1. Drugs Used to Treat Heart Failure
Chapter 28
Drugs Used to Treat Heart Failure
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2. Chapter 28
Lesson 28.1
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3. Objectives
Summarize the pathophysiology of heart failure, including the body’s compensatory mechanisms
Identify the goals of treatment of heart failure
Identify essential assessment data, nursing interventions, and health teaching needed for a patient with heart failure
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4. Heart Failure
Cluster of signs/symptoms that arise when the ventricles (left, right, or both) lose ability to pump enough blood to meet the body’s circulatory needs
Systolic dysfunction
Symptoms: decreased exercise tolerance, poor peripheral tissue perfusion
Diastolic dysfunction
Symptoms: pulmonary congestion, pulmonary edema
Affects an estimated 5 million Americans.
The number of other conditions that complicate its treatment increases as people live longer.
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5. Pathogenesis of Heart Failure
Body compensates for inadequate cardiac output
Releases epinephrine and norepinephrine
RAAS stimulates renal distal tubule to retain sodium and water
Increases production of vasopressin
Kidneys increase sodium reabsorption, increasing blood volume, causing increased pressure within capillaries, resulting in edema formation
Release of epinephrine and norepinephrine produces tachycardia and increases contractility and peripheral vasoconstriction, increasing afterload.
RAAS increases load on the heart from water retention, which increases circulating blood volume, increasing preload.
Vasopressin increases intravascular volume and preload.
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6. Treatment of Heart Failure
Goals
Reduce signs/symptoms associated with fluid overload
Increase exercise tolerance
Prolong life
Treatment
Correct underlying disease (e.g., coronary artery disease, hypertension, dyslipidemia, thyroid disease)
Bed rest when necessary
Sodium-restricted diet
Control symptoms with combination of drugs
Smoking cessation is also important.
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7. Drug Therapy for Heart Failure
Vasodilators – reduce strain on left ventricle by reducing systemic vascular resistance (afterload)
Inotropic agents – boost cardiac output by stimulating the heart to increase force of contractions
Diuretics – enhance sodium and water excretion, reducing preload
Therapeutic outcomes: reduce systemic vascular resistance (afterload); reduce preload.
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8. Nursing Process for Heart Failure Therapy
Assessment
Obtain history of heart disease, related cardiovascular diseases
Six cardinal signs of heart disease
Presence of altered cardiac function
Diagnostic tests
Echocardiogram, ECG, nuclear imaging studies, chest x-ray, laboratory tests
Related diseases: hypertension, hyperlipidemia, diabetes mellitus, lung disease.
Six cardinal signs of heart disease: dyspnea, chest pain, fatigue, edema, syncope, palpitations.
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9. Chapter 28
Lesson 28.2
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10. Objectives
State the primary actions on heart failure of digoxin, angiotensin-converting enzyme inhibitors, beta blockers, aldosterone antagonists, nitrates, and calcium channel blockers
Explain the process of digitalizing a patient, including the initial dosage, preparation, and administration of the medication, as well as the nursing assessments needed to monitor therapeutic response and digoxin toxicity
Describe safety precautions associated with the preparation and administration of digoxin
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11. Drug Class: Digitalis Glycosides
Drug: digoxin (Lanoxin)
Actions
Positive inotropy
Negative chronotropy
Uses
Treat moderate to severe systolic failure not responding to diuretics and ACE inhibitors
Serious adverse effects
Digoxin toxicity
Always take the apical pulse for 1 full minute before administration; do not administer when heart rate is less than 60.
Maintenance dosing given daily.
Digoxin toxicity related to long half-life. Digoxin immune Fab (ovine) (Digibind) is the antidote.
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12. Drug Class: Phosphodiesterase Inhibitors
Drugs: inamrinone, milrinone (Primacor)
Actions
Increase the force and velocity of myocardial contractions
Uses
Short-term management of systolic dysfunction heart failure in patients not responding adequately to digoxin, diuretics, or vasodilator therapy
Act as vasodilators, reducing preload and afterload.
Both drugs have different common and serious adverse effects.
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13. Drug Class: ACE Inhibitors
Actions
Reduce afterload by blocking angiotensin II-mediated peripheral vasoconstriction; reduce preload
Uses
Treat mild to moderate systolic dysfunction heart failure
See Chapter 23 for further discussion
For specific drugs, see Table 23-5.
Therapeutic outcomes: improved cardiac output with improved tissue perfusion; improved tolerance to exercise.
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14. Drug Class: Beta-Adrenergic Blocking Agents
Actions
Inhibit cardiac response to sympathetic nerve stimulation; inhibit renin release
Uses
In combination with ACE inhibitors to treat heart failure
See Chapter 23 for further discussion
For specific drugs, see Table 13-3.
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15. Drug Class: Natriuretic Peptides
Drug: nesiritide (Natrecor)
Actions
Reduce preload and afterload pressures, increasing diuresis and sodium excretion
Suppress RAAS
Reduce secretion of norepinephrine
Uses
Treat severe heart failure
Natriuretic peptide is a hormone normally secreted by the cardiac ventricles in response to fluid and pressure overload.
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