NR508 Midterm Study Guide

Midterm Study Guide 1. first-line treatment for Heart Failure (CHF). ( pg 250-254, 273)  **Ace inhibitors **- captopril (capoten), enalpril ( vasotec), lisinopril ( Prinivil or Zestril), ramipril ( altace), trandolapril ( mavik)should be prescribed to all patients with heart failure unless contraindicated  ARB’s- candesartan ( atacand), valsartan( diovan) should be used if ACE inhibitors are intolerant to patient  Beta blockers – bisoprolol ( zebeta), carvediol ( coreg), metroprolol (Lopressor), are the recommended agents ( all patients with stable mild severe HF  Digoxin (lanoxin), hydralazine  Lasix ( furosemide)- fluid overload  Thiazide diuretics (NaCl inhibitors) – hydrochlorthiazide ( hydroDIURIL)  Potassium sparing diuretic- Aldosterone antagonist -spironalctone 9 aldactone), eplerenone (inspra),  It can be used for NYHA stage I or before any onset of HF symptoms. It regresses ventricular hypertrophy, modify cardiac remodeling, and useful for HFpEF and HFrEF. I also wanted to say diuretics based on several articles. Also depends on the co morbities 2. treatment of acute heart failure and pulmonary edema. ( pg 250-254, 25, 37, 249)  Nitrates, diuretics, morphine: Nitroprusside- vasodilator Nesiritride- atrial peptide , vasodilator and diuretic L - loop M - morphine N -nitrates O - oxygen P - positioning IV loop diuretics - Cause venodilation and diuresis - Reduces pre-load IV opiates (e.g. morphine) - Reduce anxiety - Vasodilates, reducing preload - Reduces sympathetic drive - Not routinely offered IV, buccal or sublingual nitrates (Glyceryl trinitrates "GTN") - Reduce preload and afterload - vasodilates Oxygen >> maintains O2 sats (Positioning - keep patient upright)  cardiogenic decreased preload, decrease afterload, inc o2 inc o2 CPAP, BiPAP dec preload nitroglycerin, loop diuretics (furosemide, bumetanide) dec afterload nitroprusside, ACEi/ARB noncardiogenic treat underlying cause, mechanical ventilation 3. side effects of ACE inhibitors and mechanism of action of ACE inhibitors. (pg. 279, 274-275)  side effects- cough (change to an ARB) Angioedema, rash, diaphoresis, angioedema, cough, abdominal pain, leukopenia, myalgia, headache, renal insufficiency. INCREASES creatinine, hyperkalemia, hypotension