In this episode of Think Like a Nurse, created by Brooke Wallace, ICU nurse and clinical instructor, breaks down the five essential heart failure medications every nurse must know—and exactly how they show up on the NCLEX and in real-world care. You’ll go beyond memorization to understand why each drug matters, what to monitor, and the critical “hold and call” moments that save lives. From Lasix for rapid fluid relief to Entresto and SGLT2 inhibitors that reshape the standard of care, this episode delivers mnemonics, nursing pearls, and clinical insights that help you pass NCLEX and truly think like a nurse.
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.
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.
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.
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.
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.
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.
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.