DRUGS THAT TREAT HEART FAILURE

Heart failure develops when the heart muscles fails to pump effectively and
sufficient blood does not circulate to the lungs and body tissue

Cardio Inotropic agents drug of choice with heart failure

Increase tonicity of heart muscles and increase the force to contract which
improved the heart pumping and distribution

Heart failure is classified as follows:

Left-sided failure is due to ventricular muscle damage or fluid overload that
reduces cardiac output; the heart is unable to pump blood returned from the lungs.
(DOB, frothy odor smelling)
Right-sided failure is due to pulmonary hypertension; the heart is unable to
accommodate blood returned to it from the systemic veins. (Edema)

* Most client develop both L & R sided heart failure but not left-sided failure. Hindi pwede
na left sided lang. Most common na ga compensate is right side.

DOC: Digitalis Glycosides/Cardiac Glycosides

Overview: Digitalis glycosides are also called cardiac glycosides. Digitalis is
produced from plants. These drugs are called glycosides because they contain a
sugar molecule, which is attached to a steroid nucleus.
Digitalis glycosides slows ventricular contraction will increase force if contraction
if increase force of contraction, there will be increase stroke volume and cardiac
output.
Uses
CHF (Congestive Heart Failure)

Adverse Effects
Cardiac symptoms
Gastrointestinal symptoms
Neurologic symptoms
Visual disturbances
Life-threatening digitalis
Precautions
1. Digitalis preparations should be administered with caution to:
2. Intravenous digitalis should be administered cautiously
3. Digitalis preparations are contraindicated for clients with
4. Predisposing factors for the development of digitalis toxicity include the following
5. Administer a loading dose of cardiac glycosides if ordered.
6. Administer digitalis glycosides at the same time every day.
7. Monitor the clients apical heart rate for one full minute prior to administering the
drug, and record the heart rate and rhythm.
8. Administer digitalis glycosides if possible.
 9. Slowly administer intravenous cardiac glycosides.
10. Assess client for signs and symptoms of digitalis toxicity.
11. Assess serum digitalis levels. Immediately report high serum levels to the primary
care provider.
12. Take and record daily weight.
13. Schedule regular appointments with the primary care provider for evaluation of the
clients heart failure and reaction to the digitalis glycosides.
Client Education
1. Take the medication exactly as ordered
2. Take the daily dosage when fully awake
3. Take pulse for one full minute before taking digitalis glycosides
4. Contact primary care provider if the pulse rate is irregular
5. Immediately report signs of digitalis toxicity to the health care provider
6. Avoid taking antacids of antidiarrheals within two hours of taking digitalis
glycosides
7. Consult with the health care provider before taking any OTC
8. Schedule regular follow-up appointment with the health care provider

Other Cardiotonic Inotropic Drugs

Important Drugs
Amrinone (Inocor)
Milrinone (Primacor)

DRUGS THAT TREAT ANGINA

These are four major types of angina:

1. Stable angina
2. Unstable angina
3. Variant (Prinzmetals) angina
4. Refractory (intractable) angina

Organic Nitrates
Overview: Organic nitrates are the first line of defense in the prevention and
treatment of angina. These agents relax smooth muscles in the blood vessel walls, and
thus, help to stop the pain of angina attacks.

Uses
Acute Angina
Adverse Effects
Pounding or pulsating headache
Hypotension
Dizziness and weakness
Syncope
Nausea and vomiting
 Facial flushing
Chronic angina

Acute and chronic heart failure

Precautions
1. Organic nitrates are contraindicated for clients who are hypertensive to nitrates,
clients with severe anemia, and clients with head trauma.
2. Nitrates should not be given IV to clients with severe hypotension or hypovolemia
3. Clients taking nitrates should avoid alcohol and other vasodilators without
obtaining the permission of the primary care provider.

Important Dugs
1. NTG (Nitroglycerin) (Nitro-Bid, Nitrostat, Nitrodisc, Nitrogard, Nitro-Dur)
2. Pentaerythritol tetranitrate (Peritrate)

Therapeutic Nursing Interventions

1. Assess the client for signs of coronary artery disease, and ask the client to describe
the angina attacks.
2. Advise the client to call a health care professional when an angina attack occurs
3. Assess the clients ability to apply and remove NTG (Nitroglycerin) patches of
ointment
4. Monitor the clients apical pulse and rate, quality and the blood pressure for
hypertension or hypotension
5. Teach the client how to accurately take his or her own blood pressure and pulse
6. Check the client for skin irritational if NTG (Nitroglycerin) patches are used
7. Assess the client for facial flushing and other side effects of NTG (Nitroglycerin)
8. Use care when mixing NTG (nitroglycerin) with D5W or normal saline solution for
an IV infusion
9. Assess the clients BP and pulse every minutes after starting the IV
10. Use an IV pump and titrate the dose every 3-5 minutes, using the clients level of
pain, BP, and pulse as your guide
11. Wean the client gradually from IV NTG (nitroglycerin) as ordered

Client Education
1. When taking organic nitrates:
2. Store NTG (nitroglycerin) tablets away from light, heat, and moisture
3. Rise from a lying position and change positions
4. Dangle legs for a couple of minutes when getting out of bed
5. Notify the primary care provider if NTG (nitroglycerin) produces a severe headache
that lasts more than 15-29 minutes
6. Do not drink alcohol after taking NTG (nitroglycerin)
7. Spray NTG (nitroglycerin) lingual aerosol onto or under the tongue
8. Use the special application paper supplied by the manufacturer when applying
NTG (nitroglycerin) paste to the skin
 9. Prevent angina attacks by taking NTG (nitroglycerin) around 5-10 minutes prior to
moderate physical or sexual activity
10. Avoid strenuous physical exercise, emotional stress, and cold
11. Stop smoking because nicotine acts as a vasoconstrictor
12. Carry an identification card at all times that outlines the medication regimen and
states your primary care providers name and telephone number
13. Notify dentists and other health care professionals of the NTG (nitroglycerin)
medication regimen
14. Schedule regular follow-up appointments with PCP

BETA-ADRENERGIC BLOCKERS
Beta-adrenergic blocking agents at to interrupt adrenergic stimulation to beta 1 or
beta 2 receptors by competing with norepinephrine for available beta- adrenergic
receptor sites.

Uses
Chronic stable angina
Dysrhythmias
Hypertension
Myocardial Infarction
Important Drugs
1. Propranolol hydrochloride (Inderal)
2. Atenolol (Tenormin)
3. Pindolol (Visken)
Therapeutic Nursing Interventions
1. Assess the client for signs of coronary artery disease
2. Inquire about the clients current use of beta-blockers
3. Obtain a baseline weight before starting the administration of beta-blockers
4. Check the clients pulse rate before administration
5. Monitor the clients BP
Client Education
1. Learn to take own pulse and blood pressure
2. Learn to monitor blood sugar level for low blood sugar
3. Change positions slowly to prevent orthostatic hypotension
4. Never stop medication abruptly
5. Take beta-blockers at the same time each day
6. Avoid taking beta-blockers with antacids
7. Avoid taking beta-blockers and over the counter drugs at the same time
8. Avoid prolonged exposure to the sun
Important Drugs
Verapamil hydrochloride (Calan)
Nifedipine (Procardia)
Diltiazem hydrochloride (Cardizem)
Amlodipine (Norvasc)
Nicardipine hydrochloride (Cardene SR)
Calcium Channel Blockers
Calcium Channel Blockers act to:
Prevent the flow of calcium ions into the cells
Relax arterial smooth muscle and decrease contraction of the heart muscles
Slow AV (atrioventricular) conduction
Reduce the heart rate
Dilate coronary and peripheral arteries
Decrease coronary vascular resistance
Increase coronary blood flow