Chronic HF Flashcards Preview

Pharm II MHM - FINAL > Chronic HF > Flashcards

Flashcards in Chronic HF Deck (45):
1

Heart Failure:

inability to provide enough oxygenated blood to the rest of the body

2

Risk factors for chronic heart failure

HTN
Male
Valve disorder
Pregnancy
Smoking
Rx Drugs
Alcohol/drugs
pericarditis
hyperthyroidism
DM
obesity

3

Presentation of chronic heart failure

SOB
Edema-peripheral/pulm
DOE
Orthopenia
Ascites
Hepatomegaly
heart murmurs

4

Describe systolic heart failure

-problem with ejection of blood to the lungs or systemic circulation
-result of hypertrophy and dilation of ventricle
-EF less than 40

5

Describe diastolic heart failure

-inability of the heart to fill appropriately
-results from stiffness of the myocardium
-more difficult to treat
-EF >55%

6

What is MC systolic or diastolic heart failure?

Systolic

7

What class is more effective in HF?

Loop Diuretics

8

Beta blockers to treat heart failure?

Metoprolol succinate
bisprolol
carvedilol

9

MOA BB?

blockage of beta receptors lead to decrease heart rate, decrease BP, increase coronary artery blood flow

10

BB indications (stages)

Can be used in stages A and B
Should be used in stage C

11

ADE BB

bradycardia
worse HF if dose is too high
respiratory issues

12

ACE I/ARB names

lisinopril
prils-sartans

13

ACE I/ARBS MOA

interference with RAAS ending with disrupting angiostensin II, produce decrease BP, Sodium/H2O retention, after load reducer

14

ACE I/ARBS indications

all stages of HF
goal dose is needed to max mortality/morbidity benefit

15

What meds are used in ALL stages of heart failure?

ACE I/ARBs

16

ADE ACE I/ARBsCI

ADE: hyperkalemia, cough, hypotension
CI: prego, hyperkalemia-K greater than 5.0, bilateral renal artery stenosis, angioedema

17

ACE I/ARBs excreted in the:

Kidneys

18

Spironolactone Eplirione

Aldosterone blockers

19

MOA spironlactone/eplirione?

compete w/aldosterone for intracellular mineralcortocoid receptor causing Na/H2O to excrete which decreases preload

20

Aldosterone blockers in indicated for which stages of HF?

C and D HF

21

ADE aldosterone blockers

hyperkalemia
gynecomastia
CI: hyperkalemia

22

Are aldosterone blockers protein bound?Where are they excreted?

Yes, Highly
Kidneys

23

Vasodilator drugs

hydralazine
isosorbide dinitrate

24

hydralazine MOA

direct arterial vasodilator- coronary, cerebral and renal arteries
HA (hydralzaine arterial)

25

Isosorbide dinitrate MOA

direct venodilator - convert into NO for vasodilation

26

Vasodilators are indicated for what patients?

African American pts with stage C HF (along w/ ACE, BB etc)
used in B/C/D HF
Not CI to ACE I
Any race!

27

ADE of vasodilators

Tolerance to nitrates
hypotension
CI: not really excreted

28

Are vasodilators dosed multiple times a day?

Yes so they have bad compliance

29

What are the Loop Diuretics?

Furosemide
butmetanide
torsemide

30

Whats the MOA of Loops?

Exert action at loop of henle
increases Na + H2O excreted
reduces preload and edema

31

What is the indication of Loops?

Initial: Sx HF (C or D)
goal: after diuresis + fluid reduction, get pt to lowest dose possible or consider d/c

32

ADE Loops

electrolytes- hypokalemia, hypomagnesemia, hyperglycemia, hyperuricemia

33

Do pts with renal failure need higher or lower doses of Loops?

Higher

34

MOA Digoxin

increase inotropic activity and decrease chronotropic activity
increase intracellular Na + Ca which increases force of contraction

35

Indication Digoxin

low dose for normal renal fxn
only in Sx HF stage C/D
elderly/renal insufficient- dose every other day!

36

ADE digoxin

Toxicity- monitor it!
electrolytes- hypokalemia, hypomagnesemia
bradycardia
GI disturbance

37

Why do the elderly/renal insufficient have a lower dose of digoxin?

a large VD
large in obese/small in elderly and primarily renally excreted

38

Drugs to use for Morbidity?

morbiDDDD
digoxin and diuretics

39

How does potassium effect digoxin?

hypoK increases effects
hyperK decreases effects

40

What are the 4 compensatory mechanism of HF

RAAS
SNS
Ventricular Hypertrophy
Frank Starlings Law of the heart

41

What blocks the RAAS

ACE-I ARBs Aldosterone blockers

42

What blocks the SNS

BB

43

What blocks ventricle hypertrophy

BB ACE-I ARBs Aldosterones

44

What Blocks the Frank Starling Law

Hx of HF because there is a natural temporary fixing of first event HF (NO hx MI)

45

What drugs are used to prevent mortality?

ACE I/ARBS
BBs
Aldosterone blockers
Vasodilators (in AAs)