Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

T/F patients with heart failure all have volume overload

A

FALSE

why the term “heart failure” is actually preferred over CHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

volume coming into ventricles (end diastolic pressure)

A

preload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

resistance - left ventricle must overcome to circulate load

A

afterload

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

percent of left ventricular blood ejected during each systolic contraction

A

ejection fraction (EF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is a normal EF?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is EF calculated?

A

stroke volume/end-diastolic volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

HFrEF

A

systolic dysfunction

heart failure with reduced ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Disease that might lead to HFrEF

A

cardiomyopathies, CAD, valve diseases, arrhythmias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

HFpEF

A

diastolic dysfunction

heart failure with preserved ejection fraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Problem with HFpEF is _______ and problem with HFrEF is _________

A

1) filling (diastolic dysfn)

2) ejection (systolic dysfn)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Disease that might lead to HFpEF

A

chronic hypertension, aortic stenosis, cardiomyopathies (hypertrophic or restrictive)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the Frank-Starling mechanism?

A

the ability of the heart to change its force of contraction and therefore stroke volume in response to changes in venous return

(i.e. incr. venous return to the heart –> incr. SV)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Symptoms of HF

A

FACES

Fatigue
Activity decrease
Cough (esp. supine)
Edema
Shortness of breath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the DIET approach to pt. w/ HF?

A

Diagnose
Initiate (drugs)
Educate (diet, lifestyle)
Titrate (adjust drugs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is EF in HFrEF?

A

= 40%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is EF in HFpEF?

A

> /= 50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which type of HF has actually been studied in clinical trials?

A

Only HFrEF (systolic HF)

To date, efficacious therapies have not been identified for HFpEF (diastolic HF)

**HFpEF is a dx of exclusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Stage A HF (ACC-AHA Classification)

A

High risk for HF, no SHD

HTN, CAD, DM, obesity, metabolic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Stage B HF (ACC-AHA Classification)

A

Asymptomatic HF, +SHD

previous MI, LVH, or low EF, asx valvular dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Stage C HF (ACC-AHA Classification)

A

Symptomatic HF, +SHD

SOB, fatigue, reduced exercise tolerance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Stage D HF (ACC-AHA Classification)

A

Refractory end-stage HF, +SHD

sx at rest despite maximal medical therapy; recurrent hospitalizations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When would you use diuretics in HF?

A

symptomatic benefit in pt. w/ current or prior sx of HF and reduced LVEF who have evidence of fluid retention

should use used along with salt restriction

(in general should not be only therapy in stage C)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is a ceiling dose?

A

eventually, if you keep pushing the dose, you don’t get a greater benefit (this is when you would add another drug)

**Pt. with HF need higher doses of diuretics to get same response, and have diminished responses to ceiling doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

T/F, you cannot use thiazide and loop diuretics in combination

A

FALSE

esp. in pt. with HF that have diuretics resistance to loops, you may need to a thiazide in combo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What monitoring should be done in pt. on diuretics?

A

electrolytes (esp. potassium)

loop diuretics are more powerful than thiazides and must be used with caution to avoid dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is the key point to remember when tx pt. with diuretics?

A

SODIUM RESTRICTION!

if they aren’t restricting sodium, the diuretics may not work b/c water will follow sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Nitroglycerine class

A

Nitrate - vasodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Nitroglycerine MOA (HF)

A

decreases preload

stimulates NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Nitroglycerine indications (HF)

A

warm and wet acute decompensated HF (ADHF), ACS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Nitroglycerine adverse effects

A

hypotension, reflex tachycardia, HA, tachyphylaxis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Nitroprusside class

A

direct vasodilator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Nitroprusside MOA

A

decreases preload and afterload

stimulates NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Nitroprusside indications

A

warm and wet acute decompensated HF (ADHF), alternative to inotropes in cold and wet ADHF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Nitroprusside adverse effects

A

hypotension or cyanide or thiocyanate toxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Nesiritide class

A

vasodilator, cardiac glycoside

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Nesiritide MOA

A

decreases preload and afterload

37
Q

Nesiritide indications

A

warm and wet acute decompensated HF (ADHF), alternative to inotropes

38
Q

Nesiritide adverse effects

A

primarily hypotension (up to 1 hr), tachycardia

39
Q

When would you Rx inotropes?

A

as a LAST resort w/ HF

they have a lot of serious s/e and should NEVER be used in an out-patient setting

40
Q

What are the inotrope drugs talked about in class?

A

dobutamine (B1 agonist) and milrinone (PDE inhibitor –> incr CO)

41
Q

ARNI

A

angiotensin receptor/neprilysin inhibitor

newest drug to hit the market and is going to replace ACEI

significantly decreases mortality rates

42
Q

Which therapy combo has the highest reduction in mortality rates in HF pt?

A

BB + ACEI/ARB + ICD (implantable cardioverter-defibrillator)+ HF educations + anticoagulation for AF

43
Q

When are ACEI indicated with HF?

A

Should be used in all pt. with a reduced EF to prevent HF

Recommended for all pt. with HFrEH

44
Q

ACEI s/e

A

hypotensions, cough, renal effets, angioedema, teratogenic, hyperkalemia, rash and taste disturbance, transient incr. in serum creatinine

45
Q

What do you need to monitor with on ACEI/ARB?

A

BP

BMP (electrolytes) w/in 1-2 wks

46
Q

When is SCr concerning with ACEI/ARB tx?

A

a rise of >/= 0.5 needs evaluation

although expect a transient 20-30% incr in SCr after starting drugs

serum creatinine measures kidney fn

47
Q

What do you need to remember when starting ACEI?

A

start SLOW

titrate every 2-4 wks toward target dose

48
Q

T/F you cannot use ACEI and ARB together?

A

TRUE

it can be harmful to use them in combo

49
Q

When would you use ARB is therapy?

A
  • pt. with HFrEF who are ACEI intolerant
  • reasonable as alternatives to ACEI as first line therapy in HFrEF
  • pt. w/ a hx of MI and reduced EF, should be put on ACEI/ARB to prevent HR
50
Q

How should you initiate ARB tx?

A

slowly

51
Q

What is the recommendation for using ARB and ARNI in combo?

A

ARNI should NOT be administered concomitantly with ACE inhibitors or within 36 hr of the last dose of an ACEI

52
Q

When are aldosterone antagonists recommended clinically?

A
  • pt. with class II-IV HF who have LVEF = 35%

- pt. following an acute MI who have LVEF = 40% with sx of HF or DM

53
Q

Which aldosterone antagonists are commonly used for HF?

A

Spironolactone/Eplerenone are “easy” drugs to prescribe for HF!!!

single dose once daily, no titration necessary

54
Q

What are the cautions with aldosterone antagonists?

A

1) significant risk of hyperkalemia ( > 5%), needs close monitoring!!!
2) 10% risk of gynaecomastia w/ spironolactone (< 1% with eplerenone)

55
Q

C/I to eplerenone

A

1) serum potassium > 5.5 mEq/L at initiation
2) creatinine clearance = 30 mL/min (can start at lower dose if CrCl 31-49 mL/min)
3) concomitant use of CYP3A4 inhibitors

56
Q

C/I to spironolactone

A

1) serum potassium > 5 mEq/L at initiation
2) serum creatinine >2.5 mg/dL at initiation
3) renal insufficiency

57
Q

Monitoring with aldosterone antagonists

A

1) titrate every 4-8 wks twd target dose
2) monitor BMP 3-7 days after start of therapy, the once monthly for 3 mo., then periodically as needed
(significant rights of hyperkalemia)

58
Q

When should you use BB clinically in regards to HF?

A

1) in pt. w/ MI and reduced EF, use BB to prevent HF
2) in all pt. with reduced EF

(use of 1 of the 3 BB proven to reduce mortality is recommended for all stable pt)

59
Q

What are the 3 BB proven to reduce mortality in pt. at risk for HF?

A

bisoprolol, carvedilol, and metoprolol succinate

60
Q

What is a good alternative if pt. is hypotensive on carvedilol or cannot tolerate lower BP?

A

metoprolol succinate

**also good for pt. w/ Afib, COPD, asthma

61
Q

adrenergic activation is lethal in __________

A

chronic HF

(why we use beta-blockers)

*pt. with highest NE levels have worst prognosis

62
Q

BB C/I

A

1) cardiogenic shock
2) symptomatic bradycardia
3) 2nd/3rd degree heart block w/out pacemaker
4) severe reactive airway dz

  • use w/ considerable caution in pt. w/ < 55 bpm or SBP < 80 mmHg
  • NOT recommended in pt. with asthma with active bronchospasm
63
Q

BB s/e

A

1) fatigue, weakness, lassitude
2) fluid retention
3) bradycardia
4) volume overload vs. COPD

64
Q

Introducing BB to pt.

A

titrate every 2-4 wks toward target dose

may need to adjust diuretic dose

65
Q

Monitoring with BB

A

BP, HR, HF sx, weights

66
Q

Hydralazine class

A

arteriolar dilator

antioxidant (inhibits destruction of NO)

67
Q

Isosorbide dinitrate (ISDN) class

A

venous dilator
large and small a. dilator

NO doner

68
Q

BiDil

A

NO enhancer

**This is a combination drug that is a fixed dose of isosorbide dinitrate + hydralazine

69
Q

Hydralazine s/e

A

hypotension, HA, tachycardia (less in HF), lupus like syndrome (+ANA)

70
Q

Nitrates s/e

A

hypotension, HA, flushing, tolerance

71
Q

Hydralazine, ISDN, BiDil are NOT recommended unless

A

pt. are unable to tolerate ACEI

72
Q

When is Digoxin recommended?

A

HF with concurrent Afib

**controversy to use in normal rhythm (SE risk vs. benefit)

73
Q

Digoxin MOA

A

unclear

  • prob. NOT d/t positive inotropic effect
  • likely benefits from neurohormonal inhibition
74
Q

Target peak concentration (Cp) of Digoxin

A

0.5-0.8 ng/mL

75
Q

T/F in clinical trials Digoxin use showed an increase rate of survival

A

FALSE

No survival benefit was seen at 4 yrs (although it did reduce symptomatic progression)

76
Q

Clinical benefits seen from digoxin use

A

1) improved sx
2) improved exercise tolerance
3) improved QOL
4) decr. hospitalizations

***there is NO survival benefit

77
Q

Digoxin s/e

A

CNS = HA, dizziness, halos, changes in yellow/green color perception

GI = anorexia, N/V, diarrhea, constipation

Cardiac = bradycardia (AV block), HR < 50, incr. PR interval

78
Q

Risk factors for digoxin toxicity

A

renal insufficiency, hypokalemia/hyperkalemia, drug interactions

79
Q

Digoxin interactions

A

See incr. serum concentration w/ amiodarone, erythromycin, itraconazole, omeprazole

See decr. serum concentrations w/ antacids, colestipol, laxatives

80
Q

Which HF drugs should be considered in AA population?

A

hydralazine/ISDN

81
Q

If EF < 35% despite optimized std therapy, consider

A

ICD

82
Q

Tx protocol of HFpEF

A

1) tx physological factors (BP, HR, blood volume, ischemia)
2) tx dz known to cz HFpEF (HTN, CAD)
3) use of anticoagulation and anti-arrhythmic recommendations apply to all pt. w/ HF

**lack of randomized controlled trials

83
Q

Hawthorn (Crataegus oxycantha) uses

A

CHF, angina, arrhythmias, hyperlipidemia, Buerger’s dz

84
Q

Hawthorn (Crataegus oxycantha) adverse effects

A

hypotension, palpitations, progression of HF

85
Q

Crataegus oxycantha interactions

A

1) w/ BB, CCB, PDE-5 inhibitors, nitrates - decreases BP, dizziness, and/or light headedness
2) w/ antiplatelet/anticoagulants - incr. bleeding risk

86
Q

Hypericum uses

A

depression, anxiety, sleep d/o, HIV

87
Q

Hypericum s/e

A

arrhythmia and HTN

88
Q

Hypericum interactions

A

w/ Digoxin, Statins, Verapamil, Warfarin, ARB, BB - decr. levels of drug

89
Q

CAMs that may be mechanistically harmful in HF

A

aconite, ginseng, gossypol, gynura, licorice, lily of the valley, tetrandrine, yohimbine

Pharmacology (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions