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Cardiac Glycosides
  • Digitalis preparations, such as digoxin (Lanoxin)
  • Action: Strengthen cardiac force and efficiency; Slow heart rate; Increase circulation, effecting diuresis
  • Nursing Interventions: apical pulse to ensure rate greater than 60; monitor for toxicity (nausea, vomiting, anorexia, dysrhythmia, bradycardia, tachycardia, headache, fatigue, and blurred or colored vision)
Diuretics: Thiazides
  • Thiazides, such as chlorothiazide (Diuril), hydrochlorothiazide (Esidrix, Hyrdodiuril)
  • Action: Incrase renal secretion of sodium; are safe for long-term use; block sodium and water reabsorption in kidney tubules
  • Nursing Interventions: Monitor electrolyte depletion; weigh daily to ascertain fluid loss
Diuretics: Sulfonamides
  • Sulfonamides (Loop diuretic), such as furosemide (Lasix), bumetanide (Bumex)
  • Action: Act rapidly for less responsive edema
  • Nursing Interventions: Administer in AM to prevent nocturia; monitor for electrolyte depletion; Consider sulfa allergy (furosemide)
Diuretics: Aldosterone Antagonist
  • Aldosterone antagonist (potassium-sparing), such as spironolactone (Aldactone)
  • Action: Relieves edema and ascites that do not respond to usual diuretics; Blocks sodium-retaininga nd potassium-excreting properties of aldosterone
  • Nursing Interventions: Monitor for gastrointestinal irritation and hyperkalemia
Potassium Supplements
  • Potassium (K-Lyte)
  • Action: Restores electrolyte loss
  • Nursing interventions: Monitor blood potassium levels
Sedatives and Analgesics 
  • Temazepam (Restoril); Morphine
  • Action: Promotes rest and comfort; Relieves chest and abdominal pain, reduces anxiety and decreases myocardial oxygen demands; Lessens dyspnea
  • Nursing Interventions: Monitor rest and sleep benefits
Nitrates 
  • Nitroglycerin (Cardabid)
  • Action: Dilates arteries, improves blood flow; Reduces BP
  • Nursing Interventions: Monitor BP for hypotension; Monitor for headache and flushing.
ACE Inhibitors 
  • Captopril (Capoten); enalapril (Vasotec); vamipril (Altace); benazepril (Lotensin); lisinopril (Prinivil; Zestril); univasc (Moexipril); quinapirl (Accupril); fosinopril (Monopril)
  • Action: Act as antihypertensives and reduce peripheral arterial resistance and improve cardiac output
  • Nursing Interventions: Observe patient closely for precipitous drop in BP within 3 hours of initial dose; monitor BP closely; Monitor blood potassium levels
β-Adrenergic Blockers 
  • carvedilol (Coreg)
  • Aciton: Directly blocks the sympathetic nervous system’s negative effects on the failing heart
  • Nursing interventions: Start gradually, increasing the dosage slowly every 2 weeks as tolerated by the patient
Inotropic Agents: Dobutamine and Dopamine
  • Dobutamine (Dobutrex) (IV); Dopamine HCl (Dopamine HCl, Intropin) (IV)
  • Action: Low-dose dobutamine (Dobutrex) and low-dose dopamine are relatively safe on med-surg units. In low doses the drugs dilate renal blood vessels, stimulating renal blood flow and glomerular filtration rate, which in turn promotes sodium excretion, often helping CHF patients improve.
  • Nursing Interventions: Make certain patient not taking MAO inhibitors, tricyclic depressants, phenytoin (Dilantin), and haloperidol (Haldol). Accurate I&O; assess for dizziness, nausea, vomiting, headache. Assess vital signs carefully q15min for first 2 hours, then q2h for following 4 hours, and finally once a shift. Observe carefully for extravasation, tachycardia, bradycardia, angina, palpitations, hypotension, hypertension, azotemia, and anxiety.
Inotropic Agents: Human Natriuretic Peptides Nesiritide (Natrecor)
  • Human Natriuretic Peptides Nesiritide (Natrecor)
  • Action: New class of heart failure drug known as synthetic human B-type Natriuretic Peptides (hBNPs); Nesiritide causers arterial and venous dilation, thereby decreasing systemic vascular resistance and pulmonary arterial pressures. It decreases blood pressure and promotes better left ventricle ejection and increases cardiac output. Nesiritide may also promote dieresis. It is an intravenous treatment of patients with acutely compensated CHF.
  • Nursing Interventions: Observe carefully for hypotension. Natrecor should not be used for patients with cardiogenic shock, or with a systolic BP < 90mmHg.
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