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Heart Failure Flashcards

1
Q

What the main problem in Heart Failure?

A

decreased cardiac output due to changes in heart leading to a hypoperfused state

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2
Q

what is the CO equation?

A

CO=HR x SV

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3
Q

What is the BP equation?

A

BP= CO x SVR

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4
Q

What does stroke volume depend on?

A

preload contractility afterload

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5
Q

define preload

A

fliling of the ventricle after diastole and before systole

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6
Q

what condition is increased preolad associated with?

A

pulmonary congestion peripheral edema jugular venous pressure increase edema

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7
Q

what is afterload?

A

resistance to ejection

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8
Q

what symptoms are associated with increaseed afterload

A

cold/cool extremities

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9
Q

what lab values can measure contractility?

A

LVEF decreased urine output presence of S3

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10
Q

What are S1, S2, S3, S4 sounds correspond to?

A

S1 closing of the mitral/triscupid valves S2 closing of the aortic and pulmonic valves S3 turbulence with ventricle in early filling S4 sudden contraction of atria in response to ventricular hypertrophy

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11
Q

Signs and symptoms of CHF

A

peripheral edema SOB fatigue Rales and Rhonchi abnormal chest xray (Pulmonary congestion) may have abnormal INR or increased AST ALT may have increased SCr due to dec blood flow to kidney hyperurecemia anemia

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12
Q

what is the MAP equation?

A

DBP + 1/3 PP PP= SBP-DBP

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13
Q

what is the ejection fraction equation?

A

SV/ EDV stroke volume over end diastolic volume

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14
Q

which medications can worsen/precipitate heart failure?

A

NSAIDs- Na/H20 retention, renal failure TZDs: peripheral edema CCB; edema metformin EtOH anthracyclines (“rubicins”) Triptans` Class I, IV and some III antiarrhythmics

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15
Q

what is decompensated heart failure?

A

when the mechanisms to compensate for reducesd CO fail leading to impaired heart function.

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16
Q

In heart failure, what mechanisms occur in compensation?

A

increased size of ventricles to hold more volume increasing mass of ventricles increased sympathetic flow

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17
Q

what can cause decompensated heart failure?

A

Myocardial infarction arrhythmias uncontrolled hypertension excessive fluid and salt intake use of medications that can exacerbate CHF

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18
Q

what five agents are used in Acute decompensated heart failure?

A

IV furosemide milrenone dobutamine nesiritide nitroglycerine

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19
Q

what class of agents can be used in chronic CHF?

A

ACEi/Arbs beta blockers diuretics digoxin vasodilators

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20
Q

what are the advantages of using diuretics in CHF patients?

A

improve symptoms of fluid overload

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21
Q

what are the disadvantages of using diuretics in CHF patients?

A

hypotension hypokalemia hyperglycemia possible metabolic alkalosis (increased H+ excretion) no mortality benefit

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22
Q

what are the advantages of using digoxin in CHF

A

improves symptoms only

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23
Q

what are the disadvantages of using digoxin in CHF

A

no mortality benefit prolongs QT

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24
Q

what are the advantages of using ACE/ARBS in HF

A

decrease mortality prevent progression of HF (dec remodeling) cause vasodilation (dec afterload) decrease aldosterone production (dec na/h2o retention and preload) decrease sympathetic outflow

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25
what are the disadvantages of ACE/ARbs in HF
caution in SCR \> 3.0, K\>5 hyperkalemia risk of angioedema cough with ACEis
26
when should you monitor blood chemistry after changing dose of ACE
1-2 weeks after dose change
27
what are the advantages of using BB in HF?
increase beta receptor density inhibit cardiotoxic effects of catecholamines decreased HR anti ischemia (helps with angina)
28
what should you monitor with pts on BBs?
HR BP weight 1-2 weeks after out patient use
29
what are disavantages of BBs
can cause heart block with other agents should avoid in asthmatic pateitns should not stop abruptly takes 3-6months for sx improvements
30
how do you dose BBs in HF?
start low dose then double q 2 weeks until you reach target
31
what are the symptoms of hypo perfusion
decreased mentation decreased urine output hepatic congestions systemic hypotension
32
what are non pharmacological treatments for CHF (SELF)
avoid excess salt daily weight monitoring ( if \> 2kg inc in 3 days contact provider) no smoking or drinking alcohol 20min x 3 day/week flu shot and pneumococcal vaccine
33
Non pharm tx for CHF ( clinician)
dialysis and ultrafiltration pacemakers, implantable defibrillator (ICD) ventricular arrhythmias cardiac transplant
34
what is the target level to achieve for digoxin tx in CHF?
0.6-0.8ng/ml
35
when should you avoid aldosterone antagonists? what should you monitor?
scr \>2.5 or K \> 5.0 monitor electrolytes every 4 weeks
36
which vessels do nitrates target?
veins
37
which vessels does hydralazine target?
arteries
38
which agents have mixed dilation of veins and arteries
ACE/ARB nitroprusside potassium channel activators
39
milrenone dosing for ADHF
0.375 micrograms/kg/min infusion adjust dose renally
40
dobutamine dosing for ADHF
2.5 micrograms/in infusion
41
nesiritide dosing for ADHF and brand
2 mcg/kg iv push, then 0.01 mcg/kg/min infusion Natrecor
42
nitroglycerin dosing for ADHF
5-10mcg/min infusion
43
dosing for CHF po bumetanide and brand
0.5 to 1.0 mg po qd or bid (oral) 1mg IV load then 0.5-2mg infusion max 10mg/day bumex
44
dosing for CHF po furosemide and brand
20-40mg po qd or bid (oral) 40mg IV load then 10-40mg/hour infusion max 200mg/day Lasix
45
dosing for CHF po Torsemide and brand
5-20mg qd max 200mg/day (oral) 20mg IV load then 5-20mg/hour infusion demadex
46
dosing for CHF po chlorthalidone
12.5-25mg qd , max 100/day
47
dosing for CHF po HCTZ
25mg po qd or bid, max 200/day
48
dosing for CHF po indapamide
2.5mg qd max 5mg qd
49
dosing for CHF po metolazone
2.5mg po qd max 20/day
50
dosing for CHF po spironolactone and brand
25-50 mg po qd , max 50mg/day aldactone
51
dosing for CHF po triamterene
50-75mg bid, max 200mg/day
52
what are the three dosings for sequention nephron blockade
metolazone 2.5-10mg qd +loop HCTZ 25-100mg qd or bid + loop Chlorothiazide IV 500-1000mg qd +loop
53
dosing for CHF po captopril and brand
6.25mg tid capoten
54
dosing for CHF po enalapril
2.5mg bid, max 20 bid
55
dosing for CHF po lisinopril
2.5-5mg qd, max 40 qd prinvil, eztril
56
dosing for CHF po ramipril
1.25-2.5 qd , max 10 qd altace
57
dosing for CHF po candesartan
4-7mg once, max 32 qd atacand
58
dosing for CHF po losartan
25-50mg qd, max 100 qd cozaar
59
dosing for CHF po valsartan
20-40mg bid, max 160mg bid diovan
60
dosing for CHF po eplerenone
25mg qd, max 50mg qd
61
dosing for CHF po carvedilol
3.125 mg bid, max 25bid unless \> 85kg it is 50 bid, with food
62
dosing for CHF po metoprolol succinate
12.5-25mg po qd max 200mg qd toprolol xl and lopressor xl
63
dosing for CHF po bisoprolol
1.25mg qd , max 10mg qd
64
what can cause heart failure?
Hypertension: pumping against high blood pressure hypothyoridism and diabetes: inc workload of heart CAD: reducede blood flow to heart muscle MI: section of heart damaged due to lack of O2
65
why is metoprolol XL used in HF?
because it is beta 1 selective
66
why is carvedilol used in HF
alpha and B1/B2 activity
67
when are spironolactone and eplerenone indicated for HF?
in class III or class IV patients with sxs
68
What is the MOA of digoxin in HF?
increases contractility but decreases heart rate
69
define the NYHA class for HF
Class I asymptomatic and no limits with physical activity, but sx wit strenuous exercise class II Sx of HF with normal activity or moderate exercise Class III sx with minimal exertion & marked limitations with daily activities (bathing dressing) Class IV sx at rest, hospitalized or IV inotropic support
70
what are the dose equivalencies between furosemide, bumetanide, torsemide
Furosemide 40 bumetanide 1 torsemide 20
71
dose of ethacrynic acid in HF and brand
25,50 tabs, 50mg injection edecrin
72
Loop diuretics side effects
hypokalemia orthostatic hypotension hyperuricemia hyperglycemia elevated lipids photosensitivity and rash dec NA, Mg, Cl, Ca ototoxicity especially with ethacrynic acid
73
why are spironolactone and eplernone used in CHF?
not to deplete volume improve sx, increase survival
74
eplerenone dose in CHF and brand
chf post MI 25-50mg/day Inspra
75
what should u monitor for spioronolactone and eplerenone
potassium and crcl (due to inc risk of hyperkalemia donstarte if k \> 5
76
which ACE's or ARBs have higher risk of angioedema?
ACEs\> ARbs. IF ever present, both classes contraindicated
77
what are the sx of angioedema
swelling of lips, mouth, tongue, face or neck can be quickly fatal
78
ACE/ARB counseling points
report any facial swelling D/c if planning to get pregnant potassium level should be checked ace can cause cough, report
79
irbesartan
avapro 150-300mg/day
80
olmesartan
benicar 20-40 once daily
81
telmisartan
micardis 40-80mg/day
82
Benazepril
lotensin 10-40mg/day
83
enalalprilat
vasotec 5-40mg/day
84
fosinopril
monopril 20-80mg/day
85
lisinopril
prinvil, zestril 10-40mg/day
86
quinapril
accupril 40-80mg/day
87
beta blocker side effects
dizziness, decrease HR, fatigue caution with diabetics: covers sx of hypoglycemia
88
toxicity of digoxin
Early : vomiting, loss of appetite, dec HR Severe: visual disturbances,
89
General patient education for patient with CHF
monitor weight daily in the morning before eating, document Restrict sodium in diet avoid smoking , alcohol, illicit drugs do not use NSAIDS or Cox inhibitors
90
Coreg education
-take coreg with food -swallow Coreg CR whole, not to chew or crushed. Can put beads in cold applesauce and eat right away -can make you feel dizzy and tired -can cover hypoglycemic events
91
counseling for digoxin
-makes your heart beat stronger and have a more regular rhythm -keep hydrated -many medications can interact, make sure your doctor knows which medications you are taking
92
what are the side effects of nesiritide?
hypotension, increased scr HA, abdominal pain, insomnia do not use if SBP \< 90
93
what is the MOA of nesiritide
relaxes smooth muscle leading to deccreased systemic arterial pressure, increased diuresis, inc CO

Therapeutics (23 decks)

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