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Flashcards in Treatment of HF Deck (50)
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1

Goals of HF treatment

1) Correct underling cause of HF (revascularization for ischemia)

2) Eliminate precipitating factor (infection/anemia)

3) reduce congestion

4) improve blood flow- modulate neurohormonal or devices

2

Purpose of diuretics

Reverse fluid rentention (Na loss)

most common HF therapy

3

Dosing of diuretics

Used chronically + acutely
PO at baseline
IV in hospital (higher dose for renal problem)

4

Side effects of diuretics

dehydration
hypokalemia
sulfa
tinnitus

5

loop diuretics

furosemide
torsemide
bumetanide

non-sulfa = ethacrinic acid

6

Mechanism of diuretics

1) incr salt + water excretion

2) decr intravasc fluid volume

3) decr venous congestion

4) decr dyspnea/edema

7

Effect of diuretics on Starling curve

slight decr in SV for LV end diastolic presure

8

Furosemide vs. Bumetanide vs. Torsemide
location of metabolism

furo= renal
bumet = hepatic
torsemide = hepatic

9

ACE inhibitors

- prils (lisinopril, enalapril, benazepril)

10

what do ACE inhibitors do?

inhibit ACE (block AT1 to ATII)

11

Effects of ACE inhibitors

1) direct vasodilation
2) decr aldosterone activation

12

Side effects of ACE inhibitors

1) hypotension
2) worsening renal function (afferent vasconstriction)
3) hyperkalemia
4) cough (kinin)
5) angioedema

13

ARB = angiotensin receptor blockers

- sartans (valsartan, candesartan, losartan)

14

what do ARB do?

block receptor of angiotensin II

vasodilation
salt/water excretion
K+ retention

15

ARBs equivalent to ___

ACE inhibitor

16

When do you choose ARB vs. ACE inhibitors

when patients develop cough to ACE inhibitor

17

side effects of ARBs

similar to ACE inhibitor BUT NO COUGH

18

Neprilysin inhibitor

New drug = valsartan (ARB)+ socubutril

superior to enalapril (ACE inhibitors)

19

Names of mineraocorticoid receptor antagonists

spironolactone

eplernone

20

function of MRA

block aldosterone receptor

21

Side effects of MRA

hyperkalemia (K+ retention)
gynecomastia (spironolactone only)

22

Beta blockers name

-olols (metoprol, carvedilol, bisoprolol)

23

effect of beta blockers

antagonize effects of sympathetic system (NE/epi)
blocks beta1 and a1 receptor

decr HR, decr arrhythmia, decr metab demand

24

Side effects of beta blockers

1) negative inotrope (short term loss for long-term gain)
- fluid retention
- hypotension
- decr CO --> cardiogenic shock

2) bronchoconstriction by blocking beta2

25

which type of beta blockers to use for asthma

specific beta1 blockers

26

3 major drugs for heart failure

1) ACE inhibitor
2) Beta blockers
3) angiotensin receptor blockers

27

why use vasodilators for HF?

1) arterial vasodilation (antihypertensives)
- decr LV afterload
- decr cardiac work
- less mitral regurg

2) venous vasodilation
- decr preload

3) pulm arterial vasodilation
- decr RV afterload

28

Which GDMT drug plan for NYHA class 1?

1) ACE inhibitor or ARB
2) Beta blocker

29

Which GDMT drug plan for volume overload, NYHA Class 2-4

1) ACE inhibitor or ARB
2) Beta blocker
3) Loop diuretics

30

Which GDMT plan for african americans, NYHA Class 3-4

1) ACE inhibitor or ARB
2) Beta blocker
3) Hydral isosorbide dinitrate