D116 Unit 4 Study Guide

Unit 4 Study Guide

How is Heart Failure Severity Classified According to the NYHA and ACC/AHA Systems?

Heart failure (HF) severity is commonly assessed using two primary classification methods: the New York Heart Association (NYHA) functional classification and the American College of Cardiology/American Heart Association (ACC/AHA) staging system. These systems offer complementary perspectives. The NYHA classification centers on the patient’s symptoms and the extent to which heart failure limits physical activity, providing a practical guide for clinicians to adjust treatment and anticipate outcomes. In contrast, the ACC/AHA framework categorizes heart failure based on the underlying structural changes and disease progression, including asymptomatic phases, emphasizing early identification and preventive strategies.

NYHA Functional Classification

The NYHA system divides heart failure severity into four classes based on physical activity limitations caused by symptoms such as fatigue and breathlessness:

This classification helps healthcare providers tailor treatment intensity according to the patient’s functional status.

ACC/AHA Heart Failure Staging

The ACC/AHA system defines heart failure as a progressive condition with four stages that reflect structural heart disease and symptom development:

Unlike the NYHA classes, ACC/AHA stages are irreversible, stressing the importance of early detection and prevention to slow progression (American College of Cardiology/American Heart Association, 2022).

What is the First-Line Treatment for Hypertension?

Managing hypertension initially focuses on lifestyle modifications aimed at reducing risk factors. These non-pharmacological interventions have been shown to effectively lower blood pressure and improve cardiovascular health, potentially delaying or reducing the need for medications. Key lifestyle changes include:

• Reducing sodium intake in the diet

• Maintaining a healthy body weight

• Engaging in regular aerobic physical activity

• Limiting alcohol consumption

• Smoking cessation

• Adopting heart-healthy diets such as the DASH (Dietary Approaches to Stop Hypertension) diet

Incorporating these habits can significantly impact blood pressure control and overall health outcomes (Whelton et al., 2018).

How Should Hypertension be Managed in Patients with Asthma?

For patients diagnosed with both asthma and hypertension, ACE inhibitors are generally the preferred antihypertensive agents due to their lack of bronchoconstrictive effects. Unlike nonselective beta-blockers, ACE inhibitors, identifiable by the suffix “-pril,” do not exacerbate airway reactivity, making them safer options in this population. However, it is important to monitor for common side effects such as persistent cough, which may necessitate switching to angiotensin receptor blockers (ARBs) if intolerance develops (Brunton, Hilal-Dandan, & Knollmann, 2023).

Why Are ACE Inhibitors Contraindicated During Pregnancy?

ACE inhibitors are strictly contraindicated during pregnancy, especially in the second and third trimesters, due to their teratogenic effects. Exposure to these drugs can cause severe fetal complications including low blood pressure, kidney malformations, reduced amniotic fluid, skull and lung development abnormalities, elevated potassium levels, and potentially fetal death. Pregnant patients receiving ACE inhibitors must discontinue them promptly and switch to safer antihypertensive alternatives under medical supervision (Brunton et al., 2023).

What is the Mechanism of Action, Common Side Effects, and Contraindications of HMG-CoA Reductase Inhibitors?

HMG-CoA reductase inhibitors, commonly referred to as statins, reduce low-density lipoprotein (LDL) cholesterol by blocking the key enzyme responsible for cholesterol synthesis in the liver. This inhibition leads to an upregulation of LDL receptors on hepatocytes, enhancing clearance of LDL cholesterol from the bloodstream.

Common adverse effects include headaches, digestive disturbances such as indigestion and constipation, and skin reactions. Although rare, serious complications like muscle pain, myopathy, and rhabdomyolysis can occur. Statins are contraindicated during pregnancy and breastfeeding because of potential harm to the fetus and infant. Additionally, caution is necessary when combined with drugs that interfere with cytochrome P450 enzymes (especially CYP3A4 inhibitors) to prevent toxicity (Brunton et al., 2023).

Which Patients Should Avoid ACE Inhibitors?

Patients who should avoid ACE inhibitors include those with:

• A previous history of angioedema linked to ACE inhibitor use

• Pregnancy

• Known neutropenia (low white blood cell counts)

Additionally, ACE inhibitors require cautious use in individuals with bilateral renal artery stenosis or significant renal impairment, given the increased risk of kidney injury (Brunton et al., 2023).

What Are the Main Adverse Effects of Aspirin and Warfarin?

The primary risk associated with aspirin and warfarin therapy is bleeding, which can manifest as gastrointestinal bleeding, intracranial hemorrhage, or excessive bruising. This risk heightens when these drugs are used together or in patients with existing bleeding disorders or uncontrolled hypertension. Careful monitoring is crucial to balance the benefits of anticoagulation and antiplatelet effects against bleeding risk (Gulanick & Myers, 2022).

What Are the Signs of Digoxin Toxicity? What Are Therapeutic and Toxic Serum Levels?

Digoxin has a narrow therapeutic window, with safe serum concentrations typically between 0.5 and 0.8 ng/mL. Levels above this increase the risk of toxicity. Signs of digoxin toxicity include nausea, vomiting, loss of appetite, fatigue, visual disturbances such as blurred or yellow vision, and life-threatening cardiac arrhythmias. Any arrhythmia occurring in a patient on digoxin should prompt immediate serum level measurement (Brunton et al., 2023).

What Precautions Should Be Taken When Prescribing Theophylline? What Medications Interact with Theophylline?

Theophylline, used for long-term asthma control, requires careful patient counseling to avoid doubling doses if a dose is missed. Since caffeine can prolong theophylline clearance and increase toxicity risk, patients should limit caffeine intake. Important drug interactions include enzyme inducers like phenobarbital, phenytoin, and rifampin that lower theophylline levels, and enzyme inhibitors such as cimetidine and fluoroquinolones (e.g., ciprofloxacin) that increase toxicity risk (National Asthma Education and Prevention Program, 2020).

What is the Relationship Between Thiazide Diuretics and Calcium Excretion?

Thiazide diuretics reduce calcium excretion in the urine by enhancing calcium reabsorption in the distal tubules of the kidney nephron. This action can raise serum calcium slightly while decreasing urinary calcium. Such an effect is beneficial in preventing calcium kidney stones but requires caution in patients susceptible to hypercalcemia (Brunton et al., 2023).

What Are the Side Effects of Mucolytics?

Mucolytics work by thinning respiratory mucus, making it easier to clear through coughing. Generally well tolerated, they can occasionally trigger bronchospasm, particularly in asthmatic individuals, necessitating close monitoring during treatment (Gulanick & Myers, 2022).

How Do Sympathomimetics Work?

Sympathomimetics alleviate nasal congestion by stimulating alpha-1 adrenergic receptors in nasal blood vessels, leading to vasoconstriction. This reduces blood flow and swelling in the nasal mucosa, improving airflow. However, prolonged or excessive use may cause rebound congestion, where symptoms worsen after stopping the medication (Brunton et al., 2023).

What Are the Side Effects and Drug Interactions of Glucocorticoids? What Specific Assessments Are Needed?

Long-term glucocorticoid use can cause numerous adverse effects, including osteoporosis, heightened infection risk, delayed wound healing, high blood sugar, muscle weakness, fluid and electrolyte imbalance, growth suppression in children, mood disturbances, cataracts, glaucoma, peptic ulcers, Cushing syndrome, and adrenal suppression. Monitoring strategies include bone density tests, glucose and electrolyte checks, eye exams, and infection surveillance. Drug interactions involve potassium-depleting diuretics, NSAIDs, insulin or oral hypoglycemics, and vaccines, necessitating careful management (Brunton et al., 2023).

What Is the Stepwise Approach to Asthma Management? Which Medication Classes Are Used in Each Step? How Are Short-Acting and Long-Acting Treatments Differentiated?

Asthma treatment is organized in a stepwise manner, increasing therapy intensity based on symptom severity and control. Short-acting beta-agonists (SABAs) provide quick relief for acute symptoms. Long-acting agents, including inhaled corticosteroids (ICS) and long-acting beta-agonists (LABAs), are used for maintenance therapy. As asthma severity increases, additional treatments like leukotriene modifiers, biologics, or systemic corticosteroids may be incorporated to achieve control (National Asthma Education and Prevention Program, 2020).

Which Antitussives and Decongestants Are Safe During Pregnancy? Which Are Contraindicated?

Pregnant patients require careful evaluation of medication risks versus benefits to ensure maternal symptom relief while minimizing fetal harm (Brunton et al., 2023).

References

American College of Cardiology/American Heart Association. (2022). Guideline for the management of heart failure. Journal of the American College of Cardiology, 79(17), e263–e421. https://doi.org/10.1016/j.jacc.2021.12.012

Brunton, L. L., Hilal-Dandan, R., & Knollmann, B. C. (2023). Goodman & Gilman’s: The pharmacological basis of therapeutics (14th ed.). McGraw-Hill Education.

Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, and outcomes (10th ed.). Elsevier.

National Asthma Education and Prevention Program. (2020). Expert panel report 3: Guidelines for the diagnosis and management of asthma. National Heart, Lung, and Blood Institute.

Whelton, P. K., Carey, R. M., Aronow, W. S., et al. (2018). 2017 ACC/AHA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. Hypertension, 71(6), e13–e115.