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Pharm 2024 > PPT 13: CHF > Flashcards

PPT 13: CHF Flashcards

Exam 2 (48 cards)

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1
Q

Define heart failure

A

Heart fails to meet the metabolic demands of tissues - CO inadequate

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2
Q

What is the most common cause of heart failure?

A

Coronary artery disease

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3
Q

Differentiate between systolic and diastolic heart failure

A

Systolic failure – reduced cardiac function
- Acute; heart walls thinned (less effective pumping)
↓ CO, ↓ Ejection fraction

Diastolic failure – reduced cardiac filling (can be peripheral)
- Chronic; heart more stiff/thicker walls (chronic HTN)
- ↓ CO, Normal Ejection fraction
- Does not respond well to positive inotropic drugs

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4
Q

Differentiate between symptoms of right vs left ventricular failure of CHF

A

Right ventricle – peripheral congestion
Left ventricle – pulmonary congestion

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5
Q

Heart failure where the normal CO not sufficient for demands of body

A

“High-output” failure (rare)
- Hyperthyroidism
- Beriberi
- Anemia
- Arteriovenous shunts
Responds poorly to inotropic agents – treat underlying cause

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6
Q

What are the 4 factors of cardiac performance?

A

CO = SV x HR
- Preload
- Afterload
- Contractility
- Heart Rate

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7
Q

Define the Frank-Starling Law

A

Strength of contraction increases when stretched (Rubber band analogy)
- End systolic volume (ESV)
- % of blood remains in ventricles
- ↑%, ↑ pressure

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8
Q

______ is the end diastolic pressure that stretches out ventricles

A

Preload

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9
Q

EDV =

A

Passive filling + atrial contraction + ESV

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10
Q

Stroke volume =

A

EDV – ESV

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11
Q

What is considered altered preload?

A

> 20-25 mm Hg – pulmonary congestion

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12
Q

What are ways to decrease preload?

A

salt restriction, diuretics, venodilation (Nitroglycerin)

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13
Q

_______ is the resistance against which heart must pump blood

A

Afterload

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14
Q

Afterload _____ as CO decreases

A

Increases

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15
Q

Describe the vicious spiral of progression of heart failure

A

Decreased CO
Increased NE, AII, ET
Increased Afterload
Decreased EF
(then back to top)

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16
Q

Contraction of myocytes is called

A

inotropy

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17
Q

What is the first compensatory mechanism to respond to decreased CO?

A

Increased HR

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18
Q

What increases CO? What decreases it?

A

Increases CO: increased preload, contractility, HR
Decreases CO: increased afterload

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19
Q

Discuss the compensatory responses of decreased cardiac output

A
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20
Q

What are the treatment targets for CHF?

Study These Flashcards
A
  • Correcting failure of cardiac contractility (inotropy)
  • Reversing salt and water retention (diet)
  • Unloading stressed myocardium (B-blockers, Ca++ Channel blockers, and diuretics)
21
Q

Which drug therapies directed at non-cardiac targets may be more useful for long-term treatment of heart failure

Study These Flashcards
A
  • ACE inhibitors
  • Angiotensin receptor blockers
  • Aldosterone receptor antagonists
  • Vasodilators
22
Q

Discuss the normal control of cardiac contractility

Study These Flashcards
A
  1. Trigger Ca++ enters cell
    - depends on number of L type channels, duration of channel opening, and sympathetic stimulation
  2. Binds to channel is SR, release stored Ca++
    - depends on amount stored and amount of trigger Ca++
  3. Frees actin to interact with myosin
  4. Removal of Ca++
    - SR Calcium ATPase
    - Na+/Ca2+ antiporter – sodium gradient
    - Na+/K+ ATPase: removes sodium
23
Q

What are the medications used to treat CHF?

Study These Flashcards
A
  1. Calcium (Ca-Chloride, Ca-gluconate)
  2. Cardiac Glycosides (digoxin, digitoxin)
  3. PDE Inhibitors (Milrinone)
  4. Catecholamines
    Others:
    - ACE inhibitors and ARBs
    - Diuretics
    - Calcium sensitizers (Levosimendan)
    - Vasodilators
    - Beta blockers
24
Q

What are the 3 meds to avoid in heart failure? Why?

Study These Flashcards
A
  1. NSAIDS (increases BP)
  2. Thiazolidinediones (fluid retention)
  3. Metformin (lactic acidosis)
25
What are the medications used to treat acute HF?
IV treatment: - Diuretics - Dobutamine - Vasodilators
26
What is the option for treatment of HF with euvolemic hyponatremia?
Conivaptan – ADH inhibitor → removes water, not sodium via urine
27
What are the non-pharmaceutical interventions for HF?
1. LV Reduction Surgery (Batista Procedure) - Poor prognosis, discontinued 2. Skeletal Muscle Augmentation (Cardiomyoplasty) - Invasive, high failure (23% mortality) 3. Chronic Biventricular Resynchronization 4. Cellular Cardiomyoplasty 5. Cardioverter-Defribrilator 6. Heart Transplant
28
_______ is the only oral (+) inotropic agent for HF
Digoxin
29
Digoxin has a ________ therapeutic index
narrow
30
How does digoxin help treat HF?
Positive inotropic, cardiac glycoside - inhibits Na+/K+ ATPase pump
31
What are the electrical effects of digoxin?
↑PR, ↓QT - digitalis effect = downward schwoop of ST segment (Salvador Dali)
32
What are the EKG changes that occur with digoxin toxicity?
tachycardia, fibrillation, arrest
33
What are the pharmacokinetics of digoxin?
A: Well absorbed (Foral = 65-80%) - (may be inactivated by gut bacteria in some) D: Wide in tissues and CNS M: Not extensive in humans (T1/2 = 36-40 hours) E: 2/3 excreted unchanged by kidneys
34
Which electrolyte changes effect digoxin?
1. Hyperkalemia 2. Hypercalcemia 3. Hypomagnesia
35
What effect does hyperkalemia have on digoxin effects?
- Potassium competes with digoxin - Excess K+, decreased effect
36
What effect does hypercalcemia have on digoxin effects?
Increased risk of digoxin induced arrhythmias
37
What effect does hypomagnesia have on digoxin effects?
Increased risk of digoxin induced arrhythmias
38
How do phosphodiesterase inhibitors help treat HF?
Enzymes that inactivate cAMP and cGMP - positive inotropic effects, vasodilation Increase contractility w/o inhibiting Na+/K+ ATPase (increase/prolong Ca++) PDE3 specific
39
Which phosphodiesterase inhibitor helps treat HF?
Milrinone
40
What are the beta adrenergic stimulants used to treat HF?
β1 selective - Dopamine - Dobutamine most widely used (Increased CO and Decreased ventricular filling pressure)
41
What is the advantage of using beta adrenergic stimulants over digoxin?
Less arrythmogenic than digitalis
42
What are the positive inotropic drugs used to treat HF?
Digoxin, phosphodiesterase inhibitors, beta adrenergic stimulants, and calcium sensitizers
43
What are the drugs w/o positive inotropic effects used to treat HF?
Diuretics, ACE inhibitors and ARBs, vasodilators, and beta blockers
44
How are diuretics used to help treat HF?
Reduce salt and water retention - Reduce preload - Reduce edema - Reduce cardiac size - Improved efficiency of cardiac pump
45
How are ACE inhibitors and ARBs used to help treat HF?
Reduce compensatory responses to failure
46
How are vasodilators used to help treat HF?
- Reduction in preload - Reduction in afterload
47
How are beta blockers used to help treat HF?
Decreases stress on heart (force of contraction) and reduction in mortality - Can't be used for severe CHF or acute HF
48
How are Ca++ sensitizers used to help treat HF?
1. Positive inotropic - Bind troponin, stabilize Ca2+ bound conformation 2. Vasodilatory - Open K+ channels (vasodilation) (Not yet approved in USA)

Pharm 2024 (32 decks)

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