Treatment of HF Flashcards Preview

SS- Cardio > Treatment of HF > Flashcards

Flashcards in Treatment of HF Deck (27):
1

ACE inhibitors

"pril"
natriuresis, decrease TPR and aldosterone (can have aldosterone escape)
advantages: decrease mortality post MI, preserve renal function in diabetics, little lipid/sexual effects, bradykinin (vasodilator)
decrease preload/afterload
AE: hypotension, Na depletion, dry cough (bradykinin), hyperkalemia, angiodema, renal insufficiency, hepatotoxicity, pancreatitis, increase PGs, FETOTOXICITY
AA/low renin hypertensives respond poorly: add diuretic
many are prodrugs (not captopril and lisinopril)
preferred over ARB (although the two are comparable)

2

ARB

"sartan"
block AT1 receptor: vasodilation and Na/water excretion
reduce preload/afterload
SE: hypotension, hyperkalemia, hepatic, FETOTOXICITY
olmesartan AE: spruelike enteropathy

3

aliskiren

renin inhibitor: inhibits protease activity
vasodilation and natriuresis
ZE: hypotension, hyperkalemia, angiodema, FETOXICITY
DI: inhibit p-gp

4

Tx for class I HF

no symptoms, EF

5

Tx for class II HF

dyspnea on exertion, edema
add diuretic

6

Tx for class III HF

dyspnea, orthopnea, PND, edema
add digoxin and spironolactone

7

Tx for class IV HF

refractory edema
add combination diuretics, IV vasodilators, transplant/assist devices

8

digitalis

also digoxin, digitoxin, ouabain
MOA: increase intercellular availability of Ca via inhibition of Na/K ATPase
toxicity: atrial, ventricular arrhythmias, yellow-green halo, headache, fatigue, drowsy, confusion, seizures
CI (digoxin toxicity): quinidine and amiodarone (decrease elimination), verapamil (slow HR), diuretics (hypokalemia)
does NOT effect mortality

9

digibind

Ab to digoxin

10

B-blockers

attenuate NE/Epi effects
short term: reduce CO, BP (get worsening of symptoms before improvement)
long term: increase CO, decrease LVEDP
improved mortality
CI: heart block, bradycardia, decompensated CHF/need for IV inotropes (dobutamine), volume overload

11

NE/Epi effects on CHF

B-AR down regulation, arrhythmias, increased myocardial consumption/ischemia, mycyte apoptosis followed by cardiac fibrosis

12

B blockers approved for CHF

metoprolol
carvedilol
bisprolol
nebivolol (Europe ONLY)

13

Tx Stage A CHF

at risk
preventative measures (HTN, lipids, smoking, diabetes, EtOH)

14

Tx Stage B CHF

class I CHF
add ACE I/ARB: prevent metabolic stress, apoptosis, remodeling stimulated by angiotensin, aldosterone and NE (prevent decline in cardiac function)

15

Tx Stage C CHF

class II and III CHF
add B blocker, diuretic, digoxin, spironolactone

16

Tx Stage D CHF

class IV CHF
add IV inotrope, transplant
STOP B-blockers

17

diuretics

reduce preload, CO NOT increased
no improved survival
AE: electrolyte disturbance, hypokalemia, hyponatremia, hypochloremic metabolic alkalosis, azotemia (high NO in blood), dehydration, hypotension
DI: NSAIDs reduce efficacy (promote fluid retention)
reduce dose with ACE I/ ARB (both have mild diuretic effects)

18

spironolactone/eplerenone

ONLY diuretics that improve prognosis of CHF
K sparing
block aldosterone effects
use in combo with loop diuretics

19

furosemide/ bumetanide

high ceiling (loop) diuretic
AE: ototoxicity

20

triamterene, amioloride

K sparing diuretics
amioloride NOT used in CHF
used in combo with loop diuretics

21

nitrate

venodilator: reduce preload/afterload
reduce pulmonary congestion and LV filling pressure/wall stress

22

hydralazine

arterial vasodilator: increase CO
reduce preload
effective in CHF but: stimulates RAS, variability in dose
AE: nausea, anorexia, +FANA, drug induced lupus, exacerbate angina (coronary steal)
use: limited to patients than are unable to tolerate ACE I
other vasodilators not effective in CHF (ex: parson, minoxidil, dihydropyrindine)

23

nitroprusside

veno and vasodilator: reduce preload and afterload

24

dobutamine

IV
B agonist (B1>B2), alpha 1 agonist, postive inotrope, vasodilator
limited by B-AR desensitization, arrhythmias
CI: B blocker prevents vasodilator effect of dobutamine and can cause vasoconstriction

25

milirinone

IV
PDE inhibitor: cAMP is not degraded: inotropic
decrease after load
long term use: increases mortality in CHF

26

nesiritide

recombinant B-type natriuretic peptide
reduce preload and after load
use: limited to those that do not respond to nitroglycerin
AE: hyoptension

27

B-type natriuretic peptide and Atrial natriuretic peptide

released from atria in response to volume/pressure increase
elevated in CHF
promotes vasodilation, venodilation, natriuresis
reduce preload, inhibit renin and aldosterone, afferent arteriolar vasodilation, inhibits Na reabsorption