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Heart Failure Flashcards

1
Q

Problem with filling of the left ventricle

A

relaxation = diastole

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2
Q

Problem with ejection of the blood from the left ventricle

A

contraction = systole

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3
Q

What is an ultrasound of the heart called and what does it provide an estimate of

A

ECHO, tells you the amount of left ventricular ejection fraction (EVEF) aka systolic dysfunction

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4
Q

ACC/AHA Staging system

A

A) At high risk but without HF (HTN, CAD, DM, obesity, eg)
B) Structural heart disease (i.e. low EF) but without signs or symptoms
C) Structural heart disease with symptoms
D) Advanced with symptoms despite maximized tx

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5
Q

NYHA functional class

A

1) no limitations of physical activity
2) Slight limitation of physical activity - comfortable at rest but minimal exertion
3) marked limitation of physical activity
4) Symptoms present even at rest (D)

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6
Q

CO equation

A

HR x SV

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7
Q

Key drugs that can worsen HF

A

Drug Information NATION

Dipeptidyl peptidase 4 inhibitors

Immunosuppressants

Non DHP CCB (Diltiazem and Verapamil)

Antiarrhythmics (Class 1)

Thiazolidines (increase risk of Edema)

Oncology Drugs

NSAIDS

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8
Q

Problem in HF

A

Low CO

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9
Q

How heart compensates for low CO

A

activates neurohormonal pathways ti increase blood volume or force speed of contractions, mainly through RAAS, SNS, and vasopressin (naturitic peptides become insufficient)

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10
Q

Long term effects of compensating for low CO

A

cardiac remodeling

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11
Q

What does Angiotensin 2 cause

A

Vasoconstriction (think ace

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12
Q

What does aldosterone cause

A

sodium and water retention

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13
Q

What does vasopressin cause

A

vasoconstriction and water retention

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14
Q

What does NE cause

A

an increase in HR, contractility (posiive ionotropy) and vasoconstriction

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15
Q

What do ace/ARBS and ARAS act on?

A

Stop RAAS and have mortality benefit

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16
Q

What do beta blockers act on

A

Sympathetic nervous system activation by blocking EPI and NE

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17
Q

Where do arnis act (sacubatril)

A

increases naturitic peptides

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18
Q

sulfa allergy is a concern in which drug class

A

diuretics

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19
Q

different between loop diuretics and thiazides in terms of calcium

A

thiazides increase calcium whereas loops decrease everything

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20
Q

Lasix

A

Furosemide

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21
Q

Bumez

A

Bumetanide

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22
Q

Vasotec

A

Enalipril

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23
Q

Enalapril vs Enalaprat

A

Enaliprat is for hypertension

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24
Q

Prinivil

A

Lisinopril (1/2)

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25
Zestril
Lisinopril (2/2)
26
Accupril
Quinapril
27
Altace
Ramipril
28
Cozaar
Losartan
29
Diovan
Valsartan
30
Entresto
Sacubitril/Valsartan
31
Toprol XL
Metoprolol Succinate
32
Which are the only three beta blockers recommended in heart failure
Bisoprolol, Metoprolol succinate (B1 selective), Carvedilol (nonselective beta blocker and alpha blocker)
33
B1 selective blocker pneumonic
AMEBBA Atenolol, Metoprolol, Esmolol, Bisoprolol, Betaxolol, Acebutolol
34
Oral equivilent dosing for duretics
ethacrynic acid 50 = furosemide 40 = torosemide 20 = bumetanide 1 furosimide PO is 2x IV
35
What is a concern for rapid iv administration of a diuretic
ototoxicity
36
Oral equivalent for statins
``` Pharmacists - Pitavastatin 2 Rock - Rosuvastatin 5 At - Atorvastatin 10 Saving - Simvastatin 20 Lives - Lovastatin 40 Preventing - Pravastatin 40 Fat - Fluvastatin 80 ```
37
Do not refrigerate pneumonic
Dear - Dex edetomine (precedex) Sweet - Sulfamethoxazole-TMP/Bactrim Pharmacist - Phenytoin/Dilantin (crystalizes) Freezing - Furosemide/Lasix (crystalizes) Makes - Moxifloxacin (Avelox) Me -Metronidazole/Flagyl Edgy - Enoxaparin/Lovenox
38
What drug to avoid in heart failure?
NSAIDS
39
ace inhibitor vs arb inhibitor moa
ACE: block conversion angiotensin 1 to angiotensin 2 arbs: block angiotensin 2 from binding
40
ace/arb major contraindication
angioedema
41
target dose for vasotec
enalapril 10-20mg po BID
42
target dose for prinivil, zestril
lisinopril 20-40mg daily
43
target dose for accupril
quinapril 20 mg bid
44
target dose for altace
ramipril 10mg daily
45
target dose cozaar
losartan 50-150mg daily
46
target dose diovan valsartan
160mg bid
47
metoprolol target dose
200 mg daily
48
carvedilol target dose
if greater than 85kg 50 mg bid if less than that half that dose
49
which beta blocker needs to be taken with food?
carvedilol
50
Spironolactone target dose
25 mg daily or bid
51
Digoxin target dose and dosing
0.125 - 0.25 mg Theraputic range is 0.5 - 0.9 in HF (in afib its 0.8-2) decrease dose frequency when CrCl <50 Decrease dose by 20ish percent when switching from PO to IV
52
digoxin antidote
digifab
53
10% klor kon is what in meq.ml
20meq/15ml
54
Boxed warning Ace/Arb
Pregnancy
55
Nephrilysin moa
The sacubitril component is responsible for the degradation of vasodilatory peptides
56
Difference between spironolactone and eplerenone
Spironolactone is non selective therefore has androgen side effects
57
contraindications for aldosterone
hyperkalemia, Addison's disease, crcl less than 30 (can cause hyperkalemia)
58
Who is bidil indicated for
black patients who are still symptomatic despite optimal treatment
59
DILE causing drug
anything with hydralizine (BIDIL)
60
Digoxin MOA
inhibits NA-K-ATPase pump
61
Digoxin Effect
positive ionotropic (CO), negative Chronotropic (HR)
62
Signs of digoxin toxicity
yellow green halos, blurred vision, n/v/loss of apetite, bradycardia
63
purpose of ivabradine
reduces the risk of hospitalizations but not mortality
64
major s/e of ivabradine
bradycardia (QT prolonging), hypertension, afib
65
HR needed to start Ivarbradine
>70 BPM because can cause bradycardia
66
Micro K administration
can open and sprinkle on food
67
Klor-Con M
Can cut in half or dissolve in water
68
Klorcon, K-tab
must swallow whole
69
What can aggravate hypokalemia
drugs and magnesium
70
Drugs that have mortality benefit
ace/arbs, BB, ARA, ARNI, entresto in AA patients
71
Drugs that have no mortality benefit
loop, digoxin, ivabradine

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