6: HF Treatment Flashcards by Paige Sosebee | Brainscape

Q

What stage of HF (A, B, C, or D) is usually seen in primary care?

A

Stage C

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Q

At what stage (A, B, C, or D) do patients become symptomatic and focus shifts from primary and secondary prevention to tertiary prevention?

A

Stage C

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Q

Stage A, B, C, or D?

Patients with HTN

A

Stage A

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Q

Stage A, B, C, or D?

Patients with atherosclerotic disease

A

Stage A

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Q

Stage A, B, C, or D?

Patients with metabolic syndrome

A

Stage A

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Q

Stage A, B, C, or D?

Patients using cardiotoxins

A

Stage A

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Q

Stage A, B, C, or D?

Patients with HFx CM

A

Stage A

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Q

Stage A, B, C, or D?

Patients with previous MI

A

Stage B

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Q

Stage A, B, C, or D?

Patients with LV remodeling

A

Stage B

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Q

Stage A, B, C, or D?

Patients with LVH and low EF

A

Stage B

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Q

Stage A, B, C, or D?

Patients with asymptomatic valvular disease

A

Stage B

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Q

Stage A, B, C, or D?

Patients with known structural heart disease and fatigue, SOB, reduced exercise tolerance

A

Stage C

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Q

Stage A, B, C, or D?

Patients who have marked symptoms at rest despite maximal medical therapy

A

Stage D

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Q

What are the goals for this stage?

Stage A

A

Treat HTN
Smoking cessation
Treat lipid disorders
Encourage regular exercise
Discourage alcohol, drugs
Control metabolic syndrome

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Q

What are the goals for this stage?

Stage B

A

Same as Stage A

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Q

What are the goals for this stage?

Stage C

A

Same as Stages A/B plus:
Dietary salt restriction
Drugs for routine use
Diuretic for fluid retention
ACEs
BBs

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Q

What are the goals for this stage?

Stage D

A

Same as Stages A/B/C plus:
Control fluid retention
Referral to HF program for appropriate patients
Decision regarding appropriate level of care
Information regarding inactivating previously implanted defibrillator

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Q

At what stage might implantable defibrillators be used?

A

Selected patients in Stages B and C

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Q

What drugs might be used in this stage?

Stage A

A

ACE or ARB in appropriate patients for vascular disease or diabetes

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Q

What drugs might be used in this stage?

Stage B

A

ACE or ARB in appropriate patients

BB in appropriate patients

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Q

What drugs might be used in this stage?

Stage C

A

Aldosterone antagonist
ARB
Digitalis
Hydralazine/Nitrates

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Q

When do options like hospice, heart transplants, experimental measures, and chronic inotropes come into play?

A

Stage D

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Q

Stage A, B, C, or D?

At high risk for HF but without structural heart disease or symptoms of HF.

A

Stage A

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Q

Stage A, B, C, or D?

Structural heart disease but without symptoms of HF.

A

Stage B

Q

Stage A, B, C, or D?

Structural heart disease with prior or current symptoms of HF.

A

Stage C

Q

Stage A, B, C, or D?

Refractory HF requiring specialized interventions.

A

Stage D

Q

What classification of recommendation (1, 2a, 2b, or 3)?

Benefit greatly outweighs risk.

A

Class 1

Q

What classification of recommendation (1, 2a, 2b, or 3)?

Benefit outweighs risk; additional studies with focused objectives needed.

A

Class 2a

Q

What classification of recommendation (1, 2a, 2b, or 3)?

Benefit and risk roughly equal; additional data would be helpful.

A

Class 2b

Q

What classification of recommendation (1, 2a, 2b, or 3)?

Risk greatly outweighs the benefit.

A

Class 3

Q

What classification of recommendation (1, 2a, 2b, or 3)?

Procedure or treatment should be performed or administered.

A

Class 1

Q

What classification of recommendation (1, 2a, 2b, or 3)?

It is reasonable to perform the procedure or administer treatment.

A

Class 2a

Q

What classification of recommendation (1, 2a, 2b, or 3)?

Procedure or treatment may be considered.

A

Class 2b

Q

What classification of recommendation (1, 2a, 2b, or 3)?

Procedure or treatment should not be performed or administered as it is not helpful and may be harmful.

A

Class 3

Q

What level of evidence (A, B, C)?

Data derived from multiple randomized clinical trials.

A

A

Q

What level of evidence (A, B, C)?

Data derived from a single randomized trial, or nonrandomized studies.

A

B

Q

What level of evidence (A, B, C)?

Consensus opinion of experts.

A

C

Q

These diuretics are typically used in patients with acute volume overload to rapidly diurese them.

A

Loop Diuretics
Bumetanide
Furosemide
Torsemide

Q

Weaker diuretics used for maintenance therapy or for hypertensive properties.

A

Thiazide Diuretics
Chlorothiazide
Chlorthalidone
Hydrochlorothiazide
Indapamide
Metolazone

Q

Diuretic that is a mainstay in HF patients.

A

Potassium-Sparing Diuretics
Amiloride
Spironolactone
Triamterene

Q

Diuretic that can be added to loop diuretics for an additional boost.

A

Sequential Nephron Blockade Diuretics
Metolazone
Hydrochlorothiazide
Chlorothiazide

Q

ACE inhibitors are a Class 1 recommendation in Stage C HF with a level of evidence A. When could they not be used?

A

Severe renal failure

Hx of hyperkalemia

Q

What is an example of a drug combination that is a Class 3 recommendation with level of evidence C?

A

Routine combined use of an ACEI, ARB, and aldosterone antagonist is not recommended for patients with current or prior symptoms of HF and reduced LVEF.

Q

When might an ARB be used in place of an ACE?

A

If the patient is already taking an ARB

Patient develops ACE cough

Q

Should ACEs and ARBs be combined?

A

No, combination has not shown any benefits and should not be routinely done.

Q

When are aldosterone antagonists (spironalactone) usually added?

A

After you’ve already been put on ACEs and BBs to help prevent fluid volume overload in the future.

Q

Which ARBs should be used in Stage C?

A

Candesartan

Valsartan

Q

Which ARB is preferred in Stage C for patients who are also post MI?

A

Valsartan

Q

Which aldosterone antagonist is suggested in Stage C?

A

Spironolactone

Q

Which aldosterone antagonist is suggested for patients who are post MI?

A

Eplerenone

Q

Which BBs are recommended in Stage C?

A

Bisoprolol
Carvedilol
Metoprolol Succinate

Q

Which BB is recommended in Stage C for those who are also post MI?

A

Carvedilol

Q

At what stage is Digoxin recommended in HF?

A

Stage C

Q

Why is BB use recommended in Stage C?

A

Reduce mortality

Q

What are some contraindications or cautions for carvedilol?

A

Nonselective BB with alpha blocking properties so caution in:
Sever pulmonary disease that requires bronchodilators (like COPD) as it can impair bronchodilators

Q

Why is metoprolol succinate (XL) commonly used in HF?

A

It’s a selective BB

Q

T/F Digoxin is first-line treatment in HF.

A

False. It used to be. Now it used more selectively and in low doses.

Q

After other meds (ACEs, BBs, etc) have reached target doses, what 2 meds have been shown to be beneficial in the AA population?

A

Hydralazine

Isosorbide Dinitrate

Q

What med should not be continued in patients with significant symptoms of volume overload or fluid retention?

A

CCBs