🧠 EPISODE NOTES

1. Furosemide (Lasix) – “The Diuretic Dynamo”

Mnemonic: “Furosemide flushes fluid fast but watch for falling potassium.”

Mechanism: Loop diuretic; blocks sodium & chloride reabsorption in the Loop of Henle.

Watch for:

Hypokalemia (↓ potassium → arrhythmia risk)

Hypotension, dehydration, ototoxicity (with rapid IV push)

Nursing actions:

Daily weights, strict I&O, monitor BP & labs.

Hold & notify provider if potassium critically low.

2. Carvedilol (Coreg) – “The Beta Blocker Boss”

Mnemonic: “Carvedilol carves out congestion—but check pulse before blocking.”

Mechanism: Non-selective beta blocker with alpha-blocking → lowers HR & afterload.

Benefits: Reduces remodeling, improves survival in chronic HFREF.

Watch for:

Bradycardia, hypotension, bronchospasm (especially in asthma/COPD).

Nursing actions:

Check apical pulse for one full minute.

Hold if <50–60 bpm.

Never stop suddenly → rebound hypertension.

3. Spironolactone (Aldactone) – “The Potassium-Sparing Powerhouse”

Mnemonic: “Spironolactone spares potassium but screen for swelling breasts.”

Mechanism: Aldosterone antagonist; reduces sodium reabsorption & prevents fibrosis.

Watch for:

Hyperkalemia (↑ potassium → peaked T-waves).

Endocrine side effects: gynecomastia, menstrual changes.

Nursing actions:

Monitor K+, BUN/Creatinine.

Avoid K+ supplements & salt substitutes.

4. Entresto (Sacubitril/Valsartan) – “The Dynamic Duo”

Mnemonic: “Entresto enhances natriuresis but no ACE overlap.”

Mechanism:

Sacubitril: Inhibits neprilysin → ↑ beneficial natriuretic peptides.

Valsartan: ARB that blocks angiotensin II → ↓ vasoconstriction.

Key rule: 36-hour washout between ACE inhibitors & Entresto to prevent angioedema.

Watch for: Angioedema, hypotension, hyperkalemia.

Teaching: Report any facial or throat swelling immediately.

5. SGLT2 Inhibitors (Empagliflozin, Dapagliflozin) – “The Glucose Guardians”

Mnemonic: “SGLT2 sweeps sugar and sodium but scrub for infections.”

Mechanism: Blocks sodium-glucose cotransporter 2 → promotes excretion of glucose & sodium.

Benefits: ↓ hospitalizations and mortality in both HFREF & HFpEF, even without diabetes.

Watch for:

Genital infections (yeast, UTI), dehydration, hypotension.

Nursing teaching:

Encourage hygiene & hydration; monitor urine changes.

🩷 Nursing Pearls

Daily weights, potassium levels, BP, and heart rate are your best indicators.

Know when to hold and when to notify the provider.

Heart failure management is about balance: not too dry, not too wet, and always watching potassium.

📝 NCLEX Practice Question

A patient on furosemide and spironolactone reports eating two bananas a day and using salt substitute.
Which lab result is most concerning?
A) Sodium 140
B) Potassium 6.1
C) Potassium 3.2
D) Calcium 9.5
Answer: B → Hyperkalemia risk due to spironolactone and potassium intake.

Have a FAQ to ask Brooke? Send an email to [email protected].