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My own Naplex > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Problem with filling of the left ventricle

A

relaxation = diastole

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2
Q

Problem with ejection of the blood from the left ventricle

A

contraction = systole

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3
Q

What is an ultrasound of the heart called and what does it provide an estimate of

A

ECHO, tells you the amount of left ventricular ejection fraction (EVEF) aka systolic dysfunction

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4
Q

ACC/AHA Staging system

A

A) At high risk but without HF (HTN, CAD, DM, obesity, eg)
B) Structural heart disease (i.e. low EF) but without signs or symptoms
C) Structural heart disease with symptoms
D) Advanced with symptoms despite maximized tx

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5
Q

NYHA functional class

A

1) no limitations of physical activity
2) Slight limitation of physical activity - comfortable at rest but minimal exertion
3) marked limitation of physical activity
4) Symptoms present even at rest (D)

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6
Q

CO equation

A

HR x SV

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7
Q

Key drugs that can worsen HF

A

Drug Information NATION

Dipeptidyl peptidase 4 inhibitors

Immunosuppressants

Non DHP CCB (Diltiazem and Verapamil)

Antiarrhythmics (Class 1)

Thiazolidines (increase risk of Edema)

Oncology Drugs

NSAIDS

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8
Q

Problem in HF

A

Low CO

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9
Q

How heart compensates for low CO

A

activates neurohormonal pathways ti increase blood volume or force speed of contractions, mainly through RAAS, SNS, and vasopressin (naturitic peptides become insufficient)

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10
Q

Long term effects of compensating for low CO

A

cardiac remodeling

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11
Q

What does Angiotensin 2 cause

A

Vasoconstriction (think ace

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12
Q

What does aldosterone cause

A

sodium and water retention

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13
Q

What does vasopressin cause

A

vasoconstriction and water retention

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14
Q

What does NE cause

A

an increase in HR, contractility (posiive ionotropy) and vasoconstriction

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15
Q

What do ace/ARBS and ARAS act on?

A

Stop RAAS and have mortality benefit

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16
Q

What do beta blockers act on

A

Sympathetic nervous system activation by blocking EPI and NE

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17
Q

Where do arnis act (sacubatril)

A

increases naturitic peptides

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18
Q

sulfa allergy is a concern in which drug class

A

diuretics

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19
Q

different between loop diuretics and thiazides in terms of calcium

A

thiazides increase calcium whereas loops decrease everything

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20
Q

Lasix

A

Furosemide

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21
Q

Bumez

A

Bumetanide

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22
Q

Vasotec

A

Enalipril

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23
Q

Enalapril vs Enalaprat

A

Enaliprat is for hypertension

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24
Q

Prinivil

A

Lisinopril (1/2)

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25
Q

Zestril

A

Lisinopril (2/2)

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26
Q

Accupril

A

Quinapril

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27
Q

Altace

A

Ramipril

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28
Q

Cozaar

A

Losartan

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29
Q

Diovan

A

Valsartan

30
Q

Entresto

A

Sacubitril/Valsartan

31
Q

Toprol XL

A

Metoprolol Succinate

32
Q

Which are the only three beta blockers recommended in heart failure

A

Bisoprolol, Metoprolol succinate (B1 selective), Carvedilol (nonselective beta blocker and alpha blocker)

33
Q

B1 selective blocker pneumonic

A

AMEBBA

Atenolol, Metoprolol, Esmolol, Bisoprolol, Betaxolol, Acebutolol

34
Q

Oral equivilent dosing for duretics

A

ethacrynic acid 50 = furosemide 40 = torosemide 20 = bumetanide 1

furosimide PO is 2x IV

35
Q

What is a concern for rapid iv administration of a diuretic

A

ototoxicity

36
Q

Oral equivalent for statins

A 
Pharmacists  - Pitavastatin 2
Rock - Rosuvastatin 5
At - Atorvastatin  10
Saving - Simvastatin 20
Lives - Lovastatin 40
Preventing - Pravastatin 40
Fat - Fluvastatin 80
37
Q

Do not refrigerate pneumonic

A

Dear - Dex edetomine (precedex)

Sweet - Sulfamethoxazole-TMP/Bactrim

Pharmacist - Phenytoin/Dilantin (crystalizes)

Freezing - Furosemide/Lasix (crystalizes)

Makes - Moxifloxacin (Avelox)

Me -Metronidazole/Flagyl

Edgy - Enoxaparin/Lovenox

38
Q

What drug to avoid in heart failure?

A

NSAIDS

39
Q

ace inhibitor vs arb inhibitor moa

A

ACE: block conversion angiotensin 1 to angiotensin 2

arbs: block angiotensin 2 from binding

40
Q

ace/arb major contraindication

A

angioedema

41
Q

target dose for vasotec

A

enalapril

10-20mg po BID

42
Q

target dose for prinivil, zestril

A

lisinopril

20-40mg daily

43
Q

target dose for accupril

A

quinapril

20 mg bid

44
Q

target dose for altace

A

ramipril

10mg daily

45
Q

target dose cozaar

A

losartan

50-150mg daily

46
Q

target dose diovan

valsartan

A

160mg bid

47
Q

metoprolol target dose

A

200 mg daily

48
Q

carvedilol target dose

A

if greater than 85kg 50 mg bid

if less than that half that dose

49
Q

which beta blocker needs to be taken with food?

A

carvedilol

50
Q

Spironolactone target dose

A

25 mg daily or bid

51
Q

Digoxin target dose and dosing

A

0.125 - 0.25 mg

Theraputic range is 0.5 - 0.9 in HF (in afib its 0.8-2)

decrease dose frequency when CrCl <50

Decrease dose by 20ish percent when switching from PO to IV

52
Q

digoxin antidote

A

digifab

53
Q

10% klor kon is what in meq.ml

A

20meq/15ml

54
Q

Boxed warning Ace/Arb

A

Pregnancy

55
Q

Nephrilysin moa

A

The sacubitril component is responsible for the degradation of vasodilatory peptides

56
Q

Difference between spironolactone and eplerenone

A

Spironolactone is non selective therefore has androgen side effects

57
Q

contraindications for aldosterone

A

hyperkalemia, Addison’s disease, crcl less than 30 (can cause hyperkalemia)

58
Q

Who is bidil indicated for

A

black patients who are still symptomatic despite optimal treatment

59
Q

DILE causing drug

A

anything with hydralizine (BIDIL)

60
Q

Digoxin MOA

A

inhibits NA-K-ATPase pump

61
Q

Digoxin Effect

A

positive ionotropic (CO), negative Chronotropic (HR)

62
Q

Signs of digoxin toxicity

A

yellow green halos, blurred vision, n/v/loss of apetite, bradycardia

63
Q

purpose of ivabradine

A

reduces the risk of hospitalizations but not mortality

64
Q

major s/e of ivabradine

A

bradycardia (QT prolonging), hypertension, afib

65
Q

HR needed to start Ivarbradine

A

> 70 BPM because can cause bradycardia

66
Q

Micro K administration

A

can open and sprinkle on food

67
Q

Klor-Con M

A

Can cut in half or dissolve in water

68
Q

Klorcon, K-tab

A

must swallow whole

69
Q

What can aggravate hypokalemia

A

drugs and magnesium

70
Q

Drugs that have mortality benefit

A

ace/arbs, BB, ARA, ARNI, entresto in AA patients

71
Q

Drugs that have no mortality benefit

A

loop, digoxin, ivabradine

My own Naplex (39 decks)

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