Heart Failure Medications

ACE Inhibitor med example for HF

Lisinopril (Zestril)

Lisinopril use

first-line HF, HTN

Lisinopril effects on body

lowers bp and afterload

Lisinopril contraindication (do not give if)

pregnant, history of angioedema, taking ARB or ARNI (36 hr gap)

Lisinopril side effects

dry cough, dizziness, first dose hypotension, high K

Lisinopril adverse effect

angioedema (airway emergency, rare)

Lisinopril give and cehck

Oral, once daily; start low, go _____

Check _____, _____, _____; hold if BP low or K+ > 5.0

low, BP, K, creatinine

Lisinopril client education

rise slowly, no salt substitutes or NSAIDs

Lisinopril client report

swelling of lips, tongue, or face

ok

Lisinopril CJMM

Recognize Cues: BP 92/58, dizzy, K+ 5.4. Take Action: Hold, call, assist with standing.

ok

ARB example

Valsartan (Diovan)

Valsartan (Diovan) use

HF when ACE inhib not tolerated

Valsartan (Diovan) effects on body

lower bp and afterload w/ rare cough

Valsartan (Diovan) would be given if patient develops persistent cough on what medication

lisinopril

Valsartan (Diovan) contraindications (do not give if)

pregnancy, taking ACE inhib, high K, severe kidney disease

Valsartan (Diovan) side and adverse effects

dizziness, headache, hypotension, high K, kidney injury, rare angioedema

Valsartan (Diovan) give and check

Oral, once or twice daily

Check _____, _____, _____; hold if BP low or K+ > 5.0

BP, K creatinine

Valsartan (Diovan) client education

rise slowly, no salt substitutes or NSAIDs, tell provider if pregnant

Valsartan (Diovan) client report what

swelling

ok

Valsartan (Diovan) CJMM

Recognize Cues: Cough on lisinopril; BP 118/72.

Take Action: Check BP, K+; teach rising slowly.

ok

Sacubitril-Valsartan (Entresto) use

chronic HFrEF, fewer hospital stays and deaths

Sacubitril-Valsartan (Entresto) contraindicated (do not give if)

ACE inhib within last 36 hrs, history of angioedema, pregnancy

Sacubitril-Valsartan (Entresto) side effects

dizziness, cough, hypotension, high K, kidney changes

Sacubitril-Valsartan (Entresto) adverse effects

angioedema (if ACE inhib within 36 hrs)

Sacubitril-Valsartan (Entresto) give and check

Oral, twice daily; replaces ACE inhibitor or ARB

Check BP, K+, creatinine; confirm the _______

36 hr gpa

Sacubitril-Valsartan (Entresto) client education

never w/ ACE inhib rise slowly, carry a med list

Sacubitril-Valsartan (Entresto) client report what

lip or tongue swelling

ok

Sacubitril-Valsartan (Entresto) CJMM

Recognize Cues: On lisinopril; Entresto newly ordered.

Take Action: Hold and call if timing is unclear.

ok

Beta blocker example

Carvedilol (Coreg)

Beta blocker use

chronic stable HFrEF, protects heart, improves survival

Beta blocker effects on body

heart works less overtime (slow HR, lower BP)

Beta blocker contraindicated

acute decompensated HF or shock, severe bradycardia, heart block, severe asthma

Beta blocker side and adverse effects

masks signs of hypoglycemia, fatigue, dizziness, slow pulse, low BP, fluid gain at start

Beta blocker give and check

Oral, twice daily with food; start low, go slow

Apical pulse, BP first; hold if HR < _____ or SBP < _____

60, 90

Beta blocker client education

never stop suddenly, take with food, weight daily, check pulse, low glucose signs may be hidden

ok

Beta blocker CJMM

Recognize Cues: HR 54, BP 98/60, tired.

Take Action: Hold, call, recheck; fall precautions.

ok

SGLT2 Inhibitor example

Empagliflozin (Jardiance)

Empagliflozin use

HF, with or without diabetes

Empagliflozin effects on the body

mild diuresis, lower bp, lower blood glucose, reduce workload of heart

Empagliflozin contraindicated

serious allergy (to drug), type 1 diabetes (ketoacidosis)

Empagliflozin side and adverse effects

genital yeast infection (excrete glucose), hypotension, frequent urination, volume loss, UTI, ketoacidosis (even with normal glucose)

Empagliflozin give and check

Oral, once daily in the _____

Hold if NPO, vomiting, or _____ depleted (sick day rule)

morning, volume

Empagliflozin client teach

genital area clean and dry, hold and call if vomiting

Empagliflozin client report

fever, genital pain, belly pain

ok

Empagliflozin CJMM

Recognize Cues: Vomiting 2 days; BP 94/56.

Take Action: Hold, notify, check glucose and ketones.

ok

HCN Channel Blocker for HF example

Ivabradine (Corlanor)

Ivabradine use

lower HR when beta blocker didnt work

Ivabradine effects on body

slow heart rate without weakening (heart) contractions

Ivabradine contraindicated

acute decompensated HF, heart block, HR < 60, low BP, pregnancy

Ivabradine side and adverse effects

bradycardia, atrial fibrillation, light flashes, headache

Ivabradine give and check

Oral, twice daily with meals

Apical pulse for 1 full minute; hold if _____ or _____

HR < 60, irregular

Ivabradine client education

light flashes common, caution driving

Ivabradine client report

dizziness or slow irregular pulse

ok

Ivabradine CJMM

Recognize Cues: HR 52, dizzy, sinus bradycardia.

Take Action: Hold, notify, fall precautions.

ok

Vasodilator combination HF example

Isosorbide Dinitrate and Hydralazine (BiDil)

Isosorbide Dinitrate and Hydralazine use

add-on HFrEF, including self-identified black clients

Isosorbide Dinitrate and Hydralazine effects on body

easier pumping, less congestion, lower BP

Isosorbide Dinitrate and Hydralazine contraindicated

Sildenafil or Tadalafil (PDE-5 inhibitors), severe hypotension, severe anemia

Isosorbide Dinitrate and Hydralazine side and adverse effects

headache, lupus-like (joint pain, fever, rash), hypotension, flushing, dizziness, fast heart rate

Isosorbide Dinitrate and Hydralazine client education

headache often fades, rise slowly, never take with sildenafil or tadalafil

Isosorbide Dinitrate and Hydralazine client report

joint pain, fever, rash

ok

Isosorbide Dinitrate and Hydralazine CJMM

Recognize Cues: BP 88/50, dizzy; took sildenafil last night.

Take Action: Hold, lie client flat, recheck BP. Contact provider

ok

Cardiac Glycoside HF example

Digoxin (Lanoxin)

Digoxin use

HF symptoms, slows fast atrial fibrillation

Digoxin effects on body

stronger beat (better cardiac output), slower rate, helps symptoms, not survival

Digoxin contraindicated

ventricular fibrillation, heart block, low K, kidney disease

Digoxin side effects

nausea, poor appetite, fatigue

Digoxin adverse effects

toxicity: vomiting, yellow-green vision, slow pulse, dysrhythmias

Digoxin give and check

Oral, once daily; IV for urgent use

Apical pulse 1 min; hold if _____; check _____

HR <60, K

Digoxin client education

check pulse before each dose, same time, same brand

Digoxin client report

vomiting, vision changes, slow pulse

ok

Digoxin CJMM

Recognize Cues: HR 54, nausea, yellow halos, K+ 3.1.

Take Action: Hold, notify, monitor rhythm.

ok

4 IV medications for acute HF

dobutamine (Dobutrex), milrinone (Primacor), epinephrine, vasopressin (Vasostrict)

IV safety for all 4 IV medications for acute HF

with another nurse verify drug, dose, and pump; continuous ECG and BP; titrate only by order; strict I&O

must never do for all 4 IV medications for acute HF

stop suddenly

reasons to call provider for all 4 IV medications for acute HF

new dysrhythmia, chest pain, BP outside the ordered range, or IV site pain or swelling