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T&D III exam 1 > Heart Failure > Flashcards

Flashcards in Heart Failure Deck (43):
1

Vasodilators

ACE-I
AT-RB
Hydralazine
organic nitrates
Nitroprusside
Nisiritide

2

Diuretics

Thiazides
Loop
K-sparing (Spironolactone, Eplerenone)

3

Beta-blockers

Carvedilol
Metoprolol
Bisoprolol

4

Positive inotropic drugs

Digoxin (vagomimetic)
Dobutamine
Dopamine (adrenergic agonist)

5

positive inotropic + vasodilator drugs

PDE inhibitors
Milrinone

6

used for acute CHF but not chronic

Sodium nitroprusside

7

Effect of sodium nitroprusside on SV in normal indiv

Decrease

8

Effect of sodium nitroprusside on SV in ptn with severe CHF

Increase

9

Decreased mortality

Hydralazine + ISDN
ACE-I
ARB

10

Chronic CHF

Hydralazine
ACE-I
ARB

arterio > veno

11

Acute and chronic CHF

Organic nitrates

12

Combination used

ACEI / ARBs not tolerated

13

African americans remain sx with

ACEI/ARB, BB, aldo antagonist

14

Nesiritide

Recombinant human B-type natriuretic peptide

15

Tx acute decompensated CHF with dyspnea

Nesiritide

16

MOA Nesiritide

activates GC -- inc cGMP -- vasodilation -- dec afterload and preload

17

inc cAMP in heart vs vascular

heart - contractility
BV - vasodilation

18

PDE-I MOA

inhibit breakdown of cAMP

19

Short term tx of severe acute CHF

ADR?

Milronone, Inamrinone

Proarrhythmic
hypotension
thrombocytopenia

20

tx of compensated CHF

BB

21

Beneficial effect of BB in CHF

antiarrhythmic effects (prevent a-fib)
inh cardiac remodeling
dec myocardial oxygen demand

22

what's important to keep in mind regarding dosing of BB

dose gradually with careful monitoring

23

Direct effect on myocardial contractility

Digoxin

24

How does intracellular calcium increase with Digoxin

inhibit Na/K ATPase, no sodium gradient for the NCX to work -- inc calcium inside

25

Vagomimetic effects seen in

Digoxin

26

SA node with digoxin

vagomimetic

(dec automaticity, dec HR)

27

AV node with digoxin

direct and vagomimetic

(dec AV nodal conduction and causes AV nodal block)

28

How does decreased AV nodal conduction help CHF patients

Controls ventricular rate (keeps it from going too high) when patients go into A-fib

29

EKG on digoxin

increased PR interval

30

does digoxin improve mortality?

no

31

How is digoxin eliminated?

Renally
- must be monitored

32

How is digoxin's absorption affect its use?

Incomplete absorption with narrow therapeutic index - a small shift in dose can have negative effects

33

Tx of digoxin

CHF
Slow ventricular rate in A flutter and fib

34

ADR digoxin

GI
Visual
CNS - nightmares, hallucinations

35

Enhance digoxin toxicity

hypokalemia
dec renal function
hypercalcemia
Acidosis
Hypothyroidism

36

Drug interaction Digoxin

inc tox

K-depleting diuretics
Sympathomimetics

37

dec tox with Digoxin

Chestyramine, colestipol (Resins)

- prevents its absorption

38

Tx of toxicity with Digoxin

Digoxin immune Fab ABs
Tx arrhythmias - lidocaine, atropine

39

what drug decreases vagomimetic effects of Digoxin

atropine

40

Increases contractility, no change in HR. Acts on Beta-1

Tx of decompensated acute CHF

Dobutamine

41

Control congestion

Diuretics - thiazides and loops

42

what is used as an adjunct with diuretics in control of congestion? why?

K-sparing diuretics - prevent hypokalemia

43

Moderate to severe CHF with less than 35% LVEF

ARB
- spironolactone and eplerenone