Pharm 3 Exam: CHF drugs

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Author:
MLBuonarosa
ID:
111569
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Pharm 3 Exam: CHF drugs
Updated:
2011-10-24 05:11:02
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CHF
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Description:
drugs to treat CHF
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  1. Arterial BP
    Cardiac output x peripheral resistance
  2. HTN in US
    • ~ 50 million people affected
    • Most heart failure is because of HTN
  3. Diuretics
    • First line of treatment for HTN
    • Cause diuresis (i.e., urinating)
    • Decreases fluids which decrease periphery resistance
  4. kidney nephrons
    • filters extracellular fluid several times/day
    • all glucose is reabsored
    • water and electrolytes are partially reabsorbed
    • urea is almost all excreted
  5. Action of diuretics
    • decrease reabsorption of sodium and water
    • act on proximal loop, or distal loop or loop of Henle
  6. Side effects of diuretics
    • Hypovolumia (low blood volume which leads to hypotension)
    • Acid-base disturbances
    • Electrolyte inbalance: most concerned with K+ and Mg +2
    • Diuretics are said to be K+ sparing or K+ wasting
  7. Loop diuretics
    • Inhibit electrolye reabsorption in the loop of Henle
    • Can be given in cases of renal output <30 ml/hr
    • Very strong, useful for rapid diuresis
    • temporary increase in blood flow without increase in GFR
  8. furosemide
    • (Lasix)
    • loop diuretic
  9. Uses for diuretics
    • CHF
    • Hepatic disease
    • HTN not response to thiazides
    • pulmonary edema
    • ascites
    • oliguria (100-400 ml/24 hours)
  10. Loop diurectics: ADRs and interactions
    • fluid and electrolyte balance (monitor for hypokalemia)
    • hearing loss with rapid IV push
    • Rate of infusion: 20-40 mg/min
    • Interacts with aminoglycosides ("mycins")
  11. Symptoms of hypokalemia
    • slow bowel
    • dysrythmia
    • muscle weakness
    • dizziness
    • thirst
    • mental confusion
    • *All patients on a K+ wasting diurectic, should be on K+ replacement
  12. Symptoms of hyperkalemia
    • Weakness
    • Paralysis
    • V fib: cause of most sudden death
    • Death
  13. Potassium (K+)
    • Goal: 3.5-5.0 mEq/L
    • If too low, replace with 10 mEq/L IVPB in 50 ml of D5W over one hour.
    • DO NOT PUSH K+ : DEATH RESULTS
    • May replace moderate loss, with PO dose
  14. Hyperkalemia and glucose
    • Hyperglycemia results from inhibition of insulin release
    • With diabetics, monitor blood glucose levels if taking furosemide
    • Administer insulin if necessary
  15. Thiazide diuretics
    • Action: increase excretion of Na, Cl, water, and K
    • act on distal tubule - inhibit Na reabsorption
    • antihypertensive: reduces peripheralvascular resistance
  16. Thiazides and HTN
    #1 for hypertension
  17. hydrochlorothiazide
    • HCTZ
    • HydroDiuril
  18. Thiazide uses
    • HTN, HF
    • edema of early renal disease
    • cirrhosis
    • works best if ouput > 30 ml/hr
    • Takes 1 mth to see full effect
    • Increases effectiveness of other HTN meds by 30-50%
  19. Thiazides diurectics: ADRs
    • Electrolyte imbalances
    • Increase fasting blood glucose levels
    • increase BUN
    • hyperuricemia (uric acid)
    • increased serum cholesterol, triglycerides, LDLs
  20. Thiazide diurectics: interactions
    • digoxin
    • NSAIDs
    • lithium
  21. K+ sparing diurectic
    • Nonselective blocker, blocks aldosterone (aldosterone antagonist): indirectly blocks Na+ uptake and K+ secretion
    • HTN and edema
  22. K+ sparing diurectics: ADRs and patient teaching
    • ADR: hyperkalemia
    • PT: diet, avoid salt substitutes (most have a lot of K+)
  23. spironolactone
    • Aldactone
    • K+ sparing diurectic
  24. Osmotic diurectics
    • Causes an osmotic gradient: water moves from extravascular to intravascular
    • relief of oliguria
    • Increases intracranial pressure and intraoccular pressure
  25. mannitol
    • Osmitrol
    • Osmotic diurectic
  26. Patient monitoring for all diuretics
    • Daily weight: best monitor of fluid balance
    • intake and output
    • edema
    • blood pressure
    • lung sounds

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