144 Heart Failure Tx Flashcards Preview

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Flashcards in 144 Heart Failure Tx Deck (23)
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1
Q

Prevent Heart Failure

A

•Control blood pressure

  • Control diabetes mellitus
  • Control lipids
  • Smoking cessation
  • Weight control
  • Early recognition and treatment of acute coronary syndromes
2
Q

HF: Selected Diagnostic Testing

A
3
Q

Chronic Medical Treatment of HF with Reduced EF (EF<40%)

A
4
Q

Vasodilator Drugs: venodilator, mixed, arteriolar dilator

A
5
Q

Drugs that target: Renin-Angiotensin-Aldosterone System

A
6
Q

Spironolactone

A

–Cheap, generic

–Side Effects: Hyperkalemia, Relatively nonselective: sex steroid hormone effects à gynecomastia, irregular menses

–Prodrug. Has active metabolites with long half-lives: long time to steady state

7
Q

Sacubutril

A

•Sacubutril: Neprilysin Inhibitor: only formulation is sacubutril/valsartan

–sacubutril/valsartan aka “ARNI” Angiotensin Receptor Blocker Neprilysin Inhibitor

8
Q

Aliskiren

A
9
Q

B-blockers mechanism in HF

A

Beta-blockers improve beta-receptor sensitivity in the long run, improving myocardial performance

Failing Heart: Toxic Neurohormonal Milieu

Failing Desensitized Heart: Enter Metoprolol: Sensitivity Restored, Accounts for Efficacy in Left Ventricular Systolic Dysfunction (HFrEF)

10
Q

Specific B-blockers for HF

A
11
Q

Mineralocorticoid Receptor Antagonist Mechanism

A
  • •Spironolactone:
    • –Cheap, generic
    • –Side Effects: Hyperkalemia, Relatively nonselective: sex steroid hormone effects à gynecomastia, irregular menses
    • –Prodrug. Has active metabolites with long half-lives: long time to steady state
  • •Eplerenone:
    • –Quite selective for mineralocorticoid receptor (MR)
    • –Side Effects: Hyperkalemia.
    • –Often used post-myocardial infarction (based on trial data)
  • •Other CV Indications (mostly spiro): HTN, HF with preserved EF
12
Q

Nitrates mech and use in HF

A
13
Q

Eplerenone

A

–Quite selective for mineralocorticoid receptor (MR)

–Side Effects: Hyperkalemia.

–Often used post-myocardial infarction (based on trial data)

for HFrEF

14
Q

Hydralazine

A
15
Q

Hydralazine / Isosorbide Mononitrate combination therapy

A
  • •Nitrates:
    • –Side Effect: Headache, hypotension
    • –Exhibits tachyphylaxis (effect wanes with time)
    • –Isosorbide Dinitrate (TID dosing) is the evidence-based HF choice
  • •Hydralazine:
    • –Side Effect: Headache, tachycardia
    • –TID dosing
  • •Clinical Use:
    • –Evidence for benefit in all patient populations, particularly African-Americans
    • –Use also in patients who can’t tolerate ACE-I or ARB
    • –Three times daily dosing (TID) can be hard to adhere to
16
Q

Ivabradine Mechanism

A

HF

17
Q

Diurectic sites of action

A
18
Q

Chronic Medical Treatment of HF with Preserved EF (EF>50%)

A
  • •Volume Control
  • •Blood Pressure Control
  • •Spironolactone: Near-evidence based therapy (TOPCAT)
  • •Weight management (inflammatory adipokines)
  • •Exercise
19
Q

HF subtypes

A

•Signs of congestion: any of the following

–Orthopnea, ­+JVP, rales, ascites, leg swelling

•Signs of poor perfusion: any of the following

–Cool extremities, ¯BP, ¯pulse pressure, sleepy/obtunded, worsening renal function, ¯urine output

20
Q

HF subtypes treatments

A
21
Q

Treatment of acute pulmonary edema

A
22
Q

–Phosphodiesterase 3 inhibitors (milrinone)

A

used in stage IV heart failure

23
Q

IV inotropes

A