Heart Failure Flashcards Preview

Fall 2014 - Pharm Cardio > Heart Failure > Flashcards

Flashcards in Heart Failure Deck (55):
1

Define Heart Failure

-clinical syndrome or condition caused by heart's inability to generate enough cardia output to meet body's metabolic demands

2

Pathophysiology (Signs and Sxs) of HF

-intravascular and interstitial volume overload: SOB, rales, edema
-manifestations of inadequate tissue perfusion (fatigue, poor exercise tolerance)

3

5 Year Mortality Rate HF

> 50%

4

Causes of HF

-coronary artery disease
-HTN
-idiopathic dilated cardiomyopathy

5

Preload

amount of venous return to heart

6

Afterload

resistance against which the ventricle must pump

7

Contractility

force of contraction

8

What effect do positive inotrope medications have on contractility?

positive inotropes increase contractility

9

Sxs of Heart Failure

-dyspnea, orthopnea, SOB, PND, exercise intolerance, tachypnea
-cough
-fatigue, weakness, lethargy
-nocturia, polyuria
-hemoptysis
-abdominal pain, anorexia, nausea, bloating, ascites

10

Signs of Heart Failure

-rales, S3 gallop
-pleural effusion
-tachycardia
-cardiomegaly
-peripheral edema
-JVD
-hepatojugular reflex, hepatomegaly

11

Lab Tests for HF

-BNP > 100 pg/mL
-EKG
-SCr
-CBC
-CXR
-echocardiogram

12

Stage A HF

-pts at high risk of developing HF but w/o structural heart dz or sxs of HF

-eg pts w/ HTN, DM, obesity, metabolic syndrome, atherosclerotic dz

13

Stage B HF

-pts with structural heart dz but w/o signs or sxs of HF

-eg pts w/ previous MI, LVH, low EF

14

Stage C HF

-pts with structural heart dz with current or prior sxs of HF

-eg pts w/ known structural heart dz and SOB, fatigue, reduced exercise tolerance

15

Stage D HF

-pts with refractory HF requiring specialized interventions

-eg pts with marked sxs at rest despite maximal medical therapy

16

NY Functional Class I

-pts w/ cardiac dz but w/o limitations of physical activity

17

NY Functional Class II

-pts with cardiac dz that results in slight limitations of physical activity (ordinary activity results in fatigue, palpitation, dyspnea and angina)

18

NY Functional Class III

-pts with cardiac dz that results in marked limitation of physical activity

19

NY Functional Class IV

-pts with cardiac dz that results in an inability to carry on physical activity without discomfort

20

Drugs that May Precipitate/Exacerbate HF

-negative inotropic effect (anti-arrhythmics, BB, CCB, terbinafine)
-cardiotoxic: doxorubicin, daunomycin, imatinib, ethanol, amphetamines
-Na and water retention: NSAIDs, COX2 inhibitors, glucocorticoids, androgens, estrogens, salicylates (ASA)

21

Treatment Principles for HF

-optimize preload
-reduce afterload
-increase contractility

22

ACE-I Effect on Ventricular Workload

-decrease preload and afterload

23

ACE-I Benefits for HF

-reduce morbidity and mortality
-reduce hospitalizations in HFrEF
-slow dz progression: decrease or prevent ventricular remodeling

24

ACE-I Recommended for which HF Pts?

-all pts with reduced EF to prevent HF
-all pts with HFrEF unless CI (2/3 tri preg, angioedema, renal artery stenosis, hyperkalemia)

25

Beta Blockers that Are Used in HF

-carvedilol, metoprolol, bisoprolol

26

BBs Effect on Ventricular Workload

-decrease preload and afterload; decrease HR and antiarrhythmic

27

Benefits of BBs in HF

-reduce morbidity and mortality
-reduce hospitalizations
-cause "reverse modeling" of L ventricle; return heart to more normal size, shape, function

28

BBs Recommended for which HF Pts?

-all pts with reduced EF to prevent HF
-all STABLE pts with HF unless CI (eg asthma)

29

How should pharm therapy be initiated with BB for HF?

-start at low doses
-titrate slowly up to target dose and monitor closely

30

Monitoring for BB for HF

-BP
-HR
-fluid status

31

Aldosterone Antagonists MOA

-decrease sodium retention

32

Aldosterone Antagonists Effect on Ventricular Workload

decrease preload

33

Aldosterone Antagonists Benefits in HF

-reduce morbidity and mortality
-reduce hospitalizations

34

Aldosterone Antagonists Recommended for which HF Pts?

-patients with NYHA class II-IV who have LVEF < 35%
-pts after acute MI with LVEF <40% w/ sxs of HF or DM

35

Aldosterone Antagonists Monitoring

-BP
-K+
-renal function (baseline, 3 days, 1 week, qmonth x3 for spironolactone)

36

Diuretics Effect on Ventricular Workload

-decrease preload

37

Diuretics Benefit in HF

-relieve congestive sxs (systemic edema)

38

Diuretics Recommended in which HF Pts?

(Also say which diuretic for mild, mod, severe)

-pts with HFrEF with fluid retention
+mild overload = thiazide
+moderate = loop
+severe = IV furosemide

39

Diuretics Monitoring

-BP
-serum K+

40

ARBs MOA

-block angiotensin II receptor, but do not affect bradykinin
-effect is vasodilation and inhibition of ventricular remodeling

41

ARBs Recommended for which HF Pts?

-pts w/ HFrEF who are ACE-I intolerant
-alternative to ACE-I as first line therapy in HFrEF
-consider in persistently symptomatic pts with HFrEF on guideline directed med therapy

42

Hydralazine/Isosorbide MOA

-hydralazine: direct acting vasodilator = decrease SVR, increase SV and CO
-nitrates: venodilation = decreased preload, may inhibit ventricular remodeling

43

Hydralazine/Isosorbide Recommended for Which HF Pts?

-African Americans with NYHA class III-IV HFrEF
-pts with HFrEF who cannot have ACE-I or ARBs

44

Hydralazine/Isosorbide AEs

-HA
-palpitations
-nasal congestion

45

Digoxin MOA

-positive inotrope = increase contractility

46

Digoxin Benefits in HF

-antiarrhythmic for pts with afib
-alleviates sxs and improves clinical status in pts with HFrEF (decrease hospitalizations)

47

When should dig be used in HF pts?

-add for pts who remain symptomatic despite optimized tx

48

Signs of Digoxin Toxicity

-anorexia
-N/V/D
-tiredness, weakness
-decrease HR
-yellow/green halo vision
-confusion, HA

49

Digoxin Drug Interactions

-verapamil
-captopril
-diuretics
-amiodarone, dronedarone
-clarithromycin, erythromycin

50

Managing Decompensated HF

-hospitalize
-IV loop diuretic for pts w/ sig fluid overload
-IV dobutamine to increase renal blood flow and diuresis
-if symptomatic HoTN is absent, IV NTG, nitroprusside or nesiritide may be considered

51

B-type Natriuretic Peptide Indication

-IV tx of pts with acutely decompensated HF with dyspnea at rest or with minimal activity

52

B-type Natriuretic Peptide MOA

-smooth muscle relaxation
-dilates veins and arteries
-dose dependent decrease in wedge pressure and systemic arterial pressure

53

B-type Natriuretic Peptide Half Life

18 minutes

54

B-type Natriuretic Peptide Elimination

-cell surface clearance receptors
-proteolytic cleavage
-renal filtration
-clearance proportional to body weight

55

B-type Natriuretic Peptide Monitoring

-monitor BP and decrease dose if HoTN develops