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M3 Pharm B2 > Cardio and Renal 4 > Flashcards

Cardio and Renal 4 Flashcards

0
Q

What happens in heart failure?

A

Heart fails to pump blood, so heart will dilate (to compensate), which will result in an increased force of contraction

After compensation, the heart fails to compensate further, so it’ll lead to decompensation, decreased contraction, and thus, decreased cardiac output

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1
Q

What are the three conditions that lead to heart failure?

A
  1. Coronary Artery Disease
  2. MI
  3. Valvular disease
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2
Q

Decrease Cardiac Output Consequence: Increase Venous Pressure

A

Which leads to

  1. Increased BP, and thus Increased Preload
  2. Increased capillary filtration, leading increased salt and water retention (edema)
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3
Q

Decrease Cardiac Output Consequence: Decreased Renal Blood Flow

A

Which leads to increase Renin-Angiotensin, and then increased Aldosterone, and then ultimately

Increased salt and water retention (edema)

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4
Q

Decrease Cardiac Output Consequence: Decreased BP

A

Which leads to

Increase symps, which leads to increased vasoconstriction, which finally leads to increase afterload

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5
Q

NYHA Classification of Heart Failure: Class I

A

No limitation of physical activity, ordinary physical activity doesn’t cause fatigue or dyspnea

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6
Q

NYHA Classification of Heart Failure: Class II

A

Slight limitation of physical activity.

Comfortable at rest, but ordinary physical activity will result in fatigue and dyspnea

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7
Q

NYHA Classification of Heart Failure: Class III

A

Marked limitation of physical activity

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8
Q

NYHA Classification of Heart Failure: Class IV

A

Unable to carry out any physical activity without discomfort.

Symptoms of cardiac insufficiency at rest

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9
Q

Left Sided Heart Failure

A
  • Dyspnea
  • Orthopnea
  • Paroxysmal Nocturnal Dyspnea

Diaphoresis - Cool extremities

Pathologic S3 gallop

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10
Q

Right Sided Heart Failure

A
  • Edema
  • Ascites
  • JVD
  • Hepatomegaly

Epistaxis

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11
Q

Goal of Heart Failure Treatment (4)

A
  1. Drugs that increase contractility
  2. Drugs that decrease preload
  3. Drugs that decrease afterload
  4. Drugs that reduce edema
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12
Q

Drugs for Heart Failure (1 of 5): Positively Inotropic Drugs (3)

A
  1. Digitalis Glycoside: Digoxin
  2. Adrenoreceptor Agonist: Dobutamine
  3. Phosphodiesterase Inhibitors: Milrinone
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13
Q

Drugs for Heart Failure (2 of 5): Vasodilators (3)

A
  1. ACE Inhibitors: Enalapril, Lisnopril
  2. ARB: Valsartan, Candesartan
  3. Other Vasodilators: Hydralazine, Isosorbide, Nesiritide
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14
Q

Drugs for Heart Failure (3 of 5): Aldosterone Antagonists (2)

A

Spironolactone

Eplerenone

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15
Q

Drugs for Heart Failure (4 of 5): Beta Adrenoreceptor Blocker (3)

A

Carvedilol

Metoprolol

Bisoprolol

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16
Q

Drugs for Heart Failure (5 of 5): Diuretic (3)

A

Furosemide

Bumetanide

Torsemide

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17
Q

Drugs that Increase Contractility: Digitalis

A

Aka Cardiac Glycosides

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18
Q

Drugs that Increase Contractility: Digitalis MOA

A

Inhibits Na/K ATPase Pump

Troponin/tropomysin complex form a barrier between actin and myosin

Ca2+ binds to troponin and break the complex

Myosin interacts with actin producing muscle contraction

19
Q

Drugs that Increase Contractility: Digitalis - Direct Effect (5)

A

Inhibits Na/K ATPase pump leading to

Intracellular Na+, which increases Ca2+, causing increased force of contraction

Atria: Decreased APD and ERF (causing arrhythmia)

AV node: Decrease conduction velocity***

Ventricles and Purkinje: Decrease APD and ERP

20
Q

Drugs that Increase Contractility: Digitalis - Indirect Effect (a and b)

A

a. Cholinergic effect through vagal stimulation
Atria: decrease SA node rate
AV node: Increase ERP, decrease velocity
Ventricles and Purkinje: No effect

b. Sympathomimetic Effect (B1)
Atria: INCREASE SA rate
AV node: DECREASE refractory period
Ventricles and Purkinje: Increase conduction velocity and abnormal automaticity

21
Q

What is most commonly prescribed digitalis?

A

Digoxin

22
Q

Drugs that Increase Contractility: Digitalis - Digoxin Info

A

+ve ionotropic
-ve chronotropic

t1/2: 20-40 hours
Clearance: renal

Protein binding: 25%
Vd: 6.3L/kg

Should be avoided in WPW

23
Q

Drugs that Increase Contractility: *Digitalis Side Effects (5)

A

RENAL CALCULI

  1. CV: PVCs, Tachyarrhythmias, AV block, sinus bradycardia
  2. GI: ANV & Diarrhea
    * 3. CNS: Headache, visual halos, hallucinations

**4. EKG: Prolonged PR interval, decrease QT interval, T wave inversion

24
Q

Drugs that Increase Contractility: *Digitalis Side Effects (5)

A

RENAL CALCULI

  1. CV: PVCs, Tachyarrhythmias, AV block, sinus bradycardia
  2. GI: ANV & Diarrhea
    * 3. CNS: Headache, visual halos, hallucinations

**4. EKG: Prolonged PR interval, decrease QT interval, T wave inversion

25
Q

Drugs that Increase Contractility: Digitalis Toxicity

A

HYPOkalemia

26
Q

Drugs that Increase Contractility: Digitalis: Drugs that cause toxicity (6)

A

Diuretics, Quinidine , Verapamil

NSAIDs, Amiodarone, Erythromycin

27
Q

Drugs that Increase Contractility: Digitalis Toxicity Diagnosis

A

EKG Changes: PVCs

28
Q

Drugs that Increase Contractility: Digitalis Toxicity Antidotes

A

DigiFab (Digibind)

29
Q

New Ionotropic Drugs: Bypyridines

A

Drugs ending in -rinone

Amrinone
Inamrinone
Milrinone

30
Q

New Ionotropic Drugs: Bypyridines MOA (2)

A

Inhibit PDE causing increase cAMP –> + ionotropy

Inhibition of PDE also cause increase in cGMP –> vasodilation

31
Q

New Ionotropic Drugs: Bypyridines Indication

A

Short term rx of HF

32
Q

New Ionotropic Drugs: Bypyridines Side Effects (3)

A

Hypotension

Inamrinone: Thrombocytopenia

Milrinone: Decrease survival in HF

33
Q

ER Treatment of Heart Failure: 1. Sympathomimetic Dobutamine

A

Indicated in acute heart failure to increase contractility

34
Q

ER Treatment of Heart Failure: 2. Diuretics - Loop and Thiazides

A

Reduction of congestion and edema in acute failure

Spironolactone: reduced mortality when combined with ACEI

35
Q

ER Treatment of Heart Failure: 3. ACE Inhibitors (1)

A

Lisinopril

36
Q

ER Treatment of Heart Failure: 4. CCBs

A

Amlodipine

Verapamil

37
Q

ER Treatment of Heart Failure: 5. BB

A

Carvedilol has proven to decrease mortality

Metoprolol survival benefits in latest study

38
Q

ER Treatment of Heart Failure: 6. Neseritide (New)

A

Recombinant B type natriuretic peptide

rh BNP increase cGMP —> smooth muscle relaxation

Indicated to relieve dyspnea at rest in severe CHF

39
Q

Lipid Profile in CAD

A

Lipid profile is blood test that checks

Total Cholesterol

HDL

LDL

Triglycerides

40
Q

American Heart Association’s Recommendation for cholesterol

A

Serum Cholesterol:

Normal: up to 200 mg/dL

Borderline: Up to 239 mg/dl

Elevated: >240 mg/dl

41
Q

Antihyperlipidemic prescription is dependent on what?

A

LDL levels

42
Q

Antihyperlipidemic Risk Factors: 0-1 risk factors

A

Diet: > 160

*Meds: > 190

43
Q

Antihyperlipidemic Risk Factors: 1-2 risk factors

A

Diet: > 130

Meds: > 160

44
Q

Antihyperlipidemic Risk Factors: CAD + >2 risk factors

A

*Diet: > 100

Meds: > 130

M3 Pharm B2 (10 decks)

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