Heart Failure Drugs (Ch. 22, 24, 28)
- Watch videos/study guide/blueprint.
- TB
- Dynamic quizzes
Intro
-Hypertension is a chronic condition characterized by elevated blood pressure,
which increases the risk of cardiovascular and renal complications such as
stroke, heart attack, heart failure, and kidney disease
-Antihypertensive drugs are medications that lower blood pressure by acting on
different targets in the cardiovascular system, such as receptors, enzymes,
hormones, or ion channels
-Cardiovascular medications are drugs that treat various disorders of the heart
and blood vessels, such as angina, arrhythmias, heart failure, and hyperlipidemia
-The choice of medication depends on the type and severity of the condition, the
patient’s characteristics and preferences, and the potential benefits and risks of
each drug
Medications for hypertension management
Adrenergic drugs: These drugs act on the sympathetic nervous system, which
regulates blood pressure by controlling heart rate, cardiac output, vascular tone,
and renin release. They include beta blockers, alpha blockers, centrally acting
alpha 2 agonists, adrenergic neuron blockers, and alpha 1 and beta 1 blockers.
Direct acting vasodilators: These drugs relax the smooth muscle of the blood
vessels, causing them to widen and lower blood pressure. They include
hydralazine, minoxidil, nitroprusside, and diazoxide.
Angiotensin-converting enzyme (ACE) inhibitors: These drugs inhibit the
enzyme that converts angiotensin I to angiotensin II, a potent vasoconstrictor
and stimulator of aldosterone secretion. They include captopril, enalapril,
lisinopril, ramipril, and others with the suffix -pril.
Angiotensin II receptor blockers (ARBs): These drugs block the binding of
angiotensin II to its receptors on blood vessels and adrenal glands, preventing its
vasoconstrictive and aldosterone-stimulating effects. They include losartan,
valsartan, candesartan, irbesartan, and others with the suffix -sartan.
Calcium channel blockers: These drugs block the entry of calcium into cardiac
and vascular smooth muscle cells, reducing their contractility and causing
vasodilation. They include verapamil, diltiazem, nifedipine, amlodipine, felodipine,
and others with the suffix -dipine.
1.
Diuretics: These drugs increase the excretion of water and sodium by the
kidneys, reducing blood volume and blood pressure. They include thiazide
diuretics (hydrochlorothiazide), loop diuretics (furosemide), potassium-
sparing diuretics (spironolactone), osmotic diuretics (mannitol), and
carbonic anhydrase inhibitors (acetazolamide).
2. Direct renin inhibitors: These drugs inhibit renin, an enzyme that catalyzes
the first step in the renin-angiotensin-aldosterone system (RAAS), which
regulates blood pressure and fluid balance. They include aliskiren.
Category
Common side effects
Nursing implications
Adrenergic
drugs
Hypotension,
Monitor vital signs and labs; do not abruptly stop
beta blockers; teach patients to change
bradycardia, dizziness,
fatigue, insomnia,
edema
positions slowly; avoid alcohol
Direct acting
vasodilators
Hypotension, reflex
tachycardia,
headache, flushing
ACE inhibitors Dry cough;
hyperkalemia;
angioedema; rash;
hypotension
Monitor vital signs; administer with beta blockers
or diuretics to prevent reflex tachycardia; teach
patients to report chest pain or palpitations
Monitor vital signs; monitor potassium levels;
teach patients to report swelling of face or
throat; avoid salt substitutes
ARBs
Dizziness; headache;
hypotension;
hyperkalemia;
angioedema
Monitor vital signs; monitor potassium levels;
teach patients to report swelling of face or
throat; avoid salt substitutes
Calcium
channel
blockers
Hypotension;
bradycardia;
headache; flushing;
edema
Monitor vital signs; monitor for signs of heart
failure; teach patients to report chest pain or
dyspnea; avoid grapefruit juice
Diuretics
Hypotension;
Monitor vital signs; monitor fluid and electrolyte
dehydration;
electrolyte imbalance;
polyuria
status; teach patients to weigh themselves daily
and report weight gain or loss; teach patients to
take diuretics in the morning
Direct renin
Diarrhea; cough;
Monitor vital signs; monitor potassium levels;
inhibitors
angioedema;
hyperkalemia
teach patients to report swelling of face or
throat
Medications for angina
The medications used to treat angina are aimed at relieving the pain, improving
blood flow, and preventing complications.
Nitrates: These drugs dilate the coronary arteries and peripheral veins, reducing
the oxygen demand and increasing the oxygen supply to the heart. They include
nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate. They can be
administered sublingually, orally, transdermally, or intravenously.
Beta blockers: These drugs decrease the heart rate, contractility, and blood
pressure, reducing the oxygen demand of the heart. They include propranolol,
metoprolol, atenolol, and others with the suffix -olol. They are usually taken orally
or intravenously.
Calcium channel blockers: These drugs dilate the coronary arteries and
peripheral arterioles, increasing the oxygen supply and reducing the oxygen
demand of the heart. They include verapamil, diltiazem, nifedipine, amlodipine,
and others with the suffix -dipine. They are usually taken orally or intravenously.
Antiplatelet drugs: These drugs inhibit platelet aggregation and prevent
thrombus formation in the coronary arteries. They include aspirin, clopidogrel,
ticagrelor, and prasugrel. They are usually taken orally.
Anticoagulant drugs: These drugs prevent clotting factors from forming clots in
the blood vessels. They include heparin, enoxaparin, warfarin, dabigatran,
rivaroxaban, and apixaban. They can be administered subcutaneously,
intravenously, or orally.
Category
Common side
effects
Nursing implications
Nitrates
Headache;
hypotension; reflex
tachycardia;
flushing
Monitor vital signs; teach patients to sit or lie down
when taking nitrates; teach patients to store nitrates
in a dark container and replace them every 6
months; teach patients to take one nitroglycerin
tablet sublingually every 5 minutes for up to three
doses if angina occurs
Beta blockers
Hypotension;
bradycardia;
fatigue; dizziness;
depression
Monitor vital signs and labs; do not abruptly stop
beta blockers; teach patients to change positions
slowly; avoid alcohol
Calcium
Hypotension;
Monitor vital signs; monitor for signs of heart failure;
channel
blockers
bradycardia;
headache;
flushing; edema
teach patients to report chest pain or dyspnea;
avoid grapefruit juice
Antiplatelet
drugs
Bleeding; bruising;
gastrointestinal
Monitor for signs of bleeding; teach patients to
upset
Anticoagulant Bleeding; bruising;
drugs
hematoma;
anemia
report any unusual bleeding or bruising; teach
patients to avoid nonsteroidal anti-inflammatory
drugs (NSAIDs) and alcohol
Monitor for signs of bleeding; monitor labs such as
prothrombin time (PT), international normalized
ratio (INR), and activated partial thromboplastin
time (aPTT); teach patients to report any unusual
bleeding or bruising; teach patients to avoid foods
high in vitamin K if taking warfarin
Medications for arrhythmias
Arrhythmias can be classified into bradyarrhythmias, which are slow heart
rhythms (<60 beats per minute), and tachyarrhythmias, which are fast heart
rhythms (>100 beats per minute).
The medications used to treat arrhythmias are aimed at restoring normal sinus
rhythm, controlling the heart rate, and preventing complications such as stroke
or cardiac arrest.
Sodium channel blockers: These drugs block the sodium channels in the cardiac
cells, slowing down the conduction of electrical impulses and prolonging the
refractory period. They include quinidine, procainamide, lidocaine, and flecainide.
They are usually administered orally or intravenously.
Beta blockers: These drugs decrease the heart rate, contractility, and conduction
velocity by blocking the beta receptors in the cardiac cells. They include
propranolol, metoprolol, atenolol, and others with the suffix -olol. They are usually
taken orally or intravenously.
Potassium channel blockers: These drugs block the potassium channels in the
cardiac cells, prolonging the action potential and refractory period. They include
amiodarone, sotalol, dofetilide, and ibutilide. They are usually administered orally
or intravenously.
Calcium channel blockers: These drugs block the calcium channels in the
cardiac cells, slowing down the conduction velocity and reducing the
automaticity. They include verapamil, diltiazem, and others with the suffix -dipine.
They are usually taken orally or intravenously.
Adenosine: This drug activates the adenosine receptors in the cardiac cells,
slowing down the conduction velocity and reducing the automaticity. It is used to
treat supraventricular tachycardia (SVT). It is administered intravenously as a
rapid bolus injection.
Digoxin: This drug inhibits the sodium-potassium ATPase pump in the cardiac
cells, increasing the intracellular calcium and enhancing contractility. It also has
a vagal effect that slows down the conduction velocity and reduces the
automaticity. It is used to treat atrial fibrillation (AF) and heart failure. It is
administered orally or intravenously.
Category
Common side effects
Nursing implications
Sodium
channel
blockers
Hypotension; bradycardia;
dizziness; nausea; vomiting;
diarrhea; arrhythmias
Monitor vital signs and electrocardiogram (ECG);
monitor labs such as serum drug levels and liver
function tests; teach patients to report any signs
of toxicity such as blurred vision, tinnitus, or
confusion
Beta
blockers
Hypotension; bradycardia;
fatigue; dizziness;
Monitor vital signs and ECG; monitor labs such as
serum drug levels and renal function tests; do not
depression
abruptly stop beta blockers; teach patients to
change positions slowly; avoid alcohol
Hypotension; bradycardia;
dizziness; nausea; vomiting;
arrhythmias; pulmonary
Monitor vital signs and ECG; monitor labs such as
serum drug levels, thyroid function tests, and
pulmonary function tests; teach patients to report
toxicity; thyroid dysfunction
any signs of toxicity such as dyspnea, cough, or
weight gain
Calcium
channel
blockers
Hypotension; bradycardia;
headache; flushing; edema
Monitor vital signs and ECG; monitor for signs of
heart failure; teach patients to report chest pain
Adenosine
Flushing; chest pain;
dyspnea; hypotension;
bradycardia
Potassium
channel
blockers
or dyspnea; avoid grapefruit juice
Monitor vital signs and ECG; administer as a rapid
bolus injection followed by a saline flush; teach
patients to expect transient side effects
Digoxin
Nausea; vomiting; anorexia;
bradycardia; arrhythmias;
Monitor vital signs and ECG; monitor labs such as
serum digoxin levels and potassium levels; teach
visual disturbances
patients to report any signs of toxicity such as
yellow-green halos, blurred vision, or confusion
Medications for heart failure
The medications used to treat heart failure are aimed at improving the cardiac
function, reducing the preload and afterload, and preventing complications such
as arrhythmias and thromboembolism.
Diuretics: These drugs increase the excretion of water and sodium by the
kidneys, reducing the blood volume and the preload on the heart. They include
thiazide diuretics (hydrochlorothiazide), loop diuretics (furosemide), potassiumsparing diuretics (spironolactone), osmotic diuretics (mannitol), and carbonic
anhydrase inhibitors (acetazolamide).
ACE inhibitors: These drugs inhibit the enzyme that converts angiotensin I to
angiotensin II, a potent vasoconstrictor and stimulator of aldosterone secretion.
They reduce the afterload on the heart by dilating the blood vessels and prevent
the remodeling of the cardiac tissue by inhibiting the growth factors. They
include captopril, enalapril, lisinopril, ramipril, and others with the suffix -pril.
ARBs: These drugs block the binding of angiotensin II to its receptors on blood
vessels and adrenal glands, preventing its vasoconstrictive and aldosteronestimulating effects. They reduce the afterload on the heart by dilating the blood
vessels and prevent the remodeling of the cardiac tissue by inhibiting the growth
factors. They include losartan, valsartan, candesartan, irbesartan, and others with
the suffix -sartan.
Beta blockers: These drugs decrease the heart rate, contractility, and blood
pressure by blocking the beta receptors in the cardiac cells. They reduce the
oxygen demand of the heart and prevent the activation of the sympathetic
nervous system, which can worsen heart failure. They include carvedilol,
metoprolol, bisoprolol, and others with the suffix -olol.
Digoxin: This drug inhibits the sodium-potassium ATPase pump in the cardiac
cells, increasing the intracellular calcium and enhancing the contractility. It also
has a vagal effect that slows down the conduction velocity and reduces the
automaticity. It is used to treat atrial fibrillation and heart failure. It is
administered orally or intravenously.
Vasodilators: These drugs dilate the blood vessels, reducing the preload and
afterload on the heart. They include nitroglycerin, hydralazine, isosorbide
dinitrate, and nitroprusside. They can be administered sublingually, orally,
transdermally, or intravenously.
Inotropic agents: These drugs increase the force of contraction of the heart
muscle, improving the cardiac output and tissue perfusion. They include
dobutamine, dopamine, and milrinone. They are administered intravenously.
Anticoagulant and antiplatelet drugs: These drugs prevent clotting factors from
forming clots in the blood vessels and inhibit platelet aggregation, reducing the
risk of thromboembolism in patients with heart failure. They include heparin,
enoxaparin, warfarin, dabigatran, rivaroxaban, apixaban, aspirin, clopidogrel,
ticagrelor, and prasugrel. They can be administered subcutaneously,
intravenously, or orally.
Category
Common side
effects
Nursing implications
Diuretics
Hypotension;
dehydration;
electrolyte
imbalance; polyuria
Monitor vital signs; monitor fluid and electrolyte
status; teach patients to weigh themselves daily and
report weight gain or loss; teach patients to take
diuretics in the morning
ACE inhibitors
Dry cough;
Monitor vital signs; monitor potassium levels; teach
patients to report swelling of face or throat; avoid salt
substitutes
hyperkalemia;
angioedema; rash;
hypotension
ARBs
Dizziness; headache;
hypotension;
hyperkalemia;
Monitor vital signs; monitor potassium levels; teach
patients to report swelling of face or throat; avoid salt
substitutes
angioedema
Beta blockers
Hypotension;
Monitor vital signs and labs; do not abruptly stop beta
bradycardia; fatigue; blockers; teach patients to change positions slowly;
dizziness; depression avoid alcohol
Digoxin
Nausea; vomiting;
anorexia;
bradycardia;
arrhythmias; visual
disturbances
Monitor vital signs and ECG; monitor labs such as
serum digoxin levels and potassium levels; teach
Hypotension; reflex
tachycardia;
Monitor vital signs; administer with beta blockers or
diuretics to prevent reflex tachycardia; teach patients
headache; flushing
to report chest pain or palpitations
Vasodilators
patients to report any signs of toxicity such as yellowgreen halos, blurred vision, or confusion
Inotropic
agents
Anticoagulant
and
antiplatelet
drugs
Hypotension;
tachycardia;
arrhythmias; chest
pain
Monitor vital signs and ECG; monitor labs such as
serum drug levels and renal function tests; teach
Bleeding; bruising;
hematoma; anemia
Monitor for signs of bleeding; monitor labs such as
prothrombin time (PT), international normalized ratio
(INR), and activated partial thromboplastin time
(aPTT); teach patients to report any unusual bleeding
or bruising; teach patients to avoid foods high in
vitamin K if taking warfarin
patients to report any signs of chest pain or
palpitations
Questions
A nurse is screening a male client for hypertension. The nurse should identify
that which of the following actions by the client increase his risk for
hypertension? (Select all that apply.)
A. Drinking 8 oz nonfat milk daily.
B. Eating popcorn at the movie theater.
C. Walking 1 mile daily at 12 min/mile pace.
D. Consuming 36 oz beer daily.
E. Eating a diet high in sodium.
A nurse is teaching a middle-age client about hypertension. Which of the
following information should the nurse include in the teaching?
A. “Reaching your goal blood pressure will occur within 2 months.”
B. “Diuretics are the first type of medication to control hypertension.”
C. “Limit your alcohol consumption to three drinks a day.”
D. “Hypertension can be cured with medication.”
A nurse is screening a male client for hypertension. The nurse should identify
that which of the following actions by the client increase his risk for
hypertension? (Select one).
A. Drinking 8 oz nonfat milk daily.
B. Eating popcorn at the movie theater.
C. Walking 1 mile daily at 12 min/mile pace.
D. Consuming 36 oz beer daily.
A client with hypertension is prescribed hydrochlorothiazide (HCTZ). Which of
the following statements by the client indicates an understanding of the
medication?
A. “I will take this medication at bedtime.”
B. “I will stop taking this medication if my blood pressure becomes normal.”
C. “I will report any signs of a persistent cough.”
D. “I will take this medication only when I have symptoms of high blood
pressure.”.
E. None of the above
A nurse is caring for a client who is receiving nitroprusside for hypertensive
crisis. Which of the following findings should indicate to the nurse that the
client is experiencing an adverse effect of this medication?
A. Hypotension
B. Bradycardia
C. Tachycardia
D. Hypertension.
A nurse is teaching a client who has stable angina about the use of sublingual
nitroglycerin. Which of the following statements by the client indicates a need
for further teaching?
A. “I should keep the tablets in a dark, glass bottle.”
B. “I should take one tablet every 5 minutes for up to three doses if I have chest
pain.”
C. “I should swallow the tablet with a glass of water.”
D. “I should replace the tablets every 6 months.”.
A nurse is administering aspirin to a client who has angina and is at risk for
myocardial infarction. Which of the following statements by the nurse explains
the rationale for this medication?
A. “Aspirin will help lower your blood pressure and reduce your cardiac
workload.”
B. “Aspirin will help prevent blood clots from forming in your coronary
arteries.”
C. “Aspirin will help dilate your coronary arteries and increase blood flow to your
heart.”
D. “Aspirin will help reduce inflammation and pain in your chest.”.
A nurse is monitoring a client who is receiving intravenous heparin for angina
and has a history of atrial fibrillation. Which of the following laboratory tests
should the nurse use to evaluate the effectiveness of heparin therapy?
A. Prothrombin time (PT)
B. International normalized ratio (INR)
C. Activated partial thromboplastin time (aPTT)
D. Platelet count. 0%
A nurse is caring for a client who is prescribed quinidine for the treatment of
arrhythmias. Which of the following should the nurse monitor for as an adverse
effect of this medication?
A. Hypertension
B. Hypoglycemia
C. Hypokalemia
D. Hypernatremia.
A nurse is caring for a client who is prescribed amiodarone for the treatment of
arrhythmias. Which of the following should the nurse monitor for as an adverse
effect of this medication? (Select all that apply)
A. Bradycardia
B. Hypotension
C. Photosensitivity
D. Pulmonary toxicity
E. Thyroid dysfunction.
A nurse is caring for a client who is prescribed lidocaine for the treatment of
arrhythmias. Which of the following should the nurse monitor for as an adverse
effect of this medication?
A. “I feel dizzy”
B. “My mouth feels dry”
C. “My urine is dark”
D. “I have a headache”.
A client who has been prescribed propranolol for the treatment of arrhythmias
reports experiencing shortness of breath and difficulty breathing while lying
down at night. Which of the following should the nurse instruct the client to do?
A. Sleep with an extra pillow under their head
B. Sleep on their left side
C. Sleep on their right side
D. Sleep on their back.
A nurse is caring for a client who is prescribed verapamil for the treatment of
arrhythmias. Which of the following should the nurse monitor for as an adverse
effect of this medication?
A. Hypertension
B. Hyperkalemia
C. Hypoglycemia
D. Constipation.
A nurse is caring for a client with heart failure who is receiving furosemide
(Lasix). Which of the following findings should indicate to the nurse that the
medication is effective?
A. Increased urine output
B. Decreased blood pressure
C. Increased heart rate
D. Decreased respiratory rate.
A nurse is caring for a client who has heart failure and is receiving
spironolactone (Aldactone). Which of the following findings should indicate to
the nurse that the client is experiencing an adverse effect of this medication?
(Select all that apply)
A. Hyperkalemia
B. Hypokalemia
C. Gynecomastia
D. Menorrhagia
E. Impotence.
A client who has heart failure tells the nurse, “I have been taking my
furosemide as prescribed, but I still feel short of breath.” Which of the following
statements should the nurse make?
A. “You should increase your intake of foods high in potassium.”
B. “You should decrease your intake of fluids.”
C. “You should notify your provider if you experience weight gain.”
D. “You should take your medication with food.”.
A nurse is caring for a client who has heart failure and is receiving captopril
(Capoten). Which of the following statements by the client indicates an
understanding of the medication?
A. “I will take this medication with food.”
B. “I will avoid foods high in potassium.”
C. “I will report any persistent cough to my provider.”
D. “I will take this medication at bedtime.”.
A nurse is caring for a client who has heart failure and is receiving lisinopril
(Zestril). Which of the following findings should indicate to the nurse that the
medication is effective?
A. Decreased blood pressure
B. Increased urine output
C. Increased heart rate
D. Decreased respiratory rate.
A nurse is caring for a client who has hypertension and is prescribed
metoprolol, a beta blocker. The nurse should monitor the client for which of the
following adverse effects?
A. Tachycardia
B. Hyperglycemia
C. Bronchospasm
D. Hyperkalemia.
A nurse is teaching a client who has hypertension and is prescribed nifedipine,
a calcium channel blocker, about self-care measures. Which of the following
instructions should the nurse include? (Select all that apply.)
A. Avoid drinking alcohol while taking this medication.
B. Monitor your blood pressure and pulse regularly.
C. Report any swelling in your ankles or feet to your provider.
D. Do not stop taking this medication abruptly.
E. Chew or crush the sustained-release tablet for faster action.
Which drug blocks the binding of angiotensin II to its receptors on blood vessels
and adrenal glands, preventing its vasoconstrictive and aldosteronestimulating effects?
A. Beta blockers
B. Calcium channel blockers
C. Angiotensin II receptor blockers (ARBs)
D. Direct acting vasodilators.
Quizlets
https://quizlet.com/104622637/ch-22-antihypertensive-drugs-flashcards/
https://quizlet.com/719515368/lilley-ch-24-flash-cards/
https://quizlet.com/173207450/chapter-24-heart-failure-drugs-flashcards/
https://quizlet.com/483035045/pharmacology-ch-28-diuretic-drugsflash-cards/
https://quizlet.com/509648487/pharm-chapter-28-diuretic-drugs-flashcards/