HF Flashcards
(148 cards)
1
Q
ventricular filing –
A
diastolic dysfunction
2
Q
myocardial contractility
A
systolic dysfunction
3
Q
current understanding of HF Is described by:
A
neurohormonal model
4
Q
neurohormone activation:
A
norepinephrine
angiotensin II
aldosteorne
proinflammatory cytokines
5
Q
HF targeted pharmacotherapy taht antagonized ___
A
neurohormonal activation
6
Q
diastolic dysfunction =
A
HF w/ preserved EF (HFpEF)
7
Q
systolic dysfunction:
A
HF w/ reduced EF (HFrEF)
8
Q
most trials include patients w/ ___
A
HFrEF
9
Q
NYHA classification I
A
patients with cardiac disease but without limitations of physical activity
10
Q
NYHA II
A
patients with cardiac disease that results in slight limitations of physical activity
11
Q
NYHA III
A
patients with cardiac disease that result in marked limitation of physical activity
12
Q
NYHA IV
A
short timepatients with cardiac disease that result in inability to carry on physical activity w/o discomfort
13
Q
NYHA states that symptoms may change over ___
A
short time
14
Q
ACC/AHA stage A
A
patients at risk for developing HF
15
Q
ACC/AHA B
A
patients w/ structural heart disease but no HF signs of sx
16
Q
ACC/AHA C
A
patients with structural heart disease and current or previous symptoms
17
Q
ACC/AHA D
A
refractory HF requiring specialized interventions
18
Q
in ACC/AHA stage will not change. – consistent with
A
progressive nature of HF
19
Q
majority of trials have been geared toward
A
systolic dysfunction patients
20
Q
new medications for systolic dysfunction
A
ivabradine (coplanar)
sacubitril/valsartan (Entresto)
21
Q
Diuretics are indicated in all patients with ___
A
evidence of h/o fluid retention
22
Q
monitor effect of diuretics by ___
A
daily morning weight measurements
23
Q
thiazide diuretics are __ diuretics
A
weak
24
Q
metolazone may be a dded to loops for ___
A
diuretic resistance
2.5-19mg once daily PLUS loop diuretic
25
most potent diuretic
loop
26
ceiling effect of loop diuretics
give ceiling dose more frequently rather than increasing dose
27
torsemide is preferred in patients with ___
persistent fluid retention despite high doses of other loops
28
___mg lasix = ___ mg torsemide = ___ mg bumetanide
40; 20; 1
29
dose of chlorthalidone and metolazone
daily
30
cornerstone of HF therapy
ACEI
31
first line therapy in patients with systolic HF
ACEI
32
ACEI in HF reduces mortality by ___
20-30% vs placebo
33
for HF, use ACEI w/ ___
beta blocker unless contraindicated
34
add beta blocker after ___
titrating maximal ACEI dose
| even if ACEI dose is < recommended max
35
with ACEI, monitor ___
serum K and renal function
36
abrupt withdrawal of ACEI may precipitate ___
decompensation
37
ACEI adverse effects
hypotension
functional renal insufficiency
cough (dry, hacking)
angioedema
38
to combat ACEI induced hypotension:
spread other vasoactive meds throughout the day (not all at once)
39
to combat ACEI induced hypotension, start on
catopril, titrate to max, then switch to ACEI w/ once daily dosing
40
if cough using ACEI, consider ___
substituting ARB
41
if angioedema with ACEI,
lifetime avoidance of ACEI
42
use beta blockers in all ___
stable HF pts unless intolerant or contraindicated
43
BBs that have demonstrated decreased mortality in HF
bisoprolol
carvedilol
metoprolol succinate (not IR metoprolol tartare)
44
carvedilol blocks ____
b1, b2 and a1 receptors (nonselective)
45
carvedilol may be preferred in patients with ___
poorly controlled BP (due to a and b1 blockade)
46
avoid carvedilol in ___
asthmatics (because they use beta 2 agonists)
47
begin beta blockers at very low doses with ____
gradual titration to max doses
48
delay dose increase of BB until ___ have disappeared
AEs
49
continue long term treatment with BB , even ____
if symptoms do not improve
50
abrupt withdrawal of BB may cause ___
acute decompensation
| taper if discontinued
51
BBs used for HF
bisoprolol
carvedilol
metoprolol
52
benefits of BB in pts with HF and reduced ejection fraction seem to be mainly due to ___
class effect
53
Major AE of BB used for HF
fluid retention
fatigue
bradycardia
hypotension
54
Minor AE of BB used for HF
bronchospasm (in asthma pts)
worsening glucose tolerance
sexual dysfunction in males
55
BB worsen glucose tolerance in diabetics and may mask sx of
tachycardia
tremor
BUT NOT SWEATING
56
ARBs inhibit ___ at its receptor
angiotensin II
57
ARBs do not inhibit _____
bradykinin metabolism (so no increase in bradykinin)
58
ARBs produce less ___ and __
cough and angioedema
59
combined use of ace and arb is potentially ___
harmful -- no longer recommended
60
when using ARBs, ___ may still occur but less than with ACEs
angioedema
61
angioedema using ARBs happens more frequently in ___
blacks
62
as with ACEI's, start ___ before reaching max ARB dose
BB
63
starting requirement for an aldosterone receptor antagonist (ARA)
SCr of <2.5 mg/dl (M)
SCr <2 mg/dl (F)
CrCl >30
Serum K <5
64
Aldosterone Receptor Antagonists (ARA)
spironolactone (aldactone)
| Eplerenone (Inspra)
65
discotinue ___ after starting an ARA
potassium supplements
66
counsel patients to stop ARAs during episodes of:
diarrhea
dehydration
interruptions of diuretic therapy
67
AE of Spironolactone
gynecomastia
| hyperkalemia
68
up t o 35% of patients in the general population are
hyperkalemic
69
AE of epleronone
hyperkalemia
| gynecomastia
70
serious hyperkalemia using epleronone
serum k >6 (discontinue ARA)
71
mild hyperkalemia using
serum K >5.5 (discontinue ARA or decrease dose)
72
only orally active positive cardiac inotrope
digoxin
73
digoxin does not ____
decrease mortality in HF
74
digoxin may improve:
LVEF
quality of life
exercise tolerance and
HF sx
75
loading dose of ___ for A-fib is not recomended
digoxin
76
target plasma levels when using digoxin
0.5-1.0 ng/mL
| higher levels off plasma increase mortality
77
toxicity with digoxin occur earlier with :
hypokalemia, hypomagnesemeia, hypothyroidism
78
obtain first dose of digoxin ____
3-5 days after starting therapy
79
check plasma levels _____ after dosage of digoxin changes
5-7 days
80
draw plasma levels ___ after previous dose of digoxin
6-8 hours
81
adverse effects of digoxin for HF
cardiac arrythmias
GI sx
neurological coplaints
82
neurological complaints using digoxin
visual disturbance
| altered color perception (blue/green & yellow halos)
83
hydralazine is a potent ____
arterial vasodilator
84
hydralazine is an ___
afterload reducer
85
isosorbide dinitrate is a potent ___
venous vasodilator
86
isosorbide dinitrite is an ___
preload reducer
87
H/ISDN is demonstrated to be especially useful in ___
AA with HF
88
start H/IDSN on all ___
AA on optimum therapy w/ ACEI & BB unless contraindicated
89
start H/ISDN on non AA's intolerant to/ or contraindicated for ___
ACEI/ARB
90
unique MOA for Ivabradine
deceases HR by inhibiting If pacemaker current in SA Node
91
Ivabradine reduces risk fo ___
hospitalization for worsening HF
92
class for Sacubitril/Valsartan
new class -- angiotensin receptor-Neprilysin inhibitor (ARNI
93
entrust lowered CV mortality by ___
20%
94
AMI medications
```
Oxygen
Nitrates
Analgesia
BB
CCB
Other anti-ischemic
cholesterol lowering agents
RAAS inhibitors
anti-platelet agents
parenteral anticoagulation
```
95
administer supplemental o2 to AMI patients with
o2 sat <90%
respiratory distress
other high-risk features of hypoxemia
96
oxygen may have negative effects in ___
coronary patients
97
oxygen can cause ___ in coronary patients
increased coronary vascular resistance
reduced coronary blood flow
increased risk of mortality
significantly LARGER infarct sizes than non-oxygen group
98
administer supplemental o2 to AMI pts with ___
o2 sat <90%
respiratory distress
other high-risk features of hypoxemia
99
oxygen may have negative effects in ___
coronary patients
100
o2 can cause increased ___
coronary vascular resistance
101
o2 can cause reduced ___`
coronary blood flow
102
o2 has increased risk of mortality in ___
coronary patietns
103
o2 can cause significantly larger ___
infarct sizes
104
MOA of nitrates
dilate capacitance vessels (decrease preload)
105
for continued chest pain, administer
SL nitroglycerin
0.3-0.4 mgQ5 min x 3
then assess for IV NTG
106
do not give nitrates if pt is on ___
phosphodiesterase inhibitors (ED med)
107
do not give nitrates if pt was on ____ over the last 24 hours
sildenafil, vardeniafil
108
do not give nitrates if pt was on ___ over last 48 hrs
tadalafil
109
reason you cannot give nitrates to patients on phosphodiesterase inhibitors
potential marked decrease in BP
110
____ may be given IVP for continued chest pain if already on max tolerated NTG
morphine sulfate
111
analgelsia for HF
```
morphine sulfate
traditional NSAIDs (NOT aspirin) & COX-2 inhibitors
```
112
NSAIDs actually enhance platelet aggregation by ___
inhibiting PG synthesis
113
NSAIDs should be ___ in AMI patients
avoided
114
__ is ok for anti-platelet effects in AMI pts
aspirin (low-dose)
115
begin ___ within 24h in all AMI pts
BBs PO
116
AMI pts with stable HF should be continued on:
metoprolol succinate, carvedilol, bisprolol
117
why avoid IV BBs?
may increase risk of shock
118
give CCB to ischemic patients:
with contraindications to BB
unacceptable side-effects of BBs
with continued pain after appropriate use of BBs and nitrates
119
use non-dihydropyridin CCBs as initial therapy
ORAL verapamil
| ORAL diltiazem
120
Immediate release nifedipine should nOT be used due to ___
causes dose-related increase in mortality in CAD and harm in ACS pts
121
abtianginal with minimal effects on HR and BP
ranolazine
122
A/E of Ranolazine
constipation
| dose-related QT prolongation (not sufficient for dose reduction in RCTs)
123
high intensity statin therapy
atorvastatin titrate 10-80mg PO once daily
| rosuvastatin titrate 5-40mg PO once daily
124
start ACE-I in all pts w/ LVEF < __
40% -- continue indefinitely
125
start ACEI in hospital with __ or ___ and switch to long acting ACE-I at max
catopril (TID)or enalapril (BID)
126
use ___ in those intolerant or those with c/I to ACEI
ARB
127
use ___ to those on therapeutic doses of ACE-I and BB
ARAs
128
acute need for anti-platelet agents:
give non-enteric-coated chewable aspirin (162-324mg)
129
do not order enteric-coated ASA acutely because...
delays absorption
130
in patients who acutely need anti-platelt therapy and are intolerant to aspirin, give:
clopidogrel
131
for chronic anti platelet:
give aspirin 81-325mg PO daily indefinitely PLUS
| up to 12 mo, either p2y12 aspirin receptor inhibitor
132
p2y12 aspirin receptor inhibitors
clopidogrel (daily)
| ticagrelor (BID)
133
___ is not recommended for chronic anti-platelet therapy
prasugrel
134
prasugrel increases risk of :
spontaneous bleeding, life -threatening bleeding and fatal bleeding
135
parenteral anticoag
in addition to anti platelet therapy, anticoagulation is recommended for all pts
136
enoxaprin is preferred ___
LMWH for ACS
137
avoid LMWH in ___
dialysis pts w/ ACS
138
bivalrudin is usually used in ___
Cath labs
139
potential advantages of bivalrudin
will bind to clot - bound thrombin
| no significant protein binding (more predictable anticoagulant response)
140
synthetic pentasaccharide (selective xa inhibitor)
fondaparinux
141
fondaparinux shows little risk for __
HITT
142
fondaparinux is c/I for ___
CrCl <30 mL/min (increased risk of bleeding)
| use w/ caution for CrCl 30-50 mL/min
143
UFH has a relatively short half life:
~1.5h
144
can d/c IV heparin for ___
urgent interventions
145
____ recommended over fixed dose of heparin
weight-based regimen
146
max initial bolus of IV heparin
4,000 units
147
max initial maintenance infusion of heparin
1,000 units/h
148
parenteral anticoagulation used in pts w h/o HITT undergoing PCI
argatroban
