Heart Failure Pharmacology Practice Questions with Answers and NCLEX® Review

A client diagnosed with heart failure will be prescribed medications that help them manage their condition. Some of these include ACE inhibitors and beta blockers.

With each heartbeat, a healthy heart pumps about 2,000 gallons of blood through arteries to all body parts. With heart failure, the heart can’t fill with enough blood or pump out enough blood to keep up with the body’s demands.

Heart failure can be caused by a variety of conditions, including coronary artery disease, high blood pressure, diabetes mellitus, cardiomyopathy (a disease of the heart muscle), valvular disorders (abnormalities of heart valves), and congenital defects (birth defects). Heart failure may also be triggered by other serious illnesses such as infections or cancer.

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There are two main types of heart failure: systolic and diastolic:

• Systolic heart failure occurs when the left ventricle is stiff, making it difficult for the heart to contract and relax properly.
• Diastolic heart failure occurs when the left ventricle becomes enlarged and weakens, causing blood to pool in the lungs and making it difficult for oxygenated blood from the lungs to reach other parts of your body.

Angiotensin-Converting Enzyme (ACE) Inhibitors Pharmacology

ACE inhibitors are a type of drug used to treat high blood pressure and heart failure. They work by relaxing blood vessels and making it easier for the heart to pump blood. The major organs that ACE inhibitors affect are the kidneys, blood vessels, heart, brain, and adrenal glands.

The inhibitory effects lead to increased sodium and urine excreted, reduced resistance in kidney blood vessels, increased venous capacity, and decreased cardiac output, stroke work, and volume. ACE inhibitors can reduce preload and afterload on the heart.

ACE Inhibitors work by blocking an enzyme called angiotensin-converting enzyme (ACE). This enzyme causes the body to produce more angiotensin II (a chemical messenger released by the kidneys), which then causes blood vessels to narrow by constricting muscles around them.

ACE inhibitors also interfere with the body’s renin-angiotensin-aldosterone system (RAAS). RAAS is a complex system responsible for regulating the body’s blood pressure. The kidneys release an enzyme called renin in response to low blood volume, low salt (sodium), or high potassium levels.

However, blocking ACE prevents this chemical from being released into the bloodstream. So blood vessels stay open and relaxed instead of constricted due to too much angiotensin II production by kidneys.

Health care providers (HCP) can also prescribe other medications that they feel would be more effective than the ACE inhibitor alone. This will depend on the client’s overall health and goals.

ACE inhibitors can be administered in many forms, orally (by mouth), injected into a vein, or given as an inhalation solution through a nebulizer. As a nurse, you’ll need to know if there are any side effects and the best times to administer medication.

There are several side effects associated with ACE Inhibitors, including:

• Headache
• Dry cough
• Dizziness
• Fatigue
• Nausea and vomiting
• Inability to concentrate or confusion
• Runny nose or sore throat

Angiotensin Receptor Blockers (ARBs) Pharmacology

Angiotensin receptor blockers (ARBs) are a class of drugs used to treat high blood pressure, heart failure, and diabetic nephropathy. ARBs are considered the first-line therapy for clients with hypertension and heart failure to reduce mortality and morbidity. They’re often combined with other medications such as diuretics or ACE inhibitors.

These drugs block the hormone angiotensin II, which causes blood vessels to narrow and kidneys to retain sodium. This also results in a decrease in blood pressure and an increase in the amount of water excreted by the kidneys.

ARBs prevent angiotensin II from binding with angiotensin receptors on smooth muscle cells and vascular endothelial cells. This decreases the amount of fluid in the lungs and reduces the workload of the heart muscle.

The most common side effects of ARBs include:

• Cough
• Dizziness
• Fatigue
• Headache
• Ankle swelling

Beta Blockers Pharmacology

Beta-blockers are a class of drugs often prescribed to clients with heart failure used to control high blood pressure, slow the heart rate, and reduce the risk of angina and heart attacks. These drugs also help lower the amount of oxygen the heart needs during exercise.

Beta blockers (also called beta adrenergic blocking agents) block the release of the stress hormones adrenaline and noradrenaline in certain parts of the body. This results in a slowing of the heart rate and reduces the force at which blood is pumped around your body.

Beta blockers can also block your kidneys from producing a hormone called angiotensin II. This results in lowering your blood pressure. Beta-blockers also decrease blood flow through your arteries and veins, improving circulation in clients with blocked or narrowed blood vessels.

Beta blockers can be administered in different forms. Orally or by intravenous infusion.

Intravenous infusion: Beta-blockers can be given intravenously (IV) as an infusion, which is a continuous flow of medication into a vein over an extended period of time (up to 24 hours). This allows clients to receive higher doses than they would if they were taking it by mouth.

Oral administration: Oral administration involves taking tablet form of medication by mouth regularly. Nurses may teach clients how to self-administer oral medications at home.

Side effects of beta-blockers include:

• Fatigue
• Dizziness
• Nausea and vomiting
• Headache
• Cold extremities (hands and feet)
• Low blood pressure
• Slow heart rate

Digoxin Pharmacology

Digoxin is a drug to treat heart failure, and is also sometimes used to treat atrial fibrillation and congestive heart failure. It’s a cardiac glycoside that helps the heart pump more efficiently and lowers the workload on the heart.

Digoxin works by increasing the force of contraction of the heart’s left ventricle, which helps increase blood pressure. It slows down the heart rate, which reduces the stress on the heart and allows it to function more efficiently.

Digoxin is given to clients who have had a previous episode of congestive heart failure or those at high risk for developing it. It can also be prescribed when there is an inability to get adequate blood flow through the ventricles due to atrial fibrillation or other conditions that cause rapid heart beating.

The health care provider (HCP) and/or nurse must monitor the client’s heart rate before administering digoxin. Also, a key point is to teach the client to monitor their heart rate before taking digoxin.

The amount of digoxin prescribed is individually based on each client’s weight and other factors (such as age and renal function). Health care providers (HCP) and nurses monitor clients for side effects. The most common side effects of digoxin include:

• Nausea
• Diarrhea
• Vomiting
• Arrhythmia (irregular heartbeat)

Diuretics Pharmacology

Diuretics are a class of drugs that help remove excess bodily fluid. Diuretics are often used in clients with high blood pressure, heart failure, or kidney disease.

When clients have heart failure, the heart isn’t able to pump blood around their body as well as it normally would. This means that the kidneys must work harder to filter waste and keep your blood pressure at normal levels.

Diuretics are effective in opening up these faucets (kidneys) to release toxins from the body. Diuretics reduce stress and workload of the heart by decreasing the amount of blood or fluid going inside the heart. Diuretics are calming down the increased pressure on the heart to normalcy.

And because the urinary tract primarily functions to excrete fluid from the body, the kidneys must be properly working to relieve the heart of unnecessary pressure due to fluid overload. Diuretics can improve symptoms such as: shortness of breath (related to fluid volume excess) and edema in the extremities (from fluid buildup).

Examples of diuretics include Lasix and Hydrochlorothiazide.

Diuretics should be used with caution because they can cause serious side effects if not taken under medical supervision. They can also interact with other medications such as insulin or antacids.

Diuretics can cause side effects including:

• Dehydration
• Electrolyte imbalances (sodium and potassium)
• Low blood pressure
• Hyperkalemia (when a potassium-sparing diuretic such as; spironolactone is prescribed)

Conclusion on Heart Failure Pharmacology

Heart failure is a condition in which the heart is not able to pump blood effectively. If left untreated, it can lead to serious complications, including an increased risk of stroke, kidney failure, and anemia.

Heart failure medications treat the symptoms of heart failure by improving their ability to pump blood. They do this by improving how much oxygen the heart can deliver to your body’s cells. There are several types of heart failure medications that work differently from one another.

The most common types of heart failure drugs include angiotensin-converting enzyme (ACE) inhibitors, Angiotensin receptor blockers (ARBs), Beta-blockers, Digoxin, and Diuretics.

Sources

https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.120.007014
https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=90&ContentID=P01761