A sorbitol b water c an antacid d a laxative question

A. Sorbitol
B. Water
C. An antacid
D. A laxative
Question: Check your knowledge
Which solution should the nurse administer with packed red blood cells?
A. Lactated Ringer’s solution
B. 0.9% sodium chloride
C. D5W
D. 0.45% sodium chloride
Week 5
Chapter 25
Heart Failure Drugs
Heart Failure (cont.)
● One of the most common causes for hospitalization in Canada
● 5 000 annual deaths from heart failure

● 5-year survival rate in those with heart failure is 50%.
● Prevention is key.
Heart 
Failure
Notes
- There are two types of heart failure
* The heart is unable to pump blood in sufficient amounts from the ventricles to meet the
body’s metabolic needs
* Symptoms depend on cardiac area affected
- Left ventricular failure—elevated left ventricular pressure produces pulmonary edema
(pulmonary congestion) resulting in cough, SOB & air hunger
- Right ventricular failure—elevated right ventricular pressure leads to venous
congestion & peripheral edema i.e. edema of the ankles, jugular venous distention,
ascites (abd distention) & hepatic congestion
Heart Failure: Causes
Cardiac defect
● MI
● Valve deficiency
Defect outside the heart
● Coronary artery disease
● Pulmonary hypertension
● Diabetes
Supraventricular dysrhythmias
● Atrial fibrillation :
● Atrial flutter
Conduction System of the Heart

The New York Association’s Classification of Heart Failure
Class I
● No physical activity limitations
Class II
● Ordinary physical activity results in fatigue, dyspnea, or other symptoms.
Class III
● Marked limitation in physical activity
Class IV
● Symptoms at rest or with no physical activity at all
Drug Therapy for Heart Failure
● Positive inotropic drugs: increase the force of myocardial contraction
● Positive chronotropic drugs: increase heart rate
● Positive dromotropic drugs: accelerate cardiac conduction (electrical impulse)
Drug Therapy for Heart Failure (cont.)
Positive inotropic drugs
● Phosphodiesterase inhibitors
● Cardiac glycosides
● B-type natriuretic (increase the heart contraction ) peptides
Other drugs used in heart failure
● ACE-inhibitors
● Angiotensin II receptor blockers (ARBs)
● ß-Blockers
● Diuretics (removes the volume)
Drugs of Choice for Early Treatment of Heart Failure
● ACE Inhibitors (first)
● ARBs (second)
● Certain ß-blockers (bisoprolol, extended-release metoprolol tartrate, and carvedilol)
Drugs of Choice for Early Treatment of Heart Failure

● Loop diuretics (furosemide ) are used to reduce the symptoms of heart failure
secondary to fluid overload.
● Aldosterone inhibitors ( spironolactone, eplerenone ) are added as heart failure
progresses.
● Only after these drugs are used is digoxin added.
Drugs of Choice for Early Treatment of Heart Failure
● dobutamine: positive inotropic drug
● hydralazine/isosorbide dinitrate recommended specifically for use in Black
patients
ACE Inhibitors
● Prevent sodium and water resorption by inhibiting aldosterone secretion
● Diuresis results, which decreases preload, or the left ventricular end volume, and the
work of the heart
● Examples: lisinopril, enalapril
lisinopril (Prinivil®, Zestril®)
● Uses: hypertension, heart failure, and acute myocardial infarction
Adverse Effects:
● Hyperkalemia
● Dry cough
● Decreased renal function
Angiotensin II Receptor Blockers
● Potent vasodilators; decrease systemic vascular resistance (↓afterload)
● Used alone or in combination with other drugs such as diuretics in the treatment of
hypertension or heart failure