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Pharm I Fall 2016 NUNM Jensen > Heart Failure > Flashcards

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

St. John's wort side effects?

Arrhythmia and HTN