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Pharm I ( Melicia) > Heart Failure > Flashcards

Heart Failure Flashcards

(74 cards)

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1
Q

Primary signs/sxs of HF

A

tachycardia, decreased exercise tolerance, SOB, cardiomegaly, peripheral/pulmonary edema

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2
Q

Compensatory responses in HF

A

increased SNS activity, increased preload, vasoconstriction, ventricular hypertrophy/remodeling

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3
Q

What are the 2 goals of treatment of HF

A
  • reduce sxs and slow progression as much as possible

- manage acute episodes of decompensated failure

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4
Q

Pharmacological tx for stage C HF with reduced EF?

A

Renin-Angiotension System Inhibition with ACE-I or ARB or ARNI

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5
Q

ARNIs should not be given to pts who…

A

are taking an ACE-I

those with hx of angioedema

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6
Q

Ivabradine can be beneficial to which pts?

A

Can reduce HF hospitalizations for pts with symptomatic stable chronic HFrEF who are receiving max dose of BB and are in NSR

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7
Q

What is recommended in additional to standard HF therapy in African American pts?

A

venodilator: hydralazine Isosorbide Dinitrate

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8
Q

MOA of Ivabradine

A

prolongs diastolic time by selectively and specifically inhibiting the Icurrent within the HCN channel, reducing HR

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9
Q

Side effects of Ivabradine

A

dizziness, fatigue

less common: increase BP, visual light disturbances, Afib

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10
Q

contraindications for Ivabradine

A

acute decompensated HF, BO <90/50, sick sinus syndrome, AA block, severe hepatic impairment, PPM dependent

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11
Q

Avoid use of Ivabradine with…

A

strong CYP3A4 inhibitors

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12
Q

Define systolic dysfunction

A

reduced mechanical pumping action and reduced EF

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13
Q

Define diastolic dysfunction

A

stiffening and loss of adequate relaxation —> reduction in filling and CO (EF may be norm)

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14
Q

What are the 4 stages in the ACC/AHA heart failure staging system?

A

Stage A: Pt at high risk for developing HF

Stage B: Pt with structural heart disease but no HF

Stage C: Pt with structural heart disease + current or hx of HF sxs

Stage D: refractory HF requiring specialized interventions

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15
Q

Therapies used in chronic systolic HF

A

diuretics, aldosterone antagonist, ACE-I, ARBs, BB, cardiac glycosides, vasodilators, resynchronization/CCV

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16
Q

Therapies used in acute HF

A

diuretics, vasodilators, beta agonists, bipyridines, natriuretic peptide, LVAD

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17
Q

What lab marker can be used to predict the prognosis and classification of HF?

A

BNP

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18
Q

Na/K ATPase inhibitors- example? MOA?

A

Digoxin

increases Ca, increase cardiac contractility (Chronic HF)

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19
Q

Renal sodium transporter inhibitor- example? MOA?

A

Furosemide, Spironolactone, other diuretics

reduce preload and afterload (acute and chronic HF)

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20
Q

ACE-I: example? MOA?

A

Lisinopril

reduce preload and afterload, reduce remodeling

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21
Q

Vasodilators: example? MOA?

A

Nitroprusside, Nitroglycerine

reduce preload and afterload
acute HF

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22
Q

Phosphodiesterase inhibitors: example? MOA?

A

Milrinone

vasodilation, increase contractility (acute HF)

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23
Q

Natriuretic peptide: example? MOA?

A

Nesiritide

vasodilation reduces preload and afterload; some diuretic effect (acute HF)

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24
Q

HCN:example? MOA?

A

Ivabradine

slows HR

(chronic stable worsening HF)

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25
Where in the nephron does Furosemide act?
loop diuretic decreases NaCl and KCl reabsorption in the thick ascending loop of henle
26
Loop diuretic (Furosemide) toxicities?
hypovolemia, hypokalemia, orthostatic hypotension, ototoxicity avoid in those with sulfa allergy
27
What will happen if you give a higher dose of Furosemide than what is included in the usual range (20-160mg)?
it is not likely that there will be an additional response.
28
HCTZ MOA?
decreases NaCL reabsorption in the distal convoluted tubule | same effect Furosemide but not as strong
29
When should you prescribe HCTZ?
in mild chronic HF, mild-mod HTN, hypercalciuria
30
HCTZ toxicities? contraindications?
hyponatremia, hypokalemia, hyperglycemia, hyperurecemia, hyperlipidemia sulfa allergy
31
What should you monitor in patients on HCTZ?
glucose, uric acid, electrolytes
32
Name an Aldosterone Antagonist. MOA?
Spironolactone blocks aldosterone receptors in collecting tubules of nephron -> increases Na and water excretion, reduces remodeling, reduces mortality
33
When should you use an Aldosterone antagonist (Spironolactone)?
in chronic HF also: aldosteronism, HTN Really good bc it reduces remodeling
34
Aldosterone Antagonist toxicities?
hyperkalemia, antiandrogen actions (i.e gynecomastia), renal toxicity
35
How can you reduce the risk for hyperkalemia with Aldosterone Antagonists?
Start slow and make sure they have a Cr clearance so that the drug can be cleared Avoid K+ supplements, avoid foods high in K+, avoid NSAIDS monitor Cr ~need to give this drug carefully but can be very beneficial
36
Effects of ACE-I
arteriolar and venous dilation, reduces aldosterone secretion, reduces cardiac remodeling
37
Clinical applications for ACE-I?
Chronic HF, HTN, diabetic renal disease
38
ACE-I side effects?
cough, hyperkalemia, angioedema Avoid use with: other angiotensin antagonist
39
When should you use an ARB? side effects?
When pt can't tolerate ACE-I hyperkalemia, angioedema
40
Name a ANRi (Angiotensin Receptor Naprilosin Inhibitor)
Savubitril/valsartan (Entresto)
41
What should you discontinue before starting pt on ANRi?
ACE-I (at least 36 hrs before starting)
42
BB example? MOA?
Carvedilol blocks B1 receptors and alpha1 receptors --> slows HR, reduces BP
43
When should you use a BB?
in chronic HF, slows progression
44
BB side effects?
bronchospasm, bradycardia, AV block, acute cardiac decompensation
45
Name 3 Vasodilators
Veno: Isosorbide Dintrate, Hydralazine Isosorbide Dinitrate, Arterial: Hydralazine
46
Isosorbide dinitrate MOA?
releases nitric oxide- activates guanylyl cyclase -> venodilation: reduces preload and ventricular stretch
47
Side effects of isosorbide dinitrate?
postural hypotension, tachycardia, HA
48
Effect of Hydralazine?
reduces BP and afterload: results in increased CO
49
Side effects of Hydralazine?
tachycardia, fluid retention, lupus like syndrome
50
What class of drug is Nitroprusside in? MOA?
Vasodilator rapid powerful vasodilation reduces preload and afterload
51
When should you use Nitroprusside?
acute severe decompensated failure
52
Nitroprusside toxicities?
excessive hypotension, thiocyanate and cyanide toxicity
53
Can you give Nitroprusside over several days?
NO! Its metabolism causes cyanide
54
Name a cardiac glycoside, MOA?
Digoxin Na/KATPase inhibition results in reduced Ca expulsion and increased Ca stored in SR --> increases cardiac contractility, cardiac parasympathomimetic effect??
55
When can you use Digoxin?
chronic sxs HF rapid ventricular rate in AFib
56
Side effects of Digoxin?
N/V/D cardiac arrhythmias
57
Digoxin dose should be lowered in which pts?
elderly, those with low lean body mass, impaired renal func.
58
Effects of Digoxin on ECG: therapeutic dose, toxic dose?
increases PR interval, decreased QT interval tachycardia, fibrillation, arrest at really high dose
59
Name 2 Beta Adrenoceptor Agonists
Dobutamine, Dopamine
60
Dobutamine MOA?
beta1 selective agonist--> increases cardiac contractility | only use in acute HF
61
Dobutamine toxicities?
arrhythmias
62
Dopamine MOA?
dopamine receptor agonist --> increased renal blood flow, higher doses increase cardiac force and BP
63
When can you use Dopamine?
Acute decompensated HF and shock
64
Dopamine toxicities?
arrhythmias additive effect with sympathomimetics
65
Name a bipyridine, MOA?
inamrinon, milrinone phosophodiesterase type 3 inhibitors- decreased cAMP breakdown---> vasodilators, lower PVR and increased cardiac contractility
66
When can you use bipyridines? toxicities?
acute decompensated HF ( increases mortality in chronic HF) arrhythmia
67
Name a natriuretic peptide, MOA?
Nesiritide activates BNP receptors, increases cZGMP--> vasofilation and diuresis
68
When can use a natriuretic peptide? toxicities?
acute decompensated failure renal damage, hypotension, may increase mortality
69
Ivabradine is a...
HCN I-f inhibitor
70
When can you use Ivabradine?
when pt has sxs of HF that are stable normal HR, taking a BB at highest dose tolerated
71
How should you treat class A HF?
No sxs but risk factors: Treat obesity, HTN, DM, hyperlipidemia, etc.
72
How should you treat class B HF?
sxs with severe exercise: diuretic, ACEI/ARB, BB
73
How should you treat class C HF?
sxs with marked or mild exercise: diuretic, ACEI/ARB/BB + aldosterone antagonist, Digoxin, CRT, hydralazine/nitrate
74
How should you treat class D HF?
drugs from class A-C transplant, LVAD

Pharm I ( Melicia) (18 decks)

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