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Kol- Pharm 323 Spring > Heart Failure > Flashcards

Heart Failure Flashcards

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1
Q

Heart failure leads to inadequate ____ _____ AND/OR ____ ______

A

Inadequate tissue perfusion AND/OR volume overload

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2
Q

inability of the heart to adequately pump all the blood it has received. The lack of cardiac output thus fails to meet the metabolic needs of the body

A

Heart Failure

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3
Q

Is there a cure for heart failure?

A

Nope

Goal = prevent, treat, and remove UNDERLYING CAUSE

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4
Q

How does chronic hypertension lead to HF?

A

Too much afterload for too long.

Too much pressure for the L ventricle to pump against

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5
Q

What is cardiac remodeling?

A

reduced cardiac output&raquo_space;> compensatory responses&raquo_space;»

^increase HR
^venous/arterial pressure

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6
Q

What are the compensatory responses as a result of reduced cardiac output?

A
  1. Cardiac Dilation
  2. Activation of SNS
  3. Activation of RAAS
  4. Retention of water/increased bld volume
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7
Q

What does left sided HF result in?

A

pulmonary HTN

Pulmonary Edema –> wet lungs

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8
Q

What does right sided HF result in?

A

Veins distended
Edema in Legs
Ascites in belly

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9
Q

what are the 2 goals of drugs to treat HF?

A
  1. increase force of contraction (positive ionotropic effect)
  2. decrease HR to reduce O2 consumption
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10
Q

List the main classes of drugs to treat HF (7) (6 if you lump one in with another)

A

1.Diuretics
Thiazide Diuretics: Hydrocholorthiazide
Loop Diuretics: furosemide
K Sparing Diuretics: spironolactone
2.Drugs that Inhibit RAAS
ACE: lisinopril (Zestril)
ARB: valsartan
ARNI: sacubitril/valsartan (Ernesto)
Aldosterone receptor blocker: spironolactone
3.Beta Blockers: carvedilol (Coreg), metoprolol XL (Toprol-XL), bisoprolol (Zebeta)
4.HCN Channel Blocker :ivabradine (Crolanor
5.Cardiac Glycosides: digoxin
6.Vasodilators: isosorbide dinitrate with hydralazine
7.Acute HF drugs: IV infusions

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11
Q

3 diuretics to treat HF

A

Thiazide Diuretics: Hydrocholorthiazide
Loop Diuretics: furosemide
K Sparing Diuretics: spironolactone

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12
Q

Drugs that inhibit RAAS to TREAT HF

A

ACE: lisinopril (Zestril)
ARB: valsartan
ARNI: sacubitril/valsartan (Ernesto)
Aldosterone receptor blocker: spironolactone

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13
Q

1st line therapy drug class for HF? why?

A

diuretics!

Reduce the blood volume (preload) –> decreases workload on heart

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14
Q

Are diuretics a cure for HF?

A

reduces symptoms, does not prolong survival

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15
Q

3 ways diuretics treat HF

A
  1. treat pulmonary/peripheral edema
  2. decrease preload/afterload
  3. causes cardiac dilation
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16
Q

prototype for Loop Diruetics?

A

furosemide (Lasix)

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17
Q

how does furosemide (Lasix) fxn?

A

-Loop Diuretic

Inhibits reabsorption of Na & Cl at loop of Henle –> resulting in decrease BLOOD VOLUME

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18
Q

onset/duration for PO furosemide (Lasix)

A

onset 1hour - duration for 8 hours

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19
Q

onset/duration for IV furosemide (Lasix)

A

onset 5 min - duration 2-3 hours

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20
Q

Most efficacious diuretic for HF?

A

furosemide (Lasix)

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21
Q

which diuretics have risk of HYPOkalemia?

A

Thiazide Diuretics: Hydrocholorthiazide

Loop Diuretics: furosemide

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22
Q

What other electrolytes get messed up with Thiazide Diuretics: Hydrocholorthiazide and Loop Diuretics: furosemide

A

Na and Cl

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23
Q

Loop and Thiazide diuretics have risk of ____ and _____ toxicity

A

digoxin and lithium

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24
Q

Which HF drug has risk of transient ototoxicity? why?

A

Loop Diuretics: furosemide (Lasix)

-if give IV too fast

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25
If diuretics are decreasing blood volume things are we watching for in patient
hypotension, dehydration, postural hypotension, hypovolemia
26
Which HF drug will increase uric acid/ gout flare up?
Thiazide Diuretics: Hydrocholorthiazide | Loop Diuretics: furosemide
27
Prototype for thiazide diuretics?
hydrochlorothiazide (HCTZ)
28
how does hydrochlorothiazide (HCTZ) fxn?
1) reduces BLOOD VOLUME - works on the distal tubule - Results in excretion of H20, Na, K+ 2) Reduces arterial resistance (over time)
29
Onset/ duration/ peak for hydrochlorothiazide (HCTZ)
2 hrs., peak 4-6, lasts 12 hours
30
what is our most WIDELY USED diruetic?
hydrochlorothiazide (HCTZ)
31
Which HF drug has risk of hyperglycemia in DM patients?
hydrochlorothiazide (HCTZ)
32
hydrochlorothiazide (HCTZ) is contraindicated with which other allergy
sulfa
33
prototype for Potassium Sparing Diuretics
spironolactone (Aldactone)
34
how does spironolactone (Aldactone) fxn?
Competes with aldosterone at receptors in the distal tubule blocking aldosterone --> fluid lost, K remains = potassium sparing!
35
Onset for spironolactone (Aldactone)
Potassium Sparing Diuretic Aldosterone Receptor Blockers Takes up to 48 hours to work
36
Side effects for spironolactone (Aldactone)?
Potassium Sparing Diuretics Aldosterone Receptor Blockers - hyperkalemia (high K+) - Endocrine effects: gynecomastia
37
Nursing consideration for HYPOkalemia associated with diuretics?
``` Hypokalemia (Thiazide/Loop) ✔ K levels before admin. Teach high K+ foods Risk for dysrhythmias Risk for digoxin & lithium toxicity ```
38
Nursing consideration for HYPERkalemia associated with diuretics? (think about other drugs you would or would not give this with)
✔ K levels before admin. | Typically, don’t admin. with RAAS drugs, K supplements
39
Why do we check daily wait for HF patient on diuretics
*Patients may be given a ‘sliding scale’ based on daily wt.
40
Which diuretic are we definitely not giving to someone pregnant?
Loop Diuretics: furosemide (Lasix)
41
What happens when you block angiotensin (in relation to HF)?
vasodilation, dec. Na and water retention and prevent cardiac remodeling
42
What happens when you block aldosterone (in relation to HF)?
prevent Na and water retention and prevent cardiac remodeling
43
Do we give RAAS drugs in pregnancy?
NOPE
44
All RAAS drugs have a risk for....
HYPERkalemia!
45
What is the one RAAS drug we are NOT using in HF treatment?
direct renin inhibitor
46
How are angiotensin and aldosterone the same and how are they different in treating HF
BOTH: - decrease Na/H20 retention - prevent cardiac remodeling ANGIOTENSIN: causes vasodilation
47
What is prototype for ACE Inhibitors?
lisinopril (Zestril)
48
How does Lisinopril treat HF?
Ace inhibitor - arteriolar dilation: reduces afterload, increase renal blood flow - Venous dilation = reduces preload - Suppresses Aldostone - prevents cardiac remodeling STOP ANGIE 1. Blocks the conversion of angie 1 to angie 2-> vasodilation and decreased fluid volume 2. Block aldosterone 3. Increase bradykinin
49
3 things that happen when you stop Angiotensin?
1. Blocks the conversion of angie 1 to angie 2-> vasodilation and decreased fluid volume 2. Block aldosterone 3. Increase bradykinin
50
side effects of lisinopril (4)
ACE Inhibitor Dry cough, angioedema, 1st dose hypotension, Increased K+
51
prototype for Angiotensin II Receptor Blockers
valsartan (Diovan)
52
How does valsartan (Diovan) fxn in HF?
Angiotensin II Receptor Blockers block receptors for AT2 (angiotensin II) after it is formed **Many of the same protective qualities of ACE inhibitors but ---doesn’t decrease cardiac remodeling---
53
Who is going to take valsartan (Diovan)?
a non pregnant person who ca't tolerate an ACE inhibitor
54
side effects of valsartan (Diovan)
cough , angioedema and hyperkalemia, hypotension | much less of a problem then ACE
55
what is prototype for Angiotensin Receptor Neprilysin Inhibitor (ARNI)
sacubitril/valsartan (Entresto)
56
how does sacubitril/valsartan (Entresto) fxn?
Angiotensin Receptor Neprilysin Inhibitor (ARNI) -Increases natriuretic peptides by inhibiting neprilysin neprlysin = normally breaks down natriuretic peptide natriuretic peptide = signals body to get rid of fluid -->(so blocking neprlysin = more natriuretic peptide = less fluid) -Suppresses the negative effects of RAAS -Valsartan part = blocks Angie II once formed -Sacubitril = inhibits neprilysin
57
what do neprlysin and natriuretic peptide do normally?
neprlysin = normally breaks down natriuretic peptide natriuretic peptide = signals body to get rid of fluid
58
who is taking sacubitril/valsartan (Entresto) and how are they taking it?
a non pregnant person who ca't tolerate an ACE inhibitor *off ACE for 36 hours before starting sacubitril/valsartan (Entresto)
59
side effects of sacubitril/valsartan (Entresto)?
same as ARBs as it contains a ”sartan” | cough , angioedema and hyperkalemia. hypotension
60
prototype for aldosterone receptor blockers?
spironolactone (Aldactone)
61
spironolactone (Aldactone) falls into what 2 class of drugs?
Aldosterone Receptor Blockers (RAAS) | Potassium Sparing Diuretic (Diuretic)
62
Do. we combine (ARBs) Angiotensin II Receptor Blockers, ACE, and spironalactone
typically not b/c of risk of hyperkalemia
63
How do beta blockers work to treat HF?
- Decreases HR (NEGATIVE CHRONOTROPE) - Slows conduction through myocardium (NEGATIVE DROMOTROPE) - Decreases force of contraction (NEGATIVE IONOTROPE) - Other actions: decreases peripheral vascular resistance over time and block beta1 on juxtaglomerular cells that release renin
64
what is our prototype for beta blockers for HF?
-Metoprolol XL (Lopressor, Topol XL)
65
What is unique about beta blockers for HF?
can worsen HF so only use 3 that are approved for HF carvedilol (Coreg) metoprolol XL (=succinate = long acting) (Toprol-XL) bisoprolol (Zebeta)
66
is Metoprolol XL (Lopressor, Topol XL) used as monotherapy to treat HF?
nope | -Usually used in combination with ACE + diuretics
67
dosage for Metoprolol XL (Lopressor, Topol XL)
- Start with small doses 1/10 or 1/20 and doubled every 2 weeks - -->full benefits not until 3 months out - ->decreasing sympathetic load on heart
68
Side effects of Metoprolol XL (Lopressor, Topol XL)
- Bradycardia - Decreased cardiac output - Watch for S/S of heart failure - AV heart block - slowing connection from SA-AV node through atrium, can have prolongation of PR interval - Rebound cardiac excitation if stop suddenly - May mask SNS s/s of hypoglycemia in diabetics
69
Which HF drug can mask SNS s/s of hypoglycemia in diabetics?
Metoprolol XL (Lopressor, Topol XL)
70
Which HF drug may cause Rebound cardiac excitation if stop suddenly?
Metoprolol XL (Lopressor, Topol XL)
71
Common side effects of Metoprolol XL (Lopressor, Topol XL)?
fatigue, drowsy, dizzy, HA, sexual dysfunction, depression
72
Prototype for HCN Channel Blockers
ivabradine
73
how does ivabradine fxn?
HCN Channel Blockers slows HR by inhibiting channels in the SA Node (decrease conduction) *works similarly to beta blocker
74
who is taking ivabradine?
Used if can't tolerate Beta Blocker! HF +High resting HR (>70)+ Low ejection fraction (<35%)
75
What are HR goals for patient on ivabradine?
-HR Goal is 50-60 w/ this drug
76
side effects of ivabradine
HCN Channel Blockers Bradycardia, HTN w/ renal dysfunction, afib, luminous phenomena (transient enhanced brightness/halos)
77
patient teachings for ivabradine
HCN Channel Blocker - Check radial pulse. Report brady or irregular - Teach about visual changes---transient and will disappear
78
when do we hold Metoprolol XL (Lopressor, Topol XL)
apical pulse <60 bpm
79
patient teaching for Metoprolol XL (Lopressor, Topol XL)
- Check BP and Pulse before admin. - ->Hold if apical pulse <60 bpm - Teach pt not to stop suddenly > wean off medication - Teach diabetics to monitor bld. Sugar more closely and look for other signs of hypoglycemia. - Watch for s/s of heart failure (edema, wt gain, SOB)
80
s/s of heart failure to educate patients about
edema, wt gain, SOB
81
prototype for Cardiac Glycosides
digoxin (Lanoxin)
82
How does digoxin (Lanoxin) fxn?
- slow the heart (neg chronotropic) - ***increase force of contraction (pos. inotropic effect) - Increases CO - Improves Efficiency
83
Which HF drug has narrow therapeutic range?
digoxin (Lanoxin) Cardiac Glycosides
84
what is therapeutic range for digoxin (Lanoxin)
(0.5-0.8ng/ml)
85
what is half life digoxin (Lanoxin)
1/5 days
86
How do we give digoxin (Lanoxin)?
-->Digitalization= gives loading doses of IV digoxin to get to dose faster, then switch to routine dose Routine Dose: 0.125-0.25mg daily
87
What is routine dose for digoxin (Lanoxin)
0.125-0.25mg daily
88
Whats up with K and Digoxin
Hypokalemia increases risk of digoxin toxicity
89
side effects of digoxin?
- Fatigue, drowsiness, dizziness | - cardiac dysrhythmias (AV block, bradycardia)
90
signs of digoxin toxicity?
- Nausea, vomiting - will lose more potassium and get more dig toxic!, anorexia, fatigue - Visual disturbances (yellow/green halos, blurring)
91
digoxin antidote?
digoxin immune Fab (Digibind)
92
patient teaching for digoxin
- Check apical pulse. Hold if <60 - Teach patients to check pulse daily - Teach patients of drug-drug, drug-food interactions p. 540- LONG list - high fiber/bran - antacids
93
2 HF drugs to hold if apical pulse is <60
Digoxin , Metoprolol XL
94
Prototype for direct vasodilators
isosorbide dinitrate (Isordil) and hydralazine
95
if isosorbide dinitrate (Isordil) and hydralazine come in same pill = what is unique about this pill
BiDil clinical trials only for African Americans
96
how do isosorbide dinitrate (Isordil) and hydralazine fxn?
Isosorbide: Causes direct relaxation of venous smooth muscle Hydralazine: causes dilation of arterioles
97
Who takes isosorbide dinitrate (Isordil) and hydralazine
someon who cant take an ACE or an ARB
98
side effects of isosorbide dinitrate (Isordil) and hydralazine
- orthostatic hypotension - Reflex tachycardia - SLE syndrome (hydralazine)

Kol- Pharm 323 Spring (41 decks)

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