Heart Failure Flashcards by Diego Juarez

the equation for cardiac output

CO = SV x HR

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HF patients should limit sodium intake to ______ unless they also have HTN then they should limit it to _________.

2 grams/day
1.5 grams/day

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how often should HF patients monitor their weight?

every morning before eating and after peeing

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when should apatient be concerned when their weight increases?

if within 24 hours they gain 3 pounds or more than 5 pounds in 1 week. They need to see the doctor for decompensation

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What pain medication should be avoided Heart failure?

NSAIDs due to risk of renal insufficiency and fluid retention, should asof avoid ephedrine because of increased morbidty and mortality

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What 2 vaccines are recommended with CHF?

pneumococcal and annual influenza

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What drugs can worsen heart failure?

Verapamil/diltiazem, class 1 anti-arrhythmic, NSAIDs, Triptan migraine drugs, thiazolinediones, excessive alcohol

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what ejection franction defines systolic heart failure (ventricles failiing)?

systolic = < 40%, diastolic > 40%

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What are the 2 mainstays of therapy for HF if not contraindicated?

ACE + BB

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what other classes are added to therapy to the mainstay therapy in HF when needed?

ARBS
aldosertone antagonists
Hydralazine + a nitrate , sometimes digoxin

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Pts with congestive heart failue will also need what?

diuretic - probably loop

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Some pts may receive both ACE and ARB. Whats the problem with this?

both can increase K

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Pts on ACE or ARB should not be using Ms. _____?

Dash - salt substitutes - have more K

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ARBs block the AT II receptors on the ___________________-

smooth muscle wall of the vessel

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candesartan - brand, dosing

Atacand - target dose: 32 mg/day

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DIovan dosing?

Target dose: 160 mg BID (Di=2 = BID)

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Eplerenone is a selective aldosterone blocker therefore it __________________-

has less side effects than spironolactone

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What are the contraindications for K sparing diuretics?

K+ > 5.0 meq/L
Scr > 2.5 mg/dL
CrCl < 30

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what are the 3 most commonly used ACEs for HF? Starting dose and target dose?

Lisinopril 5mg po daily , target: 20 daily
Ramipril 2.5mg daily , t: 10 mg dailiy
Enalaprilat 5 mg t: 10 BID

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when should you DC/ Ace’s arbs?

Pregnancy, angioedema, cough for ace, hyperkalemia

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two most commo n RBs for HF, doses and target doses?

losartan 25mg daily to target 150mg daily
valsartan 40mg bid to 160mg bid

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A triple combo of ACE + ARB + aldosterone antagonist is not recommended because of _____________

high risk of hyperkalemia

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What BB should be avoided in heart failure?

ISA Beta Blockers - CAPP - carteolol, acebutolol, penbutolol, pindolol

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bisoprolol - brand and HF dosing

Zebeta - target dose: 10 mg/d

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counseling pearl for coreg

take with food, all forms

hydralazine is a direct ________ vasodilator which reduces ________.

arterial , afterload

Nitrates are ________ vasodilators which reduce ________.

venous, preload

Hydralazine and nitrates are used in what HF pt group?

those that cannot tolerate ACE / ARB therapy b/c of renal insuff., angioedema, or hyperkalemia

when should nitrates be used alone in tx for HF?

Never! hydralazine is used to improve efficacy and reduce nitrate tolerance

what are side effects of hydralazine?

lupus like syndrome - (report fever, joint/muscle ache, fatigue) reflex tachycardia

what is the role of aldoserterone receptor antagonists in HF?

tx for class 3 or class 4 hf in addition to standard therapy

aldactone

spirionolactone

spironolactone dose and targed dose for HF

12.5 daily goal: 25 daily

contraindiation to sprionolactone

Clcreatienin <30ml/in, hyperkalemia, cyp 34 INHIBITORS

spironolactone side effects?

hyperkalemia, increase SCr, gynecomastia, tenderness, impotence, hirusutism

BBW spironolactone

risk of tumors based on rat models

inspra

eplerenone

how can u reduce the riks of hyperkalemia with potassium sparing diuretics

dont start if potassium is > 5, patient has clcr <30, dont use with NSAIDs

two most commone beta blockers used for hf with doses and target doses?

metoprolol succinate (XL) 12.5 daily t: 200 daily carvedilol start IR 3.125 bid or cr 10mg daily t: IR: 25 bid or 50 bid if > 85, ER: 80mg daily

coreg conversion factor

ir 25mg bid = CR 80mg daily

MOA hydralzaine

arterial vasodilator which decreases after load

MOA of nitrates in HF?

venous vasodilators wihich decrease the preload

what combination of therapy is indicated for AF Am patients w/ class II / IV hf

African Am who are symptomatic despite ACE and BB optimiation : the comb rec is BiDil

Bidil

isosorbide dinitrate and hydralazine

SE of bidily?

Lupus- lik sysndrome : report fever, joint-muscle aches, -Has, reflex tach, dizziness

can you used just hydralazine by itself for therapy w/ hF?

no you must use it with nirtates because using hydralazine with nitrates reduces tolerance of nitrates

what is a major contrainidation of isosorbide mononitrate?

PDE-5 inhibtoors

imdur

isosoribide mononitrate

monoket

isosorbide mononitrate

what is the role of diuretics in HF?

used for symptomatic treatment of fludi overload. Try to avoid side effects, can incerase the dose, swith to IV or add metolzaone for better control

Lasix

furosemide

hydralazine - brand

Apresoline

what are some side effects of isosorbide mononitrate?

HA, dizziness, tachyphylaxis (need 10-12 hour nitrate free interval)

dose equivalencey of furosemide, bumetanide, torsemide

bumetinide 1mg torsemide 20mg furosmeide 40mg

major side effects of loop diuretics

hypokalemia, dec NA, CA, Cl, MG, Ca orthostatic Hypo

what main side effect is important to monitor at high doses of loop diuretics esp ethacryrnic acid?

cuases ototoxicity esp at high doses or rapid IV administration

furosemid IV PO conversion

IV 1 PO 2x the dos e of IV

in what setting can AMG + Loops be dangerous?

in patients w/ impaired renal function, increase risk of ototoxicty so avoid this combo. (unless it is a life threatening situation

What is digoxins role in HF?

symptom improvement, increase exercise tolerance, increase QOL

Digoxin acts as a ____________inotrope and ___________chronotrope.

inotrope (increase contractility and cardiac output) positve chronotrope (decrease HR) negative

what is the most commone digoxin dose? What thereapuetic range?

0.125 mg daily, 0.5 to 0.9 ng/mL

decrease the dose of digoxin by _____% when going from oral to IV

20-25%

what is the antidote for digoxin?

digibind or digiFab

what are the signs of digoxin toxicity?

first - NV, loss of appetitie, bradycardia others - blurred or "yellow" vision, abd pain, confusion, delirium,

hypokalemia, hypercalcemia and digoxin, whats the scoop?

HYPOkalemia and HYPERcalcemia may increase risk of digoxin toxicity

What is a good marker to help identify whether a person is having an acute exacerbation of HF?

BNP : B-type natriuretic peptide and Pro-BNP

For an acute exacerbation of HF, what agents to use?

if fluid overload: IV loop diuretics, can ad metolazone 30 min before loop If congestive sx: can add IV vasodilators-nitroglycerin, nitorpursside or nesiritide. Make sure patient not hypotensive If los bp or sx of low CO (low perfusion) : inotropig drugs dobutamine or milrione to be used

nitroprusside acts where? Brand name? storage?

is an arterial and venous vasodilator = more pronounced effects on blood pressure Nipride protect from light

nesiritide brand name

Natrecor

what does a blue colored solution of nitroprusside indicate?

the drug has degraded to cyanide - do not use

what can you do if you cannot take coreg po easily ?

sprinkle the capsule beads over applesauce and eat right away

MOA of nitroglycerin?

venous dilator

mOA of nesiritide?

it is BNP causese smooth muscle cell relaxation, dec arterial BP

MOA of nitroprusside?

Venous and arterial vasodialtor : stronger effect of nBP

Contraindiation of Nitroglycerin?

SBP < 90mmgHG, PDE5 inhibitos, Increased intracranial pressure

what is advantage of nesiritide?

no developemnt of tolerance to increasing dose

nitroglycerin side effects?

hyotension, HA, dizzy, tachycardia, tachyphylaxis

ci for nitorpursside?

same as nitroglycerin

CI for nesiritide?

SBP < 90 mm HG

Nonpharm rec for HF?

[-monitor weight daily -sodium restriction -avoid alcohol, smoking, drugs -avoid NSAIDS -compliance is KEY

why must coreg be taken with food?

delays absorption so less dizziness

counseling for digoxin

makes heart beat stronger and more regularly keep normal hydration cuz can affect levels N, V, D, loss of appetiet, seeing halos, blurred vission, feeling like passing out: call doctor right away