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PNM300 - Test 2 (CH 25,27) Study Guide
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PNM300 - Test 2 (CH 25,27)Study Guide
What is heart failure? - Answer The heart is unable to pump blood in sufficient amounts
from the ventricles to meet the body's metabolic needs
What are symptoms of heart failure dependent on? - Answer symptoms depend on
cardiac area affected
Left Ventricle Heart Failure Symptoms - Answer - elevated left ventricular pressure
produces pulmonary edema (pulmonary congestion)
- resulting in cough, SOB & air hunger
Right Ventricular Failure - Answer - elevated right ventricular pressure leads to venous
congestion & peripheral edema
- i.e. edema of the ankles, jugular venous distention, ascites (abd distention) & hepatic
congestion
Class I
(New York Heart Association) - Answer No physical activity limitations
Class II (New York Heart Association) - Answer Ordinary physical activity results in
fatigue, dyspnea, or other symptoms.
Class III (New York Heart Association) - Answer Marked limitation in physical activity
Class IV (New York Heart Association) - Answer Symptoms at rest or with no physical
activity at all
What is Inotrophy? - Answer force of myocardial contraction
What is chronotropy? - Answer heat rate
What is dromotrophy? - Answer cardiac nerve conduction
What is automaticity ? - Answer A property of specialized excitable tissue in the heart
that allows self-activation through the spontaneous development of an action potential,
such as in the pacemaker cells of the heart.
What is ejection fraction? - Answer The proportion of blood that is ejected during each
ventricular contraction compared with the total ventricular filling volume.
What is refractory period? - Answer The period during which a pulse generator (i.e., the
,sinoatrial node of the heart) is unresponsive to an electrical input signal, and during
which it is impossible for the myocardium to respond; during this period, the cardiac cell
is readjusting its sodium and potassium levels and cannot be depolarized again.
What are positive inotropic drugs? - Answer - Phosphodiesterase inhibitors
- Cardiac glycosides (DIGOXIN)
- B-type natriuretic peptides
What drugs are usually used to treat early heart failure? - Answer - ACE Inhibitors
- ARBs
- Certain ß-blockers (bisoprolol, extended-release metoprolol tartrate, and carvedilol)
- loop diuretics
- aldosterone inhibits
Loop Diuretics and Heart Failure - Answer Loop diuretics (furosemide) are used to
reduce the symptoms of heart failure secondary to fluid overload.
Aldosterone Inhibitors and Heart Failure - Answer - spironolactone, eplerenone
- used as heart failure progresses
When is digoxin introduced in heart failure? - Answer after first line of early treatment
meds fail to manage heart failure
Heart Failure medications recommended for black patients with HF - Answer
Hydralazine and isosorbide dinitrate are approved specifically for individuals who are
Black.
How does hydralazine work? - Answer causes arterial vasodilation
Dobutamine Hydrochloride and HF - Answer - is available only as an intravenous drug
and is given by continuous infusion
- used for unstable patients
What do Phosphodiesterase Inhibitors/Inodilators do? - Answer - Intracellular increase
in cyclic adenosine monophosphate (C-AMP)
- Positive +inotropic response (increase Ca)
- Vasodilation (afterload)
What is a inodilators? - Answer inotropes + dilators
There is only one phosphodiesterase inhibitor available in Canada what is it? - Answer -
milrinone
, - only available as an injection
- Short-term management of heart failure for patients in the Critical Care Unit
not meant for long term
What is Digoxin used for? - Answer Used in heart failure and to control ventricular
response to atrial fibrillation
What is a positive +inotropic effect? - Answer - Increased force and velocity of
myocardial contraction (without an increase in oxygen consumption)
What is a negative -chronotropic effect? - Answer - Reduced heart rate
What is a Negative -dromotropic effect? - Answer Decreased automaticity at sinoatrial
node, decreased atrioventricular nodal conduction, and other effects
A patient is in the emergency department with new-onset atrial fibrillation. Which order
for digoxin would most likely have the fastest therapeutic effect?
A)Digoxin 0.25 mg PO daily
B) Digoxin 1 mg PO now, then 0.25 mg PO daily
C) Digoxin 0.5 mg IV push daily
D) Digoxin 0.75 mg IV push now, then 0.125 mg IV tid - Answer D) Digoxin 0.75 mg IV
push now, then 0.125 mg IV tid
Rationale: A digitalizing dose (0.5 - 0.75 mg IV) is often used to quickly bring serum
levels of the drug up to a therapeutic level. IV doses would accomplish this more
quickly.
Why is digoxin not a first line drug for heart failure? - Answer - does not decease
mortality
- very narrow therapeutic window (0.8 to 2 mg/ml)
- Hypokalemia increases its toxicity.
Adverse Effects of Digoxin (Cardio) - Answer - dysrhythmias
- including bradycardia or tachycardia
- hypotension
Adverse Effects of Digoxin (CNS) - Answer - headaches
- fatigue, malaise
- confusion
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