Cardio 10 Deck 6

Question 1

Pathophysiology of Heart Failure

Answer 1

Complex syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricles to fill or eject blood (cardiac output [CO])

Question 2

Determinants of ventricular function

Answer 2

Preload, afterload
Contractility, stroke volume, CO
Heart rate

Question 3

Left ventricular dysfunction

Answer 3

Increase in end systolic volume
Increase in end diastolic volume
Pulmonary congestion
Decreased CO, hypoperfusion

Question 4

Compensatory systems

Answer 4

Sympathetic activation

Renin–angiotensin–aldosterone system

Question 5

American College of Cardiology Heart Failure grages

Answer 5

A through D

D is the most severe

Question 6

New York heart failure grades

Answer 6

Progresses from 1 to 4

4 is the most severe

Question 7

Stage A treatment

Answer 7

Lifestyle modification: dyslipidemia, diabetes, hypertension (diuretics or angiotensin-converting enzyme inhibitors [ACEIs])

ACEIs are drug of choice in patients with diabetes.

Angiotensin II receptor blockers (ARBs) are considered in ACEI-intolerant patients, but more expensive.

Question 8

ACE drug of choice in

Answer 8

patients with diabetes

Question 9

Angiotensin II receptor blockers (ARBs) are considered

Answer 9

in ACEI-intolerant patients, but more expensive.

Question 10

Stage B treatement

Answer 10

ACEIs in all patients, ARBs for those who cannot tolerate an ACEI
Beta blockers in most

Question 11

Stage C treatment

Answer 11

ACEIs and beta blockers in all patients
Diuretics, digoxin
Spironolactone

Question 12

Stage D treatment

Answer 12

Entresto
Inotropes: dobutamine
Ventricular assist device, transplantation, hospice care

Question 13

Coronary artery disease

medications used

Answer 13

Nitrites

Aspirin

Question 14

Chronic atrial fibrillation

medications used

Answer 14

Warfarin or other new anticoagulants that reduce risk of stroke

Question 15

Diabetes medications used

Answer 15

ACEIs
Thiazides: may increase glucose levels
Beta blockers avoided

Question 16

Hypertension

Medication used

Answer 16

Use of diuretics early to decrease preload

ACEIs

Question 17

Hyperlipidemia medication used

Answer 17

statins

Question 18

Infants and children

medication used

Answer 18

Digoxin, thiazide, and loop diuretics all used

Question 19

Pregnancy Medications used

Answer 19

ACEIs contraindicated in pregnancy

Diuretics may decrease placental perfusion

Question 20

Treatment Considerations for heart failure

Answer 20

Early therapy works best.
As heart failure progresses, non-selective beta blocker with both alpha and beta impact work better than cardioselective types.
The advent of neprilysyn inhibitors (i.e. Entresto) has dramatically decreased risk of death and hospitalizations.

Question 21

Monitoring Heart Failure

Answer 21

Functional capacity
Fluid status
Weight changes
Jugular venous distension 
Cardiac rhythm
Laboratory tests
Electrolytes
Creatinine 
Thyroid and liver function

Question 22

Patient Education for heart failure

Answer 22

Treatment plan
Pathophysiology and chronicity of heart failure
Home monitoring
Drug therapy
Patients should take exactly as directed.
Patients should not miss or double doses.

Question 23

Digoxin MOA

Answer 23

inhibits sodium/potassium ATPS pump in myocardial cells. Promotes influx of calcium. Increases contractility.

Question 24

Digoxin Pharmacokiniteics

Answer 24

Readily abosrobed from teh GI tract. Widly distributed protein binding. Half life is 36-48 hours

PO 0.5 - 2 hours peak 2-8 hours durtation 3-4 days

Question 25

Digoxin drug interactions

Answer 25

amiodarone may increase toxicity

beta blockers, calcium chalen blockers

potassium depleting diuretics my increase toxicity due to hyopcoemia

Question 26

digoxin loading dose

Answer 26

not recomended for heart failure

Question 27

digoxin therapeutic serum level

Answer 27

0.8 - 2 ml

Question 28

digoxin toxic serum level

Answer 28

greater than 2mg

Question 29

digoxin monitoring

Answer 29

apical pulse rate

<60 hold drug

Question 30

Antidoe for digoxin

Answer 30

Digoxin immune FAB

Question 31

Digoxin toxicity S/S

Answer 31

GI distrbances, neurologic abnomralites, fatigue, weakness, headake, depression, facial pain, personality changes, halows, bradicardia

Question 32

Enteresto class

Answer 32

combination of sacubitril, a neprilysin inhibitor and valsrtan, an angiotensin II receptor blocker

Question 33

Entresto MOA

Answer 33

Sacubitril inhibits neprilysin increasing peptide levels that are degraded by neprilysin. Valsartan directly antagonizes angiotensin II receptors, blocks vasocnstrictor aldosering secreing effects of angiotensin II

Decreases risk of mortality in pts with HF. prodcues vasodilation, decreases periphearl resistance, decreases b/p

Question 34

Enteresto avoid in

Answer 34

pregnancy may cause fetal harm. Unknoinw if distributed in breast milk

Question 35

Enteresto interactions

Answer 35

ACE inhibitors, may cause angioedema, potassium sapring diuretics, may increase risk of hyperkalemia. NSAID may wrosen reanl function.

Ginger, ginseng, licorice may worsen hypertension

Question 36

HF Dose Enteresto

Answer 36

initially 49 to 51 mg twice daily. May double dose after 2 to 4 weeks

Question 37

Enteresto ADR

Answer 37

cough, dizinees

angioeima, hypotension, imparied renal function, elevated serum creatinine. renal imparient.

Question 38

Enteresto evaluation

Answer 38

monitor BMP. Serum BUN, Potassium. Montor for hyperkalema and hypotension.

Question 39

Enteresto if hypotension occurs

Answer 39

place patietn in trandelmeberg position. alter dose or inerupt treatment. Screan for dug interactions.