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Pharmacology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Inability of the heart to maintain adequate cardiac output (CO) to meet the body’s metabolic demands

A

Heart Failure

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2
Q

Most common causes of Heart Failure

A

HTN or CAD

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3
Q

Chronotropy refers to

A

HR

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4
Q

Inotropy refers to

A

strength of contraction

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5
Q

the distending force in diastole (resting force, myocardial compliance, fill vol)

A

Preload

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6
Q

Systemic vascular resistance and capacitance

A

Afterload

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7
Q

____ heart failure occurs when ventricles fill a lot (dilated) but are too weak to contract to pump out enough
results in low ejection frxn

A

Systolic Heart Failure aka Reserved Ejection Frxn (HFrEF)

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8
Q

_____ heart failure occurs when heart muscle is stiff and can’t relax normally. Ventricular hypertrophy results in less blood filling the ventricles but it’s pumped out pretty well
Results in normal ejection frxn

A

Diastolic Heart Failure aka Preserved Ejection Frxn (HFpEF)

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9
Q

Is Reduced Ejection Frxn (HFrEF) systolic or diastolic dysfunction?

A

HFrEF = systolic dysfunction

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10
Q

Is Preserved Ejection Frxn (HFpEF) systolic or diastolic dysfunction?

A

HFpEF = diastolic dysfunction

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11
Q

Ejection frxn </= 40% is what type of heart failure?

A

Reduced Ejection Frxn (HFrEF)

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12
Q

Ejection frx >/= 50% is what type of heart failure?

A

Preserved Ejection Fraction (HFpEF)

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13
Q

Ejection frxns 41-49% are the weird middle ground referred to as borderline ____

A

HFpEF

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14
Q

what is an “improved HFpEF” pt?

A

Someone that shows EF of Preserved but has had Reduced in the past. We treat these ppl as Reduced

EF>/= 50% who has had a prior EF of </= 40%

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15
Q

Alternative to Loop Diuretic for pt with Sulfa Allx

A

Ethacrynic acid

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16
Q

Diogixin Antidote

A

Digibind

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17
Q

Potential alternative in HFrEF if unable to tolerate ACE/ARB/ARNI

A

Hydralazine/Isosorbide

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18
Q

Use ____ adjunct to standard therapy in African Americans with HFrEF

A

Hydralazine/Isosorbide

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19
Q

Hydralazine/Isosorbide should not be used with _____ due to the isosorbide component

A

PDE-5 inhibitors

Meds for: Erectile dysfn, pulm HTN

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20
Q

Hydralazine/Isosorbide MOA

A

Hydralazine: selective arteriolar vasodilator with coronary artery vasodilator properties
- Decr BP & afterload

Isosorbide: nitrate which causes vasodilation of veins (predominate) and arteries via release of nitric oxide
- Decr prelaod

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21
Q

Only used as add-on therapy in HF and atrial fibrillation

A

Cardiac glycoside

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22
Q

Digoxin MOA

A

Inhibits Na+/K+ ATPase in the cardiac tissue. Also has parasympathomimetic activity and prolongs the refractory period of the SA node

(+) Inotrope
(-) Chronotrope
Decr sympathetic tone

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23
Q

Initial vs Secondary Pharm trmnts for HF

A
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24
Q

Which pharm HF trmnts need titrated?

A

BB, ACE/ARB, ARNI, Aldo antag

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25
Q

Loop Diuretics MOA

A

Inhibits Na+, K+, Cl- co-transport in ascending limb of Loop of Henle
- incr Na+ and H2O excretion
- Decr preload/afterload

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26
Q

Loop Diuretics SE

A
  • E- abnorm -> decr K+, Na+, Mg2+, Ca2+
  • Dehydration
  • Nephrotoxicity (Elevated BUN/SCr)
  • Ototoxicity
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27
Q

Loop Diuretics BBW

A

risk of profound diuresis and electrolyte depletion

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28
Q

Beta-Blockers MOA

A

Beta-adrenergic blocker; inhib of B1 receptors slows conduction through AV node

  • (-) chronotrope & Inotrope
  • Supress renin activity (mild)
  • Lowers BP (mild if PO)
  • B2 blockade crossover may cause bronchoconstriction
29
Q

furosemide, torsemide, bumetanide, ethacrynic acid

A

Loop diuretics

30
Q

metoprolol succinate, carvedilol, bisoprolol

A

Beta Blockers “-lol”

31
Q

Beta Blockers SE

A

Fatigue, bradycardia, hypoTN, depression, dyspnea, sexual dysfn

32
Q

Beta Blockers Warnings

A
  • Avoid in pts w/ 2nd or 3rd degree heart block
  • Caution in acute HF -> (-) inotrope may decr CO. Dose is usually cut in ½ for this
  • Caution in pts with hepatic insufficiency
  • May mask symp of hypoglycemia. May block endogenous effect of epi
33
Q

Where are Beta Blockers Metab

A

liver

34
Q

Which Beta Blocker is non-cardioselective and dosed twice daily

A
35
Q

Why do Beta Blockers require taper down over 1-2wks

A

Avoid abrupt disruption -> rebound tachycardia -> MI or acute ischemia

36
Q

Ivrabridine MOA

A

Reduces spon cardiac pacemaker activity at the sinus node

To reduce risk of hosp in patients who:
Have HF w/ EF <35%
HR > 70 bpm on max titrated dose of Beta Blockers

37
Q

Ivrabridine SE

A

Afib
Bradycardia

bc it literally inhibits funny current receptors on SA node & causes latent depolarization

38
Q

Effects of Aldosterone

A
  • Na+ & water retention
  • K+ Excretion
  • Volume incr
  • Vasoconstriction
  • LV dysfunction
39
Q

What does Antiotensin II do to the heart during HF

A
  • Promotes Na+ and water retention (incr preload)
  • Direct vasoconstrictor (incr afterload)
  • Cardiac remodeling
40
Q

benazepril, captopril, enalapril, fosinopril, lisinopril, moexipril, quinapril, ramipril, trandolapril, perindopril

A

ACE Inhibitors “-pril”

41
Q

ACE Inhib MOA

A

prevent the conversion of ANG I -> II by inhib ANG converting enzyme (ACE)

  • Prevents the negative effects of ANG II
  • Results in lower levels of ANG II
42
Q

____ are preferred over ARBs as initial therapy in HFrEF trmnt

A

ACE Inhib

43
Q

ACE Inhib SE

A

HyperK+ (inhibition of RAAS)
HypoTN/orthostatic
Dizziness
Elev serum creatinine
Cough (buildup of bradykinin)

Severe: Angioedema

44
Q

ACE Inhib BBW

A

injury/death to fetus; avoid in pregnancy

45
Q

ACE Inhib considerations

A
  • Do not use in pts with hx of angioedema
  • Should not be combo with an ARB or renin inhibitor. Increased risk of angioedema and hyperK+
  • Caution in renal artery stenosis
  • Caution in renal impairment
  • Enalaprilat is an IV which may be considered in hypertensive crisis
46
Q

losartan, olmesartan, valsartan, candesartan, irbesartan, telmisartan

A

Angiotensin Receptor Blockers (ARBs)

47
Q

ARBs MOA

A

blocks ANG II from binding to ANG II type 1 (AT1) receptors
- Prevents negative effects of ANG II
- Blocks ANG II from its site of action

48
Q

ARBs SE compared to ACE-I

A

Mostly similar
Decreased incidence of cough and angioedema
Increased incidence of hypotension
Olmesartan: enteropathy -> severe, chronic diarrhea

49
Q

ARBs BBW

A

injury/death to fetus; avoid in pregnancy

50
Q

Sacubitril/Valsartan

A

ARNI = ARB/Neprilysin Inhibitor

51
Q

ARNI MOA

A

Sacubitril is a prodrug whose active metabolite inhibits neprilysin. Neprilysin breaks down BNP. BNP is released in response to cardiac distension. BNP causes vasodilation and inhibits renin secretion (inhibits RAAS). BNP decr BP.

ARNI inhibits Neprilysin. BNP is safe to do its job and decr BP

Vasodilation
Decreased sympathetic tone (prevents cardiac remodeling)
Decreased aldosterone levels
Natriuresis/diuresis

52
Q

When to use ARNI

A

For patients with HFrEF in place of ACE or ARB

53
Q

ARNI should not be given within ___ hrs of ACE therapy

A

36

54
Q

Aldosterone Antag MOA

A
  • Aldosterone receptor comp inhibitor
  • Antagonizes effects of Aldosterone
  • Na+ & H2O excretion K+ saving
    decr BP
55
Q

Dose limiting effect of Aldosteorne Antagonists

A

Hyperkalemia

56
Q

When to use Aldosterone Antagonist

A
  • Used as add-on therapy to ACE/ARB in HFrEF with EF <35%
  • Used in HFpEF with elevated BNP
57
Q

Which HF med can cause incr male breast tissue (gynecomastia) due to imbalance of estrogen and testosterone

A

Aldosterone Antagonists (spironolactone, eplerenone)

58
Q

For Aldosterone Antagonists, don’t titrate up if K+ > ____

A

4.5

if K+ is >/= 5: decrease dose

59
Q

SGLT2 Inhibitors MOA

A

Inhibits sodium-glucose cotransporter 2 (SGLT2) in proximal renal tubules

60
Q

Dapagliflozin, empagliflozin

A

SGLT2 Inhibitors
- Increased urinary excretion of glucose
- Reduces sodium reabsorption
- Downregulates sympathetic activity

61
Q

Which HF meds were actually made for DM?

A

SGLT2 Inhibitors
(Dapagliflozin, empagliflozin)

62
Q

SGLT2 Inhibitors SE

A
  • Common: UTI, genitourinary fungal infection, nausea, nasopharyngitis, weight loss
  • Severe: diabetic ketoacidosis, necrotizing fasciitis, hypovolemia, hypersensitivity reactions, bone fractures, acute kidney injury
63
Q

SGLT2 Inhibitors Contraindications

A

Type I DM

64
Q

When to use SGLT2 Inhibitors

A

Add-on to optimized “initial” pharmacologic therapy

65
Q

SGLT2 Inhibitors

Caution with use in ____disease pts

A

Chronic Kidney Disease

Dapagliflozin eGFR needs to be >30 mL/min
Empagliflozin eGFR needs to be >20 mL/min

66
Q

Typical HF med order

A
  1. ACE/ARB
  2. Beta Blocker
  3. Loop Diuretic
  4. Aldosterone Antagonist
  5. SGLT2
67
Q

What do ACE Inhibitors do to Bradykinin

A

it may incr Bradykinin -> vasodilate -> decr BP

68
Q

Which HF med requires a 36hr washout prior to administering

A

ARNIs require a 36hr washout before adminstering after ACE therapy

Pharmacology (14 decks)

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