Module 7: Heart Failure & Lipids

L side HF symptoms

-restlessness

-confusion

-dyspnea

-tachycardia

-cyanosis

pulmonary congestion

R side HF symptoms

ascites

enlarged liver

JVD

GI distress

anorexia

weight gain

Heart failure definition

heart is unable to pump sufficient blood to meet the metabolic demands of the tissues

Heart failure signs

-low cardiac output

-Inadequate tissue perfusion

-Signs of volume overload

Heart failure symptoms

Dyspnea

fatigue

exercise intolerance

fluid retention

Digoxin use

heart failure, a fib

digoxin action

-positive inotropic

-improves pumping and contraction ability of heart

-dec edema

-improved pulmonary

inotropic

strength of heart contraction

Digoxin adverse effects

digoxin toxicity (anorexia, nausea, visual disturbances)

Cardiac dysthymias

bradycardia

Digoxin nursing interventions

-assess apical pulse before giving

-hold if <60

-give with meals

-daily weight

-monitor digoxin and K levels (hypokalemia inc toxicity risk)

-Use cautiously/ adjust dose in renal impairment (can inc risk of digoxin toxicity)

digoxin antidote

Digibind

Digoxin therapeutic index

0.5-2.0 ng/ml

Phosphodiesterase Inhibitors types

Milrinone

Phosphodiesterase Inhibitors use

decompensated (worsening) heart failure

What should Phosphodiesterase Inhibitors not be give with?

nitroglycerine

Dobutamine use

decompensated (worsening) heart failure

goal of angina medications

inc heart oxygen supply and dec heart's oxygen demand

Anti-angina drug classes

nitrates

beta-blockers

calcium channel blockers

Nitrates action

-dec pre/after load

-dec systolic BP

-dec oxygen demand by dilating veins

-inc oxygen supply relaxing coronary vasospasm

-inc blood flow to ishemic areas from CA dilation

What are rapid nitrates used for?

acute angina

What are long-acting nitrates used for?

prevent angina

Nitrates nursing interventions

-limit caffeine

-teach potency is lost 3 months after bottle has been opened

Nitrates types

Nitroglycerin (rapid and long acting)

Isosorbide dinitrate (rapid and long acting)

Isosorbide mononitrate (long acting)

Nitrates adverse effects

headache

blurred vision

dry mouth

edema

fainting

weight gain

postural hypotension

dyspnea

tolerance

Adjuvant CAD meds

Ranolazine

Dyslipidemic Drugs

ACE inhibitors

Aspirin

Morphine

Thrombolytics

Desirables:

Total cholesterol

LDL

HDL

Triglycerides

<200

<130

>40

<150

What should be used first when treating high cholesterol?

diet, exercise

HMG-CoA Reductase Inhibitors types

Atorvastatin (Lipitor)

-statin

HMG-CoA Reductase Inhibitors action

Inhibit HMG-CoA reductase, which is used by the liver to produce cholesterol

-lower LDL, VLDL

-inc HDL

HMG-CoA Reductase Inhibitors use

Hyperlipidemia, CAD prevention

HMG-CoA Reductase Inhibitors adverse effects

Myopathy

rhabdomyolysis

hepatotoxicity

GI

HMG-CoA Reductase Inhibitors contradictions

liver disease

alcohol use

pregnancy (teratogenic)

HMG-CoA Reductase Inhibitors administration

-at night

-monitor liver

-hold if muscle pain

What can rhabdo lead to?

acute renal failure

Bile Acid Sequestrants types

cholestyramine (Questran)

Bile Acid Sequestrants action

Prevent resorption of bile acids from small intestine, which makes liver use LDL

Bile Acid Sequestrants adverse effects

dec fat-soluble vitamin absorption

Fibric Acid Derivatives types

Gemfibrozil (Lopid)

Fibric Acid Derivatives action

activate lipase, which breaks down cholesterol

Fibric Acid Derivatives adverse effects

prolonged prothrombin (how long it takes to form a clot)

Ezetimibe (Zetia) use

Inhibits absorption of cholesterol and related sterols from the small intestine

Niacin (Nicotinic Acid): Vitamin B3 use

lipid-lowering vitamin

requires higher dose

Niacin adverse effects

flushing, pruritus

advicor

niacin+lovastatin

treats dyslipidemia

simcor

niacin+simvastatin

treats dyslipidemia