L12-Heart Failure Flashcards Preview

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Flashcards in L12-Heart Failure Deck (16):
1

List NHPs discussed in this lecture

1. PUFAs
2. Coenzyme Q-10
3. Vit D
4. Vit E
5. Hawthorn
6. Herbal diuretics
7. L-carnitine
8. L-arginine

2

Concerns w/ NHPs & HF

- Potential for bleeding or clotting
• NHPs can increase or decrease BP
• NHPs can cause/exacerbate fluid retention
• Stimulants (e.g. weight loss products)
• On drugs with narrow therapeutic index (eg. Digoxin)
• NHPs with diuretic properties can cause hypokalemia
• Dehydration with stimulant laxatives (diarrhea)

3

1. PUFA
List some.
Which ones are beneficial?

ALA, DHA, EPA
Beneficial ones= DHA, EPA
NS: fish oil, flax seed, canola oil, soybeans

4

1. PUFA
MOA?

May reduce risk of coronary outcomes and overall mortality by:
1. Lower triglyceride levels (at higher doses)
2. Prevent serious arrthymias
3. Decrease platelet aggregation (but maybe only at higher doses)
4. Lower blood pressure
5. Lower resting heart rate

5

1. PUFA
safety?

Generally well tolerated 3-4 g/day
• AE: “fish burp”, halitosis, heartburn, dyspnea, nausea, loose stools and rash
• Proposed benefit shown in baked/broiled, not fried

6

1. PUFA
O3 Canada's Food Guide & American Heart Association recommendation

consumption of 2+ portions of fish per week for 1 and 2ndary prevention of CVD

7

1. PUFA
CCS HF guideline update recommends:

We suggest O3 PUFA therapy at a dose of 1 g daily
be considered for reduction in morbidity and cardiovascular mortality in patients with HFrEF
(Weak Recommendation, Moderate Quality Evidence)

8

2. Coenzyme Q-10
Describe

Vitamin-like
compound found in the body: found in high conc.
in the mitochondria
of the heart, liver & kidney
NS: meats & seafood (small amounts)

9

2. Coenzyme Q-10
MOA?

-helps w/ the prod’n of ATP & inhibition of ATP production can cause cell death and tissue damage.
-HF pt have lower serum levels & replacing might improve cellular energy production and prevent cell death in people with HF.

10

2. Coenzyme Q-10
Other uses.

prevent statin-induced myopathies, prevent doxorubicin-induced cardiotoxicity, immune stimulation in HIV/AIDS pts, and treatment of muscular dystrophy.

11

2. Coenzyme Q-10
safety?

no toxicity, but conducted in an era where ACEi, BB, MRAs NOT STD HF tx
SE: GI

12

2. Coenzyme Q-10
DIs?

1. Warfarin (decreased effect due to structural similarity to Vitamin K)
2. Potentiate the anti-hypertensive effects of some blood pressuring lowering drugs

13

3. Vit D
Why?

-ppl w low levels have signif increased risk of developing cdv disease, including HF (compared to those w higher)
for now, advise pts to get appropraite amount of Vit D, but dont recommend specifically to tx HF (but also no harm)

14

4. Vit E
T/F: Vit E has no role in HF

TRUE
pts on Vit E had higher risk of developing HF and HF hospitalization
-> 50% increase in chronic HF hospitalization or death in pts w LV dysfunction
->high doses may increase all-cause mortality

15

5. Hawthorn

-cardiac glycoside like dig
-long hx of use in cdv disease (some countries is 1st Rx product)
-pharm effect comes from flavonoids found in leaf, fruit, or flower of these plants

16

5. Hawthorn

-note: dig can decrease hosp, but not mortality
-> hawthorn may be similar to dig in MOA;
-can have pos inotroph effects and increased CO ; VD effects (dont use w nitrates)
-can affect bp, contractility (can decrease bp and hr; watch with other anti-HTN)
-not recommended in HF (but not rigorously studied)