ACE Inhibitors - • "pril"
• Reduce afterload
• Drugs of choice for heart failure
• Enhance excretion of sodium and water
• Lower peripheral resistance and reduce blood volume
• Increase cardiac output
Role of the Nurse: ACE Inhibitors - • Monitor C B C
• Assess for hypotension
• Monitor for impaired kidney function, hyperkalemia, autoimmune disease
Angiotensin II Receptor Blockers (ARBs) - • "sartan"
• Actions very similar to A C E inhibitors
• Usually used for patients who are unable to tolerate the adverse effects of A C E
inhibitors
Diuretics - • Increase urine flow
• Reduce blood volume and cardiac workload
• Reduce edema and pulmonary congestion
• Prescribed in combination with other drugs
Role of the Nurse: Diuretics - • Assess renal function
• Monitor electrolyte levels
• Monitor vital signs. intake/output
• Monitor blood glucose and blood-urea nitrogen (B U N)
Beta-Adrenergic Blockers - • Slow heart rate and reduce blood pressure
• Inotropic effect
• Reduce workload of heart
Role of the Nurse: Beta-Adrenergic Blockers (HF) - • Monitor for worsening symptoms
• Monitor liver function/hepatic toxicity
• Be aware of contraindications
Cardiac Glycosides - • Increase force of heartbeat. slow heart rate
• Improve cardiac output
• Second-line treatment for H F
• Narrow therapeutic range
Role of the Nurse: Cardiac Glycosides - • Evaluate for ventricular dysrhythmias
• Assess renal function
• Monitor for drug interactions
, • Know restriction on use with antidiarrheals/antacids
Direct Vasodilators - • Minor role in H F treatment
• Lower blood pressure
• Relax blood vessels
Phosphodiesterase Inhibitors - • Block enzyme phosphodiesterase
• Increase calcium for myocardial contraction
• Cause positive inotropic response and vasodilation
• Increase contractility and decrease afterload
• Short-term therapy only
Role of the Nurse: Phosphodiesterase Inhibitors - • Assess potassium levels
• Monitor for hypotension
• Assess for renal impairment
• Assess for dysrhythmias
• For I V: Monitor for ventricular dysrhythmias
Patient teaching for HF (a lot of info so probably just have an idea) - • Therapeutic
response time: weeks or months
• Don't use HF meds with other medications. O T Cs. herbals. vitamins
• Monitor sodium intake
• Report weight loss• Report fatigue and muscle cramps
• Change position slowly
• Monitor blood pressure/pulse
• Report pulse below 50
• Report signs/symptoms of worsening heart failure
• Do not stop taking abruptly
• Monitor therapeutic levels with laboratory tests
• Know signs/symptoms of toxicity
• Monitor pulse rate
• Report weight gain
• Eat foods high in potassium
• Report irregular or rapid heart rate
• Report fever of 101 degrees F or higher or increase in chest pain
• If given I V. report fever of 101 degrees F or higher or pain/swelling at infusion site
MAP = - (SBP + 2DBP) ÷ 3
Cardiac index - - CO divided by body surface area (BSA)
- Normal 2.8 to 4.2 L/min/m2
Heart Failure (HF) - • Inability of ventricles to pump enough blood for body's needs
• Weakening of heart muscle due to aging or disease
Right-Sided Heart Failure - • Blood backs up into veins
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