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PHRM 845 > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

two ways that someone dies from HF

A

arrhythmia or pump failure

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2
Q

HFrEF impairment on cardiac function

A

systolic dysfunction, decreased contractility

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3
Q

HFrEF ejection fraction

A

EF<40% w symptoms

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4
Q

HFrEF main cause

A

CAD

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5
Q

HFpEF impairment on cardiac function

A

diastolic dysfunction, impairment on ventricle filling/relaxing

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6
Q

HFpEF ejection fraction

A

EF >50% w symptoms

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7
Q

HFmrEF

A

mildly reduced 41-49%

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8
Q

HFimpEF

A

improved >40% but previously HFrEF

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9
Q

preload

A

venous return, LV end diastolic volume

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10
Q

afterload

A

wall stress

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11
Q

drugs to reduce preload

A

SGLT2, diuretics

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12
Q

drugs to reduce afterload

A

ACE, ARB, ARNI, SGLT2, vasodilators

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13
Q

drug classes that induce HF

A

positive inotropes, cardiotoxins, sodium/water retention

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14
Q

positive inotropes that induce HF

A

beta blockers, antiarrhythmics, CCB (dilt, verap), itraconzole

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15
Q

direct cardiac toxins that induce HF

A

doxorubicin, epirubicin, daunomycin, -ibs, ethanol, cocaine, amphetamines, blue cohosh

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16
Q

sodium load/water retention drugs that induce HF

A

glucocorticoids, androgens, estrogens, NSAIDs, cox2 inhibitors, -glitazone, sodium containing drugs

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17
Q

signs / symptoms pulmonary congestion (wet)

A

exertional dysopnea (DOE), orthopnea, paroxysymal nocturnal dyspnea (PND), bendopnea, rales, pulmonary edema

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18
Q

NYHA Class I

A

cardiac disease without limitations of physical activity

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19
Q

NYHA Class II

A

cardiac disease with slight limitations of physical activity

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20
Q

NYHA Class III

A

cardiac disease with limitations of physical activity

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21
Q

NYHA Class IV

A

cardiac disease with inability to cary on physical activity without discomfort

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22
Q

AHA Stage A

A

High risk developing HF (HTN, CAD, DM)

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23
Q

AHA Stage B

A

structural heart disease but no HF sx (fibrosis, MI hx)

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24
Q

AHA Stage C

A

HF symptoms or prior

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25
Q

AHA Stage D

A

advanced structural heart disease and symptoms at rest despite max therapy

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26
Q

Stage A therapy

A

ACE/ARB

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27
Q

Stage B therapy

A

ACE/ARB, beta blocker

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28
Q

Stage C therapy

A

ARNI/ACE/ARB
beta blocker
SGLT2
MRA
loop diuretic for volume overload

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29
Q

do diuretics reduce mortality?

A

no

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30
Q

who should receive loop diuretics?

A

if experiencing volume overload, want lowest dose possible

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31
Q

MOA loop diuretics

A

increase sodium and water excretion by reducing absorption at ascending limb

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32
Q

loop diuretics release ____ which _____

A

prostaglandins, increase renal blood flow

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33
Q

loop diuretics are blocked by what

A

NSAIDS

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34
Q

thiazide diuretics moa

A

block Na and Cl reabsorption in DCT

35
Q

used in combo with loop in pts resistant to single drug therapy

A

hydrochlorothiazide and metolazone

36
Q

adverse effects diuretics

A

decrease Mg, K+, Na+, increase uric acid

37
Q

if fluid overload want to reduce weight:

A

1-2 lbs/day

38
Q

when do we need electrolyte replacement?

A

K < 4
Mg < 2

39
Q

ACE inhibitors cautions for adding

A

SBP < 80, K >5, SeCr >3

40
Q

what SeCr rise is acceptable?

A

less than or equal to 30%

41
Q

adverse effects ACE

A

hypotension, renal issues, hyperkalemia, skin rash, cough, angioedema

42
Q

sacubitril/valsartan MOA

A

inhibits degraedation of BNP by inhibiting neprilysin, blocks AT1 receptos

43
Q

enalapril __ = captopril ___ = lisinopril ___

A

enalapril 20 = capto 150 = lisinopril 20-40
high dose ACE

44
Q

high dose ACE equivalent dose of entresto

A

49/51 BID
max: 97/103 BID

45
Q

low to medium dose ACE
eGFR <30
age > 75
ACE naive

A

24/26 BID

46
Q

how long to wait after ACE use before taking ARB

A

36 hours

47
Q

should stage b, no sx get ARNI?

A

no

48
Q

beta blockers benefits HF

A

decrease arrhythmias, cardiac remodeling

49
Q

dose conversion carvedilol to Coreg CR

A

3.125 BID = 10 mg daily
6.25 BID = 20 mg daily
12.5 BID = 40 mg daily
25 BID = 80 daily

50
Q

effects of aldoseterone

A

sympathetic activation
parasympathetic inhibition
vascular remodeling

51
Q

MRA effects

A

decrease K and Mg losses
decrease sympathetic simulation
blocks fibrotic action on myocardium

52
Q

avoid MRAs with what labs

A

CrCl<30 or K>5

53
Q

avoid MRAs with what drugs

A

NSAIDS

54
Q

SGLT2s eGFR

A

dapagliflozin > 30
empagliflozin > 20

55
Q

BiDil pts to use

A

african americans needing additional therapy
pts who cant receive ACE/ARB/ARNI

56
Q

Ivabradine use

A

pts with HR >70 on max beta blocker dose

57
Q

ivabradine side effects

A

fetal toxicity, afib, bradycardia

58
Q

digoxin effects

A

increase parasympathetic activity
inhibits Na/K ATPase

59
Q

goal serum digoxin conc

A

0.5-0.9 ng/mL

60
Q

drug interactions with dig

A

amiodarone (doubles dig)
quinadine
verapamil
itra and ketoconazole (doubles dig)

61
Q

what to do when taking amiodarone

A

deecrease dig dose 50%

62
Q

side effects digoxin

A

visual disturbances, anorexia, fatigue, N/V, AV block, bradycardia

63
Q

which drugs should not be used

A

diltiazem, verapamil, nifedipine

64
Q

HFpEF drugs

A

SGLT2 and diuretics mainly
ACE - they don’t reduce mortality

65
Q

acute decomp HF diagnosis

A

BNP >400, altered mental status, cold extremeties, worsening renal function,

66
Q

should you stop beta blockers in decomp hf

A

no unless recent initation led to the decomp
hold if dobutamine needed
do not add/up titrate

67
Q

which therapy of decomp HF reduces mortality

A

none

68
Q

warm and dry treatment

A

optimize chronic therapy

69
Q

warm and wet treatment

A

IV diuretics / IV vasodilator

70
Q

cold and dry treatment

A

SBP > 90 inotrope
SBP < 90 inotrope or arterial vasodilator

71
Q

cold and wet

A

IV diuretics
SBP < 90 inotrope
SBP > 90 arterial vasodilator

72
Q

acute decomp
inital IV diuretic dose should

A

match or exceed chronic dialy dose
given as bolus

73
Q

vasodilators used for which

A

wet, considered over inotropes

74
Q

who should not get vasodilators

A

symptomatic hypotension

75
Q

nitroprusside

A

balanced vasodilator
HTN crisis
cyanide and thiacynanite toxicity

76
Q

nitroglycerin

A

verous preferred vasodilator
ACS and HTN crisis

77
Q

nesiritide

A

balanced vasodilation

78
Q

vasodilator drugs

A

nitroprusside, nitroglycerin, nesiritide, morphine, enalaprilat, hydralazine

79
Q

positive inotrope drugs

A

dobutamine, dopamine, milrinone

80
Q

dobutamine

A

stimulates adenylcyclase to increase cAMP
consider if low BP

81
Q

milrinone

A

PDE inhibitor
venous > arterial vasodilation
consider if on beta blocker or high SVR

82
Q

inotropes are for which pts

A

cold

83
Q

dopamine

A

vasopressor
secondary role to dobutamine/milrinone

PHRM 845 (32 decks)

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