HF rx Flashcards
(20 cards)
Specific HF Goals of Rx
- Treat cause of HF
- Elimination of precipitating factors
e. g. infection, anemia, etc - Reduction of congestion
- Improve blood flow
a. Modulate neurohormal activation
b. Devices / transplantation
number one thing for heart failure is to
optimize patients on the frank starling curve, this means that you optimize their volume status
Regardless of HF Type,
give diuretics
Diuretics function to
Reverses fluid retention (Na loss)
diuretic: classes
- Loop diuretics preferred due to potency
(furosemide [Lasix], torsemide, bumetanide, ethacrinic acid) - Can be augmented with a thiazide diuretic
what is the most common HF therapy?
diuretics
diuretic side effects
- dehydration
- hypokalemia
- sulfa
- tinnitis
ACE Inhibitors block
conversion of ATI to ATII
ACE inhibitor effects
Direct vasodilation
Decreased aldosterone activation
Other effects beyond ATII?
ARB effect
block receptor of angiotensin II
ARB clinical use:
In studies have been equivalent to ACEI
Controversial whether use in combination (ARB + ACEI) provides added benefit
Generally used when patients develop cough to ACEI
ARB side effects
- ARBs do not produce kinin potentiation (no cough)
2. Otherwise side effects are similar to ACEI
MRA acts to
block mineralocorticoid receptor
MRA other effects
antifibrotic
MRA side effects
- hyperkalemia (requires close monitoring)
2. gynecomastia (spiro only)
B blocker function is to
Antagonize effect of sypathetic system (epinephrine/norepinephrine)
B blockers block
B1 blockage
a1 blockade
B- blocker: B1 blockade results in
- Negative chronotrope (slow heart rate, less arrhythmia)
2. Negative inotrope (decreased metabolic demand)
B blocker: a1 blockade results in
vasodilation
blocker side effects
- Negative inotrope: short-term loss for long-term gain
a. Fluid retention
b. Hypotension
c. Decreased cardiac output, even cardiogenic shock - Bronchoconstriction
