosterone secretion
3. Decreased cardiac workload

Question 19

ARNI
-What kinds of medications of these?

Answer 19

Newer agents that combine ARBs with neprisylin inhibitors

Question 20

ARNI
-It is okay to give these with ACE-I. (T/F)
-Why?

Answer 20

-FALSE; there is a risk of angioedema

Question 21

ARNI
-What is an example of this medication?

Answer 21

Sacubitril/valsartan

Question 22

ARNI: Therapetic Use
-Who is this used for?

Answer 22

Patients with reduced ejection fraction

Question 23

ARNI: Mechanism of Action
-What does this enhance?
-What does this block?

Answer 23

-Beneficial natriuretic peptides
-angiotensin II receptors

Question 24

ARNI: Mechanism of Action
-What are the 3 effects of this? VRI

Answer 24

-Vasodilation
-Reduced fluid retention
-Improved survival

Question 25

**ALDOSTERONE ANTAGONISTS** -What do these end in? -What are 2 examples?

Answer 25

-one -Spironolactone, eplerenone

Question 26

**ALDOSTERONE ANTAGONISTS**: *Therapeutic Use* -When are these used?

Answer 26

For moderate to severe HF

Question 27

**ALDOSTERONE ANTAGONISTS**: *Mechanism of Action* -What does this block? -What does this help improve?

Answer 27

-Aldosterone receptors in the heart & blood vessels -Survival

Question 28

**ALDOSTERONE ANTAGONISTS**: *Effects* -What 3 effects does this have? *PRD*

Answer 28

1. Promotes sodium & water excretion 2. Reduces potassium loss 3. Decreases cardiac remodeling

Question 29

**ALDOSTERONE ANTAGONISTS**: *Effects* -What things will you do due to reduced potassium loss?

Answer 29

1. Monitor K+ levels 2. Watch for HYPERkalemia 3. Assess renal function

Question 30

**ALDOSTERONE ANTAGONISTS**: *Benefits* -What 3 benefits does this give the patient?

Answer 30

1. Reduces symptoms 2. Decreases hospitalizations 3. Prolongs their life

Question 31

**CARDIAC GLYCOSIDE** -What is the prime example of this class?

Answer 31

Digoxin

Question 32

**CARDIAC GLYCOSIDE** -Digoxin reduces mortality (T/F)

Answer 32

FALSE --> it only helps control symptoms & improves QOL

Question 33

**CARDIAC GLYCOSIDE**: *Therapeutic Uses* -Describe it. -What is it used for?

Answer 33

-Second-line agent -Patients with HF & atrial fibrillation

Question 34

**CARDIAC GLYCOSIDE**: *Mechanism of action* -What does this primarily do? -It (slows/quickens) HR

Answer 34

-Increases myocardial contractility -Slows

Question 35

**CARDIAC GLYCOSIDE**: *Effects* -What are 3 effects of this?

Answer 35

1. Increased CO 2. Reduced symptoms 3. Improved exercise tolerance

Question 36

**CARDIAC GLYCOSIDE** -Describe its therapeutic index

Answer 36

NARROW TI --> patients are at risk for toxicity

Question 37

**CARDIAC GLYCOSIDE**: *Pharmacokinetics* -Describe Metabolism & Excretion

Answer 37

Minimal hepatic metabolism --> excreted unchanged by kidneys

Question 38

**CARDIAC GLYCOSIDE**: *Drug Interactions* -What 6 medications does digoxin interact with

Answer 38

1. Diuretics 2. ACE-I 3. ARBs 4. Sympathomimetics 5. Quinidine 6. Verapamil

Question 39

**CARDIAC GLYCOSIDE**: *Digoxin Toxicity* -What are the 4 s/s?

Answer 39

1. Dysrhythmias & bradycardia 2. GI effects: N/V 3. Neurological effecs 4. Visual disturbances

Question 40

**VASODILATOR**: *BiDil* -What is this?

Answer 40

A fixed-dose combination of hydralazine & isosorbide dinitrate

Question 41

**VASODILATOR**: *BiDil* -What is this approved for treating?

Answer 41

HF ONLY in self-identified black individuals

Question 42

**VASODILATOR**: *BiDil* -This is the first medication that has been approved for what?

Answer 42

A specific population

Question 43

**VASODILATOR**: *BiDil* -Describe what 2 things this does.

Answer 43

1. Venous dilation --> reduces preload 2. Arterial dilation --> reduces afterload

Question 44

**VASODILATOR**: *BiDil* -What is the end result?

Answer 44

Improved CO & reduced HF symptoms

Question 45

**NURSING ACTIONS** -What are you going to monitor? (4)

Answer 45

1. VS (esp. HR & BP) 2. Electrolytes 3. Fluid status 4. Kidney function

Question 46

**NURSING ACTIONS**: *Teaching* 1. Take medications as _____ 2. Monitor _____ ____ 3. Limit ____ intake 4. Report worsening symptoms. What are they? 5. Rise (quickly/slowly)

Answer 46

1. prescribed 2. daily weight 3. sodium 4. dizziness, palpitations, or chest discomfort 5. slowly

Question 47

**NURSING ACTIONS**: *Teaching* -Can this medication be discontinued abruptly? -Why?

Answer 47

-NO -It can worsen HF symptoms

Question 48

**NURSING ACTIONS**: *Teaching* -What may some patients intially experience with this medication & why?

Answer 48

Headaches from vasodilation