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Pharmacology III > Block II: HF > Flashcards

Block II: HF Flashcards

1
Q

Describe HFrEF

A

EF < 40%
decreased in V ability to contract
systolic failure

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2
Q

Describe HFpEF

A

Normal EF, EF > 50%
Decreased ability to fill
Diastolic failure

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3
Q

BNP of [] is less likely to indicate HF

A

BNP < 100

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4
Q

BNP of [] is more likely to indicate HF

A

BNP > 400

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5
Q

Where do diuretics play a role in HF?

A

Can treat HF patients with fluid retention, overload

ONLY symptomatic, do NOT decrease Morbidity/mortality

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6
Q

MOA Loop diuretics

A
  1. increase Na excretion by 20-25%
  2. Increase free water clearance (increase urination)
  3. maintain effects unless renal function sig. impaired
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7
Q

MOA Thiazides

A
  1. increase Na excretion by 5-10%
  2. decrease free water clearance
  3. lose efficacy with impaired renal function
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8
Q

if pt. is hospitalized with symptomatic fluid retention, what drug should they receive?

A

IV loop

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9
Q

SE diuretics

A
  1. hypotension
  2. renal dysfunction
  3. electrolyte disturbance
  4. hearing diff. if IV pushed too quickly
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10
Q

Role/benefits ACEI in HFpEF

A

decrease production aldosterone, decrease BP and Na+, decrease fluid overload via excretion Na and water

decrease ventricular remodeling

decrease hypertrophy

decrease NE release (anti-adrenergic)

decrease myocyte death

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11
Q

[] should be initiated in all HFrEF pts first line (esp. with left ventricular dysfunction)

A

ACEI

reduce morbidity and mortality, may slow disease progression

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12
Q

SE ACEI

A
  1. angioedema
  2. cough
  3. hypokalemia
  4. decrease renal function (widen efferent arteriole, decrease P in glomerulus)
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13
Q

What can be used first line if ACEI not tolerated or CI

A

ARB

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14
Q

role ARB in HFrEF

A

block vasoconstriction & aldosterone secreting effects aniotensin II (block receptor on target cell)

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15
Q

SE ARB

A
  1. hypotension
  2. hypokalmia
  3. worsening renal function
    * LESS Likely to prod. angioedema
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16
Q

Role Sacubatril/Valsartan

A

ARNI!!
Should be used first line (instead on ACEI) in ALL pts. who can afford

Decreases morbidity and mortality

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17
Q

MOA ARNI

A
  1. Sacubatril: inhibits enzyme that breaks down, BNP (with reverses RAAS)
  2. Valsartan: ARB
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18
Q

CI ARNI

A
  1. Hx angioedema with ACEI/ARB (ARB in it)
  2. pt. on ACEI (increases rx angioedema)
  3. pregnancy
  4. aliskiren (renin inhib)
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19
Q

SE ARNI

A
  1. hypotension
  2. hypokalemia
  3. cough
  4. dizziness
  5. renal failure
  6. angio (rare)
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20
Q

How long should you wait to start an ARNI after taking ACEI

A

36 hr. washout period

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21
Q

What is the role BB in HFrEF

A

inhibit sympathetic activation, inhibit peripheral vasoconstriction, inhibit NE release. inhib. hypertrophy from MI and NE

decrease tachycardia, decrease cardiac myocyte apoptosis, decrease arrythmia potential

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22
Q

who gets a BB?

A

ALL pt. with EF < 40%

23
Q

benefits BB

A
  1. improve EF and symptoms
  2. decrease hospitalizations
  3. decrease mortality
24
Q

AE BB

A
  1. fluid retention (diuretic may help)
  2. fatigue
  3. bradycardia/heart block
  4. hypotnesion
25
Q

What BB are used in HFrEF

A
  1. Metoprolol Succ.
  2. Carvedilol
  3. Bisoprolol
26
Q

Role SGLT2 inhibitors in HFrEF

A

Flozins

  1. decrease hospitalizations and death
27
Q

who gets an SGLT2 inhib?

A

everyone who can afford

28
Q

CI SGLT2 inhib.

A
  1. type 1 DM
  2. lactation
  3. pregnancy 2nd/3rd trim.
29
Q

SE SGLT2 inhib

A
  1. hypotention
  2. genital mycotic infection
  3. UTI
30
Q

Role Aldosterone antagonist

A

inhibition aldosterone mediated cardiac fibrosis and ventriculare remodeling
decrease morbidity and mortality

31
Q

Who should be on aldosterone antag?

A

LF < 35%
AHA class II-IV
*should have prior hospitalization OR elevated plaman BNP (400+)

32
Q

CI aldosterone antag

A
  1. K >/= 5
  2. SCr >/= 2.5 M
  3. SCr >/= 2 W
  4. CrCl < 30
33
Q

SE Aldosterone antag

A

Gynecomastia, spiro

hyperkalemia (spiro, and eplerenone)

34
Q

MOA hydralazine

A

Aterial vasodilator , antioxidant? may halt destruction NO

35
Q

MOA isodorbide dinitrate

A

venous dilation, notric oxide donor?

may decrease dyspnea on exertion

36
Q

Role Hydralazine/Isosorbide dinitrate

A

Decrease morality/morbidity in AA pts. class III-IV in combo with ACEI or BB or w/o

37
Q

AE hydralazine/isosorbide dinitrate

A
  1. HA, GI, orthostatic hypotension, syncope, palpitations, tachycardia
  2. SLE with hydralazine over 200 mg/day
38
Q

Role Digoxin in HFrEF

A

symptomatic therapy

39
Q

MOA Digoxin

A

inhibit Na+-K+ ATPase to increase contractility (+ inotrope)

may curtail neurohumoral system, and decrease CNS symp. outflow and decrease RENIN_

40
Q

when should digoxin be used?

A

consider when pt. still symptomatic despite, ACEI, diuretic, BB, aldosterone antag.
May decrease hospitalization but WONT DECREASE MORT.

41
Q

Why should digoxin be monitored?

A

for toxicity, too much drug causes toxicity

42
Q

AE dig.

A

arrythmia, GI, neurological complaints!!

hypokalemia, hypomagnesia

43
Q

MOA Ivabradine

A

If channel inhibitor, decrease risk hospitalization for worsening HF w/ stable symptomatic HFrEF if in sinus rythm w/ resting HR > 70 BPM

44
Q

Who should take Ivabradine?

A

Pt. on MAX dose BB or where BB CI (not proven to save lives, but BB is)

45
Q

CI ivabradine

A
  1. decomp. HF
  2. BR < 90/50 mmHG
  3. arrythmia
  4. HR < 60
  5. Hepatic impairment
  6. CYP3A4 inhib. (azole, macrolide, protease inhib)
  7. Pregnancy (fetal toxicity)
46
Q

SE ivabradine

A
  1. bradycardia
  2. HTN
  3. afib
  4. luminous phenomena*
  5. fetal tox
47
Q

MOA variciguat

A

PO quanyl cyclase activator, can be used as adjunct therapy to reduce risk of HF hospitalizations in symptomatic patient with evidence of worsening HF

48
Q

Role Variciguat HFrEF

A

Symptomatic

49
Q

CI variciguat

A
  1. pregnancy
  2. other SG c activators
  3. posphodiesterase inhibitors (sildafenil, etc.)
50
Q

SE variciguat

A

hypotension, anemia

51
Q

Name some nonh-pharm ways to imrpove HFrEF

A
  1. stop excess alcohol consumption
  2. avoid if alcoholic cardiomyopathy
  3. Na restirction
  4. smoking cessation
52
Q

What meds may worsen HF

A
  1. NSAIDS
  2. antiarrythmias
  3. CCB (amlodipine)
  4. amphetamines (cocaine, danomycin, doxirubivin, etoh)
53
Q

How to treat HFpEF

A
  1. control systolic and diastolic BP
    - ACEI/ARB (ARB reduce hospitalization)
    - BB
    - diuretics to reduce/relieve symptoms
    - SGLT2 inhib. (dec. hospitaliztation, no MORT)
    - ARNI (good sub if SGLT2 in. to expensive)
    - aldosterone antagonists

Pharmacology III (6 decks)

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