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Unit VI Promoting Health in Patients With Circulatory or Perfusion Disorders
Table 30.7 Medications Used in the Treatment of Heart Failure—cont’d
Medication Classification
Mechanism of Action
Exemplars
Nursing Implications
Venous vasodilator (isosorbide dinitrate)
Dilates veins, which reduces blood pressure and reduces preload. This increases cardiac output.
Isosorbide dinitrate (Isordil)
Monitor BP, pulses, level of consciousness. Assess for orthostatic hypotension.
Diuretics: Loop diuretics
Reduce resorption of sodium in the kidney. This increases water excretion. Also cause potassium loss. Reduces preload. Reduce sodium resorption in the kidneys, but not potassium resorption. Cause water loss and potential potassium increases. Reduces preload. Reduce sodium resorption. Increase excretion of water, potassium, and other electrolytes. Reduces preload.
Furosemide (Lasix)
Monitor urine output, daily weights, BP, renal function, and potassium levels. Give last dose by 1400 if possible. Increase fall risk in older adults. Monitor BP, urine output, daily weights, potassium levels, renal function. Increase fall risk in older adults. Monitor BP, urine output, daily weights, renal function, electrolytes (especially potassium). Assess for sulfa allergies. Has cross sensitivity. May increase blood glucose in diabetic patients. Monitor heart rate, BP, cardiac rhythm. Hold for heart rate less than 50. May cause orthostatic hypotension. Monitor BP, HR, daily weight, urine output, and cardiac rhythm.
Aldosterone receptor antagonists (also called mineral corticoid receptor antagonists)
Spironolactone (Aldactone) Eplerenone (Inspra) Hydrochlorothiazide (Oretic)
Thiazide diuretics
Beta blockers
Metoprolol (Lopressor, Toprol)
Block beta 1 -adrenergic receptors in heart. This reduces heart rate and blood pressure.
Inodilators
Increase myocardial contractility. Also cause vasodilation. Reduces afterload and increases contractility. Stimulate beta 1 -adrenergic receptors and dopaminergic receptors in the heart, producing cardiac stimulation and increasing the strength of contraction. Dopamine at high doses can also cause vasoconstriction. Increase glucose and water secretion in the urine. Can be used in patients with or without type 2 diabetes. Increases force of myocardial contraction. Slows SA and AV node conduction.
Milrinone (Primacor)
Inotropes
Dopamine (Inotropin) Dobutamine (Dobutrex)
Monitor BP, HR, cardiac rhythm, daily weights, urine output, pulses, and renal function.
Sodium glucose cotransporter 2 inhibitors (STGLC2i)
Dapagliflozin (Farxiga)
Monitor blood glucose, blood pressure, daily weight, urine output. May increase risk for urinary tract and yeast infections. Monitor heart rate. Hold for heart rate less than 60. Monitor BP and cardiac rhythm. Assess daily weights and urine output. Monitor for signs of toxicity: bradycardia, visual changes, nausea, vomiting, and abdominal pain. Monitor serum digoxin levels (0.5–2 ng/mL) and potassium levels as hypokalemia may precipitate toxicity. May administer digoxin immune Fab (Digibind) for toxicity.
Digitalis glycoside
Digoxin (Lanoxin)
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