Adverse effects of ACEi & ARBs
- *azotemia (hi BUN level)
According to Cr lab result, when should ARB be discontinued?
If creatinine rises 50% or goes over 3mg/dL
What drug combo can be used in place of ARBs or ACEi?
- hydralazine (vasodilator) & isosorbide (nitrate)
- hydralazine- prevents tolerance effects of nitrate & nitrate enhances the effect of hydralazine
Which beta blockers are approved for LVSD (left ventricular systolic dysfunction)?
carvedilol, metoprolol succinate, bisoprolol
How do beta blockers work?
Block epinephrine & norepinephrine receptors- which lowers HR, BP and myocardial consumption that would otherwise worsen HF
How should beta blocker be administered if pt. is euvolemic?
Should be initiated & titrated up over time to target dosage
How are aldosterone antagonists used to treat LVSD (left ventricular systolic disease)?
- These are potassium-sparing diuretics that prevent the buildup of sodium in the body (which leads to fluid retention)
- They do this by competing for aldosterone-dependent sodium-potassium exchange sites in the distal tubule cells, ridding the body of Na+ and H2O while sparing K+
- **Watch for hyperkalemia & elevated Cr level
List essential nursing considerations for patients using ACE inhibitors
- Monitor BP, UO, & lyte levels
- Monitor serum & urine Cr levels
- Monitor for development of cough
- Teach pt to change positions gradually & report dizziness a/o lethargy
- Instruct pt to weigh himself and report rapid wt gain (>3 lbs/d or >5 lbs/wk)
Which type of diuretic is preferred for treating HF pt with fluid overload?
- Loop diuretic.
- E.g: furosemide, bumetanide, torsemide
Adverse effects of loop diuretics
- Diminished hearing/ hearing loss
- kidney dysfunction
- lyte imbalances
- volume depletion
- ventricular arrhythmias
In decompensated pts which type of diuretic should be administered with loop diuretics? and when, in relation to loop?
Thizaide diuretics should be administered 1/2 hour before loop for best poss synergy
When is Nesiritide prescribed for HF?
When the standard thereapy isnt working and more aggressive measures need to be taken. Nesiritide is a natriuretic and balanced vasodilator- acts to offload fluid & pressure from the heart and lungs while diuresing and natriuresing (excreting excessive amounts of sodium) the patient.
How does milrinone help HF?
It is an inodilator that is a balanced vasodilator & has a positive inotropic effect (increases the strength of muscle contractility).
Why is dobutamine prescribed for HF?
It is a synthetic catecholamine-like epinephrine used for refractory decompensated HF and often for cardiogenic shock.
What are implications of long term use of dobutamine & milrinone?
They increase mortality. AE: thrombocytopenia, increase in myocardial oxygen demand & arrhythmias, and both carry the risk of ventricular arrhythmias.
How does digoxin improve cardiac function?
- *increases the force of myocardial contraction
- *slows cardiac conduction through the AV node& slows ventricular rate in instances of supraventricular dysrhythmias
- *increases cardiac output by enhancing force of ventricular contraction
- *promotes diuresis by increasing cardiac output
How is levodopa used to treat parkinsons?
Levodopa is prescribed as a mainstay treatment for PD. Most symptoms of PD are related to a lack of dopamine in the brain. Levodopa has the ability to to reach brain cells where it's converted to dopamine and becomes available for use.
Why is carbidopa prescribed with levodopa?
Carbidopa alone doesnt improve PD symptoms, but when combined with Levodopa, it allows Levodopa to work more effectively with less dosage. It also helps prevent nausea. Carbidopa does this by preventing peripheral breakdown of Levodopa- allowing more of it to reach the brain.
What are typical dosage schedules for carbidopa & levodopa?
Schedules vary depending on the stage of the disease. The effectiveness tends to decrease as the disease progresses. The medication helps alleviate symptoms such as rigidity, tremor & bradykinesia. Pt may still experience postural instability, altered speech, constipation and depression.