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Notes/Facts/Brand vs Generic > Chronic Heart failure > Flashcards

Chronic Heart failure Flashcards

1
Q

Capoten

A

captopril
ACE inhibitor

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2
Q

Vasotec*

A

enalapril
ACE inhibitor

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3
Q

Epaned

A

enalapril oral solution

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4
Q

Prinivil*

A

lisinopril
ACE inhibitor

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5
Q

Zestril*

A

lisinopril
ACE inhibitor

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6
Q

Qbrelis

A

lisinopril oral solution

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7
Q

Accupril*

A

quinapril

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8
Q

Altace*

A

ramipril

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9
Q

Atacand

A

candesartan
ARB

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10
Q

Cozaar*

A

losartan
ARB

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11
Q

Diovan*

A

valsartan
ARB

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12
Q

Toprol XL*

A

metoprolol succinate
Beta-1 selective Beta-blocker

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13
Q

Kapspargo sprinkle

A

metoprolol succinate
Beta-1 selective Beta blocker

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14
Q

bisoprolol

A

Beta-1 selective Beta-blocker

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15
Q

Coreg*

A

carvedilol IR
Non-selective beta blocker & alpha-1 blocker

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16
Q

Coreg CR*

A

carvedilol Controlled Release
Non-selective beta blocker & alpha-1 blocker

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17
Q

Lasix*

A

furosemide

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18
Q

Bumex*

A

bumetanide

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19
Q

torsemide*

A
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20
Q

Edecrin

A

ethacrynic acid
Loop diuretic

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21
Q

What are the Oral equivalent dosing conversions for Loop diuretics?

A

furosemide 40mg = torsemide 20mg = bumetanide 1mg = ethacrynic acid 50mg

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22
Q

what is the IV:PO dose conversion of furosemide

A

1:2

furosemide 20mg IV = furosemide 40mg PO

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23
Q

What is the IV:PO dose conversion of bumetanide?

A

1:1 ratio

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24
Q

what is the IV:PO dose conversion of ethacrynic acid?

A

1:1 ratio

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25
Q

Aldactone

A

spironolactone
aldosterone receptor antagonist

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26
Q

CaroSpir

A

spironolactone
aldosterone receptor antagonist

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27
Q

Inspra

A

eplerenone
aldosterone receptor antagonist

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28
Q

Farxiga

A

dapagliflozin

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29
Q

Jardiance

A

empagliflozin

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30
Q

With Chronic Heart Failure, the heart cannot supply _________________________________________________. This is because there are a number of problems.

There is a problem with ___________________.

or

There is a problem with___________________.

A

enough oxygen rich blood to the body

filling the left ventricle (relaxation = diastole)

ejection of blood from the left ventricle (contraction = systole)

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31
Q

diastole:

A

relaxation of ventricles ———————-“di” dilation - relaxation

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32
Q

systole:

A

contraction of ventricles

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33
Q

Ejection fraction:

A

blood pumped from the ventricle during each contraction.

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34
Q

Tell patients they have heart failure is scary. heart is failing, which is sorta true but also sorta not.

Heart failure is a syndrome, where the heart is not able to supply enough oxygen rich blood to vital organs of the body.

A

problem with oxygen demand and oxygen supply

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35
Q

an ejection fraction (EF) < 40% is classified as _____________

A

HFrEF = Heart Failure with reduced ejection fraction aka “systolic dysfunction”

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36
Q

Heart Failure is typically diagnosed with one main test -

A

an (ECHO) echocardiogram, which is an ultrasound of the heart. We can see how the heart is performing, and specifically we look to see what is the EF like.

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37
Q

(HFrEF) Heart Failure with reduced Ejection Fraction, also called ____________. The (EF) is ___________

-the left ventricle heart muscle is weakened and not able to squeeze at full potential

A

systolic heart failure

Less than or equal to 40%

remember heart can’t squeeze as well as it should

Guidelines focus on systolic heart failure.

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38
Q

(HFpEF) Heart Failure with preserved Ejection Fraction also called ____________.

-the left ventricle heart muscle has thickened from working so hard and is stiff, which takes up more space, because it is not able to relax completely, which in turn, allows less blood volume to fit in area.

A

diastolic heart failure

left ventricle cannot fill up as effectively.

39
Q

An EF of a normal heart in someone without heart failure ranges from ____________

A

55 - 70%

40
Q

Signs and Symptoms of Systolic Heart Failure

What biomarkers are elevated?

A

Shortness of breath
-orthopnea = shortness of breath that occurs while lying flat and is relieved by sitting or standing up
-dyspnea = difficulty or labored breathing

When the ventricle can’t pump correctly, the problem is that fluid backs up, and patients starts to have fluid overload symptoms. When fluid backs up in the lungs we see shortness of breath, and patients will present with cough. Fluid overload can also be present in other areas of the body, including peripheral edema, lower extremity swelling, ascites. We also can look for (JVD) jugular venous distention, that is when the neck veins are bulging out from fluid overload.
(HJR) Hepatojugular reflux = when we press on patients’ stomach around area of the liver, we can see that neck vein bulge out.
elevated (BNP) B-type natriuretic peptide

elevated (NT-proBNP) N-terminal pro B-type natriuretic peptide

*Both of these are elevated in conditions that cause the ventricles to stretch and work harder.

41
Q

There are 2 classification systems for systolic heart failure.

A

(ACC) American college of cardiology/(AHA) American heart association Staging
- A-D A = least sick patient, D = most sick
- addresses patients who do not yet have structural heart disease or symptoms of HF, but who are at high risk

(NYHA) New York Heart Association (FC) Functional Classes
- I-IV I = least sick patient, IV = most sick patient
- based on symptoms
- clinical trials historically enrolled patients based on NYHA FC

42
Q

NYHA FC Class I
symptoms a patient would have in this class include: _________

A

No limitations of physical activity.
Ordinary physical activity does not cause symptoms of HF.

43
Q

NYHA FC Class II
symptoms a patient would have in this class include: _________

A

Slight limitation of physical activity.
Comfortable at rest, but ordinary physical activity (walking upstairs) causes symptoms of HF.

44
Q

NYHA FC Class III
symptoms a patient would have in this class include: _________

A

Maked limitation of physical activity.
Comfortable at rest but minimal exertion (bathing, getting dressed) causes symptoms of HF.

45
Q

NYHA FC Class IV
symptoms a patient would have in this class include: _________

A

Unable to carry on any physical activity without symptoms of HF, or symptoms of HF at rest (SOB while sitting in a chair)

46
Q

Which ACC/AHA stages do patients have clinical diagnosis of HF?

A

stages C & D

47
Q

The ACC/AHA Staging system is used to guide treatment in order to _________________________________.

A

slow progression of structural heart disease in:

asymptomatic patients (Stages A and B)
- (LVH) left ventricular hypertrophy, low ejection fraction
valvular disease, previous MI

&

symptomatic patients (Stages C & D)

48
Q

The NYHA FC: categorizes heart failure by _____________

A

the level of limitation in physical functioning.

49
Q

Stage A using the ACC/AHA staging system includes patients that
____________________________

A

Are at risk for development of heart failure, but without symptoms of HF and without structural heart disease or elevated biomarkers.

(patients with hypertension, ASCVD, or diabetes)

50
Q

Stage B using the ACC/AHA staging system includes patients that
_______________________________

A

have Pre-HF; structural heart disease, abnormal cardiac function or elevated biomarkers, but without signs or symptoms of HF.

(patients with Left Ventricular Hypertrophy plus SOB, low ejection fraction, valvular disease)

51
Q

Stage C using the ACC/AHA staging system includes patients that
_________________________________

A

have a clinical diagnosis of HF

have structural and/or functional cardiac abnormality with prior or current symptoms of HF.

ex. patient with known structural heart disease (LVH) plus SOB, fatigue and reduced exercise tolerance

52
Q

Stage D using the ACC/AHA staging system includes patients that
________________________________

A

have a clinical diagnosis of HF

have Advanced HF with severe symptoms, symptoms at rest or recurrent hospitalizations despite maximal treatment. (refractory HF requiring specialized interventions)

53
Q

Pathophysiology of Heart Failure

As a reminder, the heart is not able to supply the body with enough oxygen rich blood. So, there is this problem of myocardial oxygen supply and myocardial oxygen demand. As a result, the (CO) Cardiac output is decreased (problem).

The body realizes this and then tries to compensate for it using a few different ways:
1)
2)
3)
4)

A

1) Activation of the Sympathetic Nervous System (SNS)

2) Activation of the Renin Angiotensin Aldosterone System (RAAS)

3) Increasing Vasopressin

4) Increasing Natriuretic Peptides
- which cause us to pee off some of that fluid

all are bad mechanisms to use to compensate, all will cause problems besides #4 enhancing peptides which is really good

54
Q

(CO) Cardiac Output:

A

the amount of blood that comes out of left ventricle during systole (contraction)

55
Q

Cardiac Output equation =

A

CO = HR x SV

Cardiac output = is the volume of blood that is pumped by the heart in one minute

(HR) Heart Rate = the number of times the heart BPM

(SV) Stroke Volume = the amount of blood volume ejected from the left ventricle during one complete heartbeat

56
Q

Lifestyle management of HF should include instructing the patient to:
______________

Lots of things the patient can do to avoid being admitted to the hospital

A

Monitor and Document body weight daily, in the morning after voiding and before eating.

Have patient notify provider if weight increases by 2-4 lbs in one day or 3-5 lbs in one week, or if symptoms worsen.

Restrict sodium intake to <1500mg/day in stages A and B HF

Restrict fluid (1.5 - 2 L/day in stage D HF

Stop smoking, limit alcohol intake, do not use illicit drugs

vaccine recommendations

Reduce weight to BMI < 30kg/m2

Exercise 30min/day for 3-5 days

Avoid stimulants.

57
Q

Drugs That Cause Or Worsen HF

remember —– Drug Info NATION———- “DI NATION”

these drugs either increase blood pressure or cause retention of fluid.

A

Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors) Alogliptin, Sitagliptin
Immunosuppressants

Non-dihydropyridine calcium channel blockers (verapamil and diltiazem); we don’t use in HF due to negative ionotropic effect, pretty well known for causing a HF decompensation.

Antiarrhythmics- most also have a negative ionotropic effect, particularly.
Class 1 antiarrhythmics. want to avoid in HF at all costs
Thiazolidinediones - cause fluid retention, which can cause an
exacerbation.
Itraconazole
Oncology agents
NSAIDs - these will compete with how loop diuretics are working. Making them a little less effective and can cause or worsen heart failure.

58
Q

ionotropic effect (negative) =

ionotropic effect (positive) =

A

Decrease

Increase HR and increase Contractility.

59
Q

Some of the Class 3 antiarrhythmics like amiodarone and dofetilide, these are considered relatively safe in HF

A
60
Q

What drugs work on the compensatory mechanism that inhibits/blocks activation of effects from the (SNS) sympathetic nervous system activation?

A

Beta-blockers

stop that increase in HR. Also reduce mortality.

61
Q

What drugs work on the compensatory mechanism that inhibits/blocks activation of effects from the (RAAS) renin angiotensin aldosterone system?

A

ACE-inhibitors, ARBs, (ARA) aldosterone receptor antagonists

these agents will help combat the fluid retention that we see in heart failure. Also reduce mortality.

62
Q

What drugs work on the compensatory mechanism that inhibits/blocks activation of effects from the

A
63
Q

What drugs work on the compensatory mechanism that inhibits/blocks activation of effects from the

A
64
Q

Loop Diuretics target _____________ directly, have no impact on mortality but patients feel a lot better when they are taking one.

A

fluid retention

65
Q

Digoxin works on the main issue in heart failure, which is ________________

A

the decreased CO. Digoxin is a + inotrope, Increasing contractility

66
Q

Sacubitril works by helping ___________________

A

keep those Natriuretic Peptides longer. So it helps with this positive compensatory mechanism.

67
Q

the Loop Diuretics work by acting at the nephron, specifically at the thick portion of the ______________. This is where the diuretics __________________________. These are very potent diuretics that are great at getting rid of fluid but are not very good for hypertension. Although they have no benefit in ___________ they are very good at ___________.

A

Ascending Limb of the loop of Henle
reabsorb ~25% of sodium & calcium.

mortality
symptomatic improvement

68
Q

Loop diuretics block ________ and _________ reabsorption in the thick ascending limb of the loop of Henle.
“this keeps the urine concentrated” water follows salts. Having this decrease in fluid volume makes it easier for the heart to pump.

They cause a lot of different electrolytes to be eliminated in the urine including: _______________. So side effects and electrolyte changes are what we are most concerned with.

There are also a few things that can increase with there use, including: ______________

A

sodium & chloride

sodium(Na), potassium(K), magnesium(Mg), chloride(Cl), calcium(Ca)

(UA) uric acid, (BG) blood glucose, (TG) triglycerides, (TC) total cholesterol, (HCO3) bicarbonate

69
Q

Oral dose equivalents for Loop diuretics:

Lasix _______ = Demadex______ = Bumex_____ = Edecrin_________

A

furosemide 40mg = torsemide 20mg = bumetanide 1mg = ethacrynic acid 50mg

70
Q

what is the IV:PO ration for furosemide??

A

1:2

ex. furosemide 20mg IV = furosemide 40mg PO

71
Q

what is the IV:PO ratio for bumetanide?

A

1:1

72
Q

what is the IV:PO ratio for ethacrynic acid?

A

1:1

73
Q

Loop Diuretics work on getting rid of fluid, decreasing the elevated preload caused by the compensatory mechanism by ____________

A

increased Vasopressin & increased RAAS from the heart failure

74
Q

Lasix*

A
75
Q

Bumex*

A
76
Q

Demadex*

A
77
Q

Edecrin

A
78
Q

ACE inhibitors work by blocking the ________________. This results in ______________

A

conversion of angiotensin I to angiotensin II.

decreasing vasoconstriction and decreased aldosterone secretion

79
Q

Capoten

A

captopril
starting dose:
Target Dose:

80
Q

Vasotec*

A

enalapril
starting dose:
Target Dose:

81
Q

fosinopril

A

fosinopril
starting dose:
Target Dose:

82
Q

Prinivil*

A

lisinopril
starting dose:
Target Dose:

83
Q

Zestril*

A

lisinopril
starting dose:
Target Dose:

84
Q

perindopril

A

starting dose:
Target Dose:

85
Q

Accupril*

A

quinapril
starting dose:
Target Dose:

86
Q

Altace*

A

ramipril
starting dose:
Target Dose:

87
Q

trandolapril

A

starting dose:
Target Dose:

88
Q

Atacand

A

candesartan
starting dose:
Target Dose:

89
Q

Cozaar*

A

losartan
starting dose:
Target Dose:

90
Q

Diovan*

A

valsartan
starting dose:
Target Dose:

91
Q

Entresto*

A

sacubitril/valsartan
combination of neprilysin inhibitor and ARB

92
Q
A
93
Q
A
94
Q
A

Notes/Facts/Brand vs Generic (23 decks)

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