CHF Cases- Leah (3)* Flashcards Preview

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Flashcards in CHF Cases- Leah (3)* Deck (23)
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1
Q

Three BBers approved for treatment of heart failure

A

Metoprolol
Carvediliol
Bisoprolol

2
Q

How do ACEi/ARBs effect potassium levels?

A

They INCREASE K+ by blocking aldosterone

3
Q

What is an acceptable increase in creatinine for patients taking ACEi’s?

A

25% increase in creatinine; if higher- stop medication

4
Q

When is spirinolactone contraindicated?

A

If potassium > 4.5 meq/L

5
Q

If patients cannot take ACEi/ARBs, what is a good substitute? (2)

A
  1. Hydrazine
    - Arterial dilator
  2. ISDN
    - Venous dilator
    * Often used in African Americans who do not tolerate ACEi/ARBs
6
Q

What is the difference between CHF and acute heart failure?

What causes acute HF?

A

Acute= person with CHF that is in an unstable condition

  • Induced by poor diet/poor medication compliance/ worsening heart failure
7
Q

Why aren’t ACEi/ARBs/BB good in acute heart failure?

A

They are good for decreasing mortality but they do not relieve conditions Assc with acute heart failure.

8
Q

Most common diuretics used in CHF?

A

Loop Diuretics, most potent

Usually furosemide, sometimes torsemide

9
Q

Important difference between furosemide and torsemide?

A
  1. Furosemide has a varying bioavailability in different patients
    (Amount abosrbed may be anywhere from 10-80-%)
  2. Torsemide has bioavailability of 90% in most all patients. More predictable.

“torsemide is trustworthy”

10
Q

Patients who have LV dysfunction/ CHF with low EF should be on what three classes of drugs?

A
  • ACEi
  • BBers
  • Diuretics

(ACEi + BB most important according to clinician, ACEi and diuretic most important according to article.)
*Diuretics = symptom control, not mortality control

11
Q

When do you start a patient on BBers/ARBs/ACEi after new onset CHF/ acute CHF?

A

Once dry weight is achieved (once edema is gone)

12
Q

Most common cause of death in heart failure?

A

Arrhythmias

V tach/ V fib

13
Q

Intervention for cardiac arrest?

A
  1. Check pulse
  2. CPR if no pulse
  3. Defibrillate ASAP
14
Q

What are ICDs used to treat?

A

V tach/ potentially lethal arrhythmias

15
Q

When do you give a CHF patient ICD?

A

Patients whose EF is less than 35% after attempting to control with medications

16
Q

Most common causes CHF? (2)

A

HTN; CAD

17
Q

Where does BNP come from?

A

DISCOVERED in brain; comes from ventricles; same activity as ANP.

18
Q

Describe the 4 classes of heart failure

A
  1. Asymptomatic
  2. Symptomatic with ^^^^^^ activity. (Running a 5k?)
  3. Symptomatic with mild activity(walking up flight of stairs)
  4. Sick. In bed.
19
Q

Acceptable (dose of digoxin? Card got cut off!)

A

0.125 mg.
don’t go higher.
Digoxin doesn’t decrease mortality.
Does decrease hospital admissions.

20
Q

Minimum effective dose metoprolol:

A

> 100 mg

21
Q

Most important heart failure consideration?

A

Adjust Meds AND doses.

22
Q

Only drug that increases EF?

A

B blockers

23
Q

Drugs (3) that decrease mortality in CHF:

A
  1. *ACEi’s (or ISDN + Hydrazine in AA patients)
  2. *B Blockers
  3. Spironolactone (when added to ACE + initial diuretic regimen)

*Probably statins too, but I don’t think they were mentioned here?