Flashcards in Heart Failure Deck (41)
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1
What are the recommendations regarding Na+ intake for patients in A/B heart failure vs. C/D heart failure stages?
A/B <1.5g per day
C/D <3g per day
2
What class of drugs is indicated in patients with current or prior symptoms of HF and reduced LVEF who have evidence of fluid retention?
Diuretics
3
What is the MOA for loop diuretics?
Blocks Na+-K+-Cl- cotransporter thus increasing their excretion
4
Why may it be necessary to switch from oral to IV loop diuretics, use alternative forms, or initiate combination therapy in patients with HF?
Diuretic resistance
5
What are three vasodilators used for HF?
Nitroglycerine
Nitroprusside
Nersirtide
6
All three vasodilators for HF decrease preload. Two of them also reduce afterload, which one doesn't?
Nitroglycerine
7
All three vasodilators for HF are indicated for warm and wet ADHF. Which one(s) are an alternative to inotropes in cold and wet ADHF?
Nitroprusside and Nersirtide
8
Beside hypotension, what are the side effects of nitroprusside?
Cyanide or thiocyanate toxicity
9
What are the two inotropes for HF?
Dobutamine and milrinone
10
Dobutamine: MOA?
B 1 agonist
11
Dobutamine: indications?
ADHF: cold and wet or cold and exacerbation
12
Dobutamine: side effects?
Proarrhythmia, tachycardia, hypokalemia, myocardial ischemia, tachyphylaxis, increased mortality
13
Milrinone: MOA?
PDE inhibitor increases CO by decreasing preload and afterload
14
Milrinone: indications?
ADHF: cold and wet or cold and exacerbation
15
Milrinone: side effects?
Proarrhythmia, hypotension, tachycardia, thrombocytopenia, increased mortality with long term use
16
What class of drugs should be used in all patients with a reduced EF to prevent HF and is recommended for all patients with HFrEF?
ACE-I
17
What are ACE-I side effects?
Hypotension, cough, renal effects, angioedema, teratogenic, hyperkalemia, rash, taste disturbances
18
What should be used in patients with HFrEF who are ACE-I intolerant?
ARBs
19
Is it a good idea to routinely combine an ACE-I, ARB, and aldosterone antagonist?
No, it's potentially harmful
20
What are the indications for aldosterone antagonists?
HF w/ LVEF <35%
Following acute MI w/ LVEF <40% w/symptoms of HF or DM
21
What are side effects of aldosterone antagonists?
Hyperkalemia (needs close monitoring)
Gynaecomastia
dizziness, worsening renal function
22
What are the two aldosterone antagonists?
Eplerenone
Spironolactone
23
What is the place of aldosterone antagonists in the order of therapies for HF?
Third-line
24
What are the indications for beta blockers in regard to HF?
MI, reduced EF
25
Which lecture notes are the worst?
These lecture notes (I'm doing my best here people)
26
What is the outcome of adrenergic activation in patients with chronic HF?
Lethal
27
Beta blockers shield the myocardium from the chronically toxic effects of what?
High norepinephrine levels (leading to improved beta stimulation and LV systolic function)
28
What are contraindications for beta blockers?
Cardiogenic shock, bradycardia, 2nd/3rd degree heart block w/o pacemaker, reactive airway disease, hypotension, asthma
29
Isosorbide dinitrate MOA?
Nitric oxide donor
Large and small artery dilator
Venous dilator
30
Hydralazine MOA?
Antioxidant (inhibits destruction of NO)
Arteriolar dilator
31
BiDil MOA?
Fixed dose I/H (I don't know what any of this means)
NO enhancer
32
What are the side effects of hydralazine?
Hypotension, HA, tachycardia, lupus like syndrome
33
What is Digoxin likely MOA?
Neurohormonal inhibition
-decreased sympathetic outflow
-improved baroreceptor function and increased vagal tone
34
Why give digoxin to HF patients?
Improved symptoms, exercise tolerance, quality of life, and fewer hospitalizations, but there is no survival benefit
35
Digoxin side effects?
HA, dizziness, halos, change in colors, anorexia, N/V, diarrhea, constipation, bradycardia, PVCs, arrhythmias
36
What are the risk factors for digoxin toxicity?
Renal insufficiency
Hypokalemia/hyperkalemia
Drug interactions
37
Digoxin interactions?
Increased serum concentrations: Amiodarone, Erythromycin, Itraconazole, Omeprazole
Decreased serum concentration: altered absorption of antacids, colestipol, laxatives
38
Hawthorn indications?
CHF, angina, arrhythmias, hyperlipidemia, Buerger's disease
39
Hawthorne side effects?
Hypotension, palpitations, progression of HF
40
St. John's wort indications?
Depression, anxiety, sleep disorders, HIV
41
