N2161 - Week 10: HF/AFib Drugs

goal of HF meds

To reduce workload on heart and to prevent cardiac remodeling.

Beta blockers and digoxin.

Drugs to reduce heart rate?

ACE inhibitors and ARBs.

Drugs to reduce afterload?

Diuretics.

Drugs to reduce preload?

loop diuretics

Manages fluid overload.

potassium-sparing diuretics

Reduces the aldosterone-induced retention of sodium and water and impaired vascular function.

ACE inhibitors and ARB

Causes vasodilation and increases in CO and tissue perfusion.

beta blockers HF

Decreases heart rate and oxygen demand and increases cardiac output.

nitrates

Reduces preload and afterload by vasodilation and reducing venous return to the heart.

vasodilators HF

Reduces afterload by improving forward CO and decreasing ventricular filling pressure.

digoxin MOA

Works at the sodium pump to increase intracellular Na+ and Ca+ to increase contractility (positive inotropic effect).

digoxin effects

- Positive inotropic (stronger contraction).

- Negative chronotropic (slower heart rate).

digoxin assessment

Apical pulse for 60 seconds (hold if

digoxin toxicity cause

- Decreased renal function.

- Dehydration.

- Hypokalemia, hypomagnesemia, hypercalcemia.

- Hypothyroidism.

- Drug interactions.

- Rapid loading.

- Antiarrhythmics.

- Anticholinergics.

- Potassium-wasting diuretics.

Drugs that cause increased serum digoxin levels?

- Antacids.

- Cholestyramine.

- Metoclopramide.

Drugs that cause decreased serum digoxin levels?

digoxin therapeutic range

0.5-1.5 ng/mL.

digoxin toxic range

>2.0 ng/mL.

digoxin toxicity CVS

- Bradycardia.

- AV conduction block.

- Supraventricular tachycardia.

- Ventricular extrasystoles.

digoxin toxicity CNS

- Confusion.

- Forgetfulness.

- Hallucinations.

- Dizziness.

- Psychosis.

- Nightmares.

digoxin toxicity visual

Colour changes and halos.

digoxin toxicity GI

- Anorexia.

- Nausea and vomiting.

- Diarrhea.

- Abdominal pain (mesenteric ischemia).

warfarin MOA

Inhibits function of vitamin K to prevent clotting.

Vitamin K.

warfarin antidote

warfarin peak time

5-7 days. May need additional faster acting anticoagulants at beginning.

warfarin client teaching

- Avoid foods high in vitamin K.

- Regular INR checks.

- General blood thinner education.

vitamin K high foods

- Kale.

- Broccoli.

- Brussel sprouts.

- Cabbage.

- Pickled cucumber.

Apixaban and Rivaroxaban

Safer anticoagulants compared to warfarin. Less bleeding risk and don't need to check INR as often.

- Beta blockers.

- CCBs.

- Digoxin.

Drugs used to control heart rate in AFib?

Antiarrhythmics (amiodarone, sotalol).

Drugs used to control rhythm in AFib?

Warfarin and apixaban.

Drugs used to control coagulation in a-fib?

antiarrhythmics MOA

Works at the Na+/K+ pump to decrease impulse conduction and relax the myocardium.