Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharm II > Heart Failure > Flashcards

Heart Failure Flashcards

1
Q

Goals of therapy

A 
Improve QOL
-Prevention of symptom onset
-Reduction of sx and/or severity of sx
Prolong survival
Slow dz progression
Prevent exacerbations
-Reduce hospitalization
Treat modifiable risk factors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Guidelines for HFpEF

A

Control BP
Use diuretics to control sx due to volume overload
Reasonable to have coronary revascularization in pts with angina/MI that is making HF worse
Manage a fib according to published guidelines

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

Stage A

A

Pts at high risk for HF

Not symptomatic and NO current evidence of structural heart dz

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

Stage A tx

A

Aggressive risk factor control

  • Control HTN per current guideline recommendations
  • Smoking cessation
  • Control dyslipidemia per current guideline recommendations
  • Increased physical activity
  • Encourage weight loss if obese
  • Control diabetes per current guideline recommendations
  • Discourage EtOH and illicit drug use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Stage B

A

Pts with structural heart dz but are asymptomatic

-Previous MI, LV remodeling, low EF, valvular dz

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

Stage B tx

A 
All txs for Stage A
ACE inhibitor or ARB
-Pts s/p ACS/MI or reduced EF
BB (select medications)
-Pts s/p ACS/MI or reduced EF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MOA of BBs

A

Inhibitor/block beta receptors
Net effect:
-Decreased sensivity to circulating catecholamines (SNS)
-Decreased HR/BP

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

Caution for BBs

A

Only initiate beta blocker when HF is stable and pt is euvolemic

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

HF indication for BBs

A

1st line for all pts with HFrEF
-Reduction in all-cause mortality, hospitalizations, improve EF
Not a class effect!! Only 3 meds indicated:
-Carvedilol
-Bisoprolol
-Metoprolol succinate

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

Goal dose carvedilol

A

25 mg PO BID (wt <85 kg)

50 mg PO BID (wt >85 kg)

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

Goal dose bisoprolol

A

10 mg PO daily

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

Goal dose metoprolol succinate

A

200 mg PO daily

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

Side effects of BBs

A 
Depression
Worsening HF sx
Sexual dysfunction
Alterations in glucose metabolism
Bradycardia/hypotension
Bronchospasm
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HF indications for ACE inhibitors

A

1st line for all pts with HFrEF
-Reduction in all-cause mortality and hospitalizations, improved QOL, improved LV side and function, reduces likelihood of developing HF in at risk pts

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

MOA of ACE-Is

A

Block conversion of angiotensin I to angiotensin II
-Decreased vasoconstriction and cardiac remodeling
-Reduction in bradykinin breakdown (increased vasodilation)
Net effect:
-Arterial and venous vasodilation
-Reduction of preload and afterload (reduced workload on heart)

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

Absolute CIs for ACE-Is

A

Hx of angioedema secondary to ACE-I
Pregnancy (category X)
Bilateral renal artery stenosis

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

Relative CIs/SEs of ACE-Is

A 
Cough
Unilateral renal artery stenosis
Renal insufficiency
Hypotension
Hyperkalemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Additional facts of ACE-Is

A

0.5 increase in SrCr is fine, anything above, d/c and try again
K over 5.0, stop drug for a few weeks, and try again
ACE and ARBs are indicated in preventing nephropathy in DM

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

HF indication for ARBs

A

2nd line for all pts with HFrEF who cannot tolerate an ACE inhibitor
Reduction in all-cause mortality and hospitalizations, improved QOL

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

MOA of ARBs

A

Block the AT1 receptor to stop the actions of angiotensin II
Decreased vasoconstriction, aldosterone release, cellular growth promotion
Net effect:
-Arterial and venous vasodilation
-Reduction of preload and afterload (reduced workload on heart)

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

Situations when ACE and ARBs can be combined

A 
Pt already on BB and ACE inhibitor AND
Symptomatic AND
Cannot take an aldosterone antagonist
Carefully monitor K, SCr, BUN
Should not combine ACE inhibitor, ARB and aldosterone antagonist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

SEs of ARBs

A

Similar to ACE-Is
Not associated with cough
Can be considered if ACE-I associated angioedema
-Cross reactivity has been reported

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

Monitoring for ARBs

A

BUN, SCr, K, BP

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

Stage C

A

Pts with structural heart dz AND prior/current sx of HF

-Sx can be classified via NYHA system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Tx for Stage C
``` All tx for Stage A ACEI or ARB BB (select meds) Diuretics Devices -Biventricular pacing -Implantable defibrilators Can add spironolactone or bidil ```
26
HF indication for loop diuretics
Decreases sx associated with fluid retention -Shown to decrease hospitalizations Use in pts with hx of or current sx of fluid retention to maintain euvolemia
27
MOA of loop diuretics
Block Na reabsorption at the thick ascending loop of Henle
28
SEs of loop diuretics
``` Azotemia (increased BUN) Hypokalemia -Arrhythmias Hypomagnesemia AKI Ototoxicity Hypotension Hyperuricemia Hyponatremia Caution in true sulfonamide allergy ```
29
HF indication for aldosterone antagonist
Pts with stage II-IV HFrEF to reduce morbidity and mortality
30
MOA for aldosterone antagonists
Inhibits aldosterone -Increased levels of aldosterone in HF to increase NA/H2O retention and "improve" CO Weak diuretic effect
31
SEs of aldosterone antagonists
Hypotension Hyperkalemia Gynecomastia (spironolone only) Breast tenderness/menstrual irregularities (spironolactone only)
32
Spironolactone initial dose
12.5-25 mg once daily
33
Target/max dose of spironolactone
25 mg once or twice daily
34
Monitoring for spironolactone and eplerenone
BP Electrolytes (K) Baseline 1 wk after starting or changing dose
35
Initial dose of eplerenone
25 mg once daily
36
Max/target dose of eplerenone
50 mg once daily
37
Caution in aldosterone antagonists
SCr >2.5 (men) SCr >2.0 (women) K >5.0
38
HF indication of hydralazine-isosorbide dinitrate
Pts with stage II-IV HFrEF to reduce morbidity and mortality | -First med to show mortality benefit
39
MOA of hydralazine-isosorbide dinitrate
Hydralazine -Directly causes smooth muscle relaxation -Net effect: reduced afterload Isosorbide dinitrate -Activation of guanylate cyclase that causes an increase in cGMP in vascular smooth muscle -Net effect: reduced preload via venous vasodilation
40
Place of hydralazine-isosorbide dinitrate in therapy
Substitute in pts who cannot tolerate either an ACE inhibitor or ARB -ACEI and ARBs are vasodilators that have higher mortality benefit than hydralazine/isosorbide dinitrate Add-on therapy in pts self-described as AA who are on optimal therapy with ACE-I/ARB and BB but still symptomatic -Prospective-randomized trial found more mortality benefit in this pt group
41
HF indication of digoxin
Add-on therapy in pts already on ACE-I/ARB, BB and other mortality benefiting meds who are still symptomatic - Reduction in hospitalizations only - No effect on mortality or dz progression - -If levels >1.2 ng/mL may have increased relative risk of mortality
42
MOA of digoxin
Inhibition of Na/K ATPase pump in myocardial cells leads to increase in intracellular Na leads to increased Ca influx - Neurohormonal modulation - Net effect: Increased contractility (pos inotrope)
43
When to start with a lower dose in digoxin
Age >65-70 yo CrCl <60 mL/min Low lean body mass
44
Dosing of digoxin
0.125-0.25 mg PO once daily Titrate to goal level of 0.5-0.9 ng/mL Can dose every other day in decreased renal function
45
Monitoring of digoxin
If signs of toxicity, change in renal function, new drug interaction, dose change, after IV load (atrial fibrillation)
46
When is cardiac manifestation more likely in digoxin?
Decreased Mg, K, and Ca levels
47
Digoxin toxicity
``` Associated with levels >2.0 ng/mL Fatigue/weakness Confusion Delirium Psychosis N/V/anorexia Visual disturbances -Halos, photophobia, red-green/yellow-green vision Arrhythmias -Vtach, vfib, AV block, sinus brady ```
48
Reversal agent for digoxin
Digibind | Antibody that binds digoxin to be excreted via kidneys
49
Stage D
Pts with significant sx at rest even though on optimal and maximum medical therapy
50
Stage D tx
``` All txs for Stage A-C Heart transplant Chronic inotropic meds Mechanical support Palliative care/hospice ```
51
Causes of HF exacerbation
``` ACS Med nonadherence Na/fluid restriction nonadherence Uncontrolled BP A fib Addition of drugs that worsen HF Pulmonary embolus Infection Excessive EtOH use ```
52
Warm and dry characteristics
Nl pt
53
Warm and wet characteristics
Congestion
54
Cold and dry characteristics
Hypoperfusion
55
Cold and wet characteristics
Congestion and hypoperfusion | Cardiac index is low
56
S/sx of ADHF (acute decompensated HF)
``` Hypoperfusion -Cool extremities -Sleepy -Declining Na levels Congestion -Orthopnea -DOE -High JVP -Pulmonary edema -Peripheral edema -Elevated BNP -Weight gain ```
57
Goals of tx of ADHF
``` Correct underlying precipitating factor Relieve the pt's sx Improve hemodynamics -Optimize chronic oral med regimen -Educate pt on adherence to lifestyle modifications and drug regimen ```
58
Tx of warm and wet
Loop diuretics | +/- vasodilators
59
Tx of cold and dry
Pos inotropes | +/- fluid replacement
60
Tx of cold and wet
Mixture of diuretics, vasodilators, inotropes
61
Diuretics with warm and wet
IV furosemide, bumetanide, torsemide
62
Cautions for diuresing in ADHF
Excessive preload reduction can cause decreased CO -Reflex increase in sympathetic tone Over-diuresis can cause AKI -Monitor SCr/BUN daily to assess intravascular volume depletion Electrolyte depletion -Monitor and replete K and Mg
63
Diuretic resistance
Failure to decrease weight by 0.5 kg (neg fluid balance of 500 mL) after several IV diuretic doses
64
Strategies to overcome diuretic resistance
Increase dose of the diuretic Increase frequency of diuretic administration Change to continuous infusion of loop diuretic Change loop diuretic (furosemide to bumetanide) Combine to loop diuretic with thiazide diuretic
65
Effects of vasodilators for warm and wet
Decreased arterial tone causing decreased SVR and increased CO Decreased wedge pressure and ventricular workload
66
Nitroprusside dose
0.25-3 mcg/kg/min
67
Nitroprusside pearls
Potent venous and arterial vasodilator Cyanide and thiocyanate toxicity -Esp in hepatic/renal insufficient and/or >3 days administration and/or receiving high doses Monitor: BP, HR, liver and kidney
68
Nitro dose
5-200+ mcg/min
69
Nitro pearls
Primary venous vasodilator Tolerance after 12 hrs requiring escalating doses Adverse effects: HA, hypotension, tachycardia Monitor: BP, HR, ECG, change in ischemic sx
70
Nesiritide dose
Bolus: 2 mcg/kg Infusion: 0.01 mcg/kg/min
71
Nesiritide pearls
Recombinant BNP Improves dyspnea and fatigue Adverse effect: hypotension

Pharm II (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions