Cardiovascular- Heart Failure Flashcards
What kinds of drugs are used in HF to decrease pathologic sympathetic stimulation?
Beta Blockers
What kinds of drugs are used in HF to decrease the load on failing hearts?
Diuretics
What kinds of drugs are used in HF to address issues involving the RAA axis?
ACEI
Systolic HF treatment involves what meds?
Diuretics, ACI, digoxin & nonspecific vasodilators
Diastolic HF treatment involves what meds?
Diuretics, vasodilators, inotropic drugs, BB, hydralazine/nitrates
ACC/AHA 2005 guidelines say that Stages A and B are
at risk for heart failure
ACC/AHA 2005 guidelines say that Stages C and D are
in heart failure
What is the frontline treatment of systolic heart failure?
Diuretic + ACEI
What is added to treat systolic heart failure after diuretic + ACEI(or ARB)?
Beta Blocker
If persistent signs and symptoms remain in a patient with systolic heart failure who is on a diuretic, ACEI, and BB what is the next line of treatment?
Aldosterone antagonist or ARB
If persistent signs and symptoms remain in a patient with systolic heart failure who is on a diuretic, ACEI, BB, and an aldosterone antagonist with a QRS
Digoxin
What stage is a patient at high risk for heart failure but without structural heart disease or symptoms of HF?
Stage A
What stage is a patient with structural heart disease but w/out symptoms?
Stage B
What Stage is a patient with structural heart disease with prior or current symptoms
Stage C
What stage is a patient with refractory heart failure?
Stage D
What classifications does the NYHA use?
Class 1-4 I= is the best 2= dyspnea w/minimal activity 3= dyspnea at lower workloads 4= dyspnea at rest
At what stage should you begin to think about heart transplants?
Stage D
How would you treat a Stage A patient?
Treat HTN- ACEI
Treat lipids
Control metabolic syndrome
Encourage lifestyle modifications
How would you treat a Stage B patient?
ACEI/ARB in appropriate pts
BB in appropriate pts
How would you treat a Stage C patient?
Routine Use of:
Diuretics for fluid retention
ACEI
BB
In selected patients: Aldosterone antag ARB Digoxin Hydralazine/nitrates
Devices:
Biventricular pacing
Implantable defibrillators
What would you prescribe to a patient with HF and fluid retention?
Furosemide 40 mg
One tablet twice daily
What would be your therapy for a patient with Stage A HF and HTN?
Lisinopril 40mg
One tablet daily
Dose an ARB for use in HF
Valsartan 80mg
One tablet twice daily
What would you give to a HF patient who is post MI?
Carvedilol 25 mg
One tablet twice daily
What drugs reverse cardiac remodeling?
Beta blockers
What ejection fraction is indicative of heart failure?
<40%
Dose an aldosterone antagonist you would give to your patient in who is Stage C
Eplerenone 50mg
One tablet daily
What vasodilator would you give to a refractory patient in Stage D
BiDil
One tablet 3x a day
How does Digoxin work?
Increased force of contraction and decreased rate of contraction
When is digoxin indicated?
Patients with LVEF <40%
who continue to have NYHA class, II, III, and IV despite optimal therapy
What drugs have been shown to increase dig levels?
Antacids
Metoclopramide (Reglan)
St. John’s wort
What drugs decrease dig levels?
Amiodarone
Alprazolam (Xanax)
Verapamil
Spironolactone (Aldactone)
Dose a cardiac glycoside
Digoxin 125mcg
1 tablet daily
How do inotropes work?
Stimulate B1 receptors of heart, comparatively mild chronotropic, hypertensive, arrhythmogenic, and vasodilative effects
Dose an inotrope
Dobutamine infusion 5 mcg/kg/minute
titrate to effect
How do B-type Natriuretic Peptides work?
Increase intracellular cGMP resulting in smooth muscle relaxation and arterial & venous dilation
