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Pharm 2 Exam > ch 42 > Flashcards

ch 42 Flashcards

1
Q

which heart failure is referred to as heart failure with reduced ejection fraction (HFrEF)

A

HF with L ventricular (LV) systolic dysfunction

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2
Q

which heart failure is referred to as heart failure with preserved LV ejection fraction (HFpEF)

A

Diastolic HF

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3
Q

drug classes for HF

A

diuretics
inhibitors of RAAS
B Blockers Digoxin

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4
Q

what does the heart do to compensate in HF

A

1) Cardiac dilation
2) activation of SNS
3) Activation of RAAS
4) Retention of water and expansion of blood volume

extra info below

Dilation of the heart from a combo of increased venous pressure and reduced contractile force

Size of heart increases to help improve cardiac output

Arterial pressures fall, the baroreceptor reflex increases sympathetic output to heart, veins and arterioles

Increased heart rate
increased contractility
increased venous tone
increased arteriolar tone

body starts to retain water to improve pressure. leads to severe cardiac, pulmonary and peripheral edema and eventually death

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5
Q

what natriuretic peptides are released in response to the stretching of the atria and dilation of the ventricles

A

ANP and BNP

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6
Q

level of BNP is an important index of

A

cardiac status in HF patients and can be a predictor of long term survival

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7
Q

As HF progresses, the effects of ANP and BNP eventually become overwhelmed by the effects of the

A

SNS and RAAS

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8
Q

signs of HF

A 
reduced exercise tolerance
fatigue
Shortness of breath
tachycardia
cardiomegaly
pulmonary edema
peripheral edema
hepatomegaly
distention of jugular veins
weight gain
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9
Q

what NYHA scheme heart failure class is

no limitation of ordinary physical activity

A

Class I

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10
Q

what NYHA scheme heart failure class is

slight limitation of physical activity: normal activity produces fatigue, dyspnea, palpitations, angina

A

Class II

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11
Q

what NYHA scheme heart failure class is

Marked limitation of physical activity: even mild activity produces symptoms

A

Class III

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12
Q

what NYHA scheme heart failure class is

Symptoms occur at rest

A

Class IV

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13
Q

ACCAHA scheme stage:

at high risk for HF but without structural heart disease or symptoms of HF

A

Stage A

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14
Q

ACCAHA scheme stage:

structural heart disease but without symptoms of HF

A

Stage B

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15
Q

ACCAHA scheme stage:

Structural heart disease with prior or current symptoms of HF

A

Stage C

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16
Q

ACCAHA scheme stage:

refractory HF requiring specialized intervention

A

Stage D

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17
Q

first line drugs for all patients with signs of volume overload (HF)

A

diuretics

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18
Q

diuretic used for long term therapy of HF when edema is not too great. But low GFR excludes this drug

A

Thiazide diuretics

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19
Q

diuretic needed for HF requiring profound diuresis. This will work even with low GFR

A

Loop diuretics

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20
Q

this class of diuretic is usually combined with either a thiazide or loop to preserve potassium. prolongs survival in pt with HF by blocking receptors for aldosterone

A

Potassium sparing

particularly Spironolactone

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21
Q

this antihypertensive can improve functional status and prolong life in HF. Blocks production of angiotensin II which decreases release of aldosterone. suppresses degradation of kinins which improves hemodynamics and favorably alters cardiac remodeling

A

ACE inhibitors (Captopril, enalapril)

22
Q

ACE inhibitors with potassium sodium and water and what does that do

A

inhibits aldosterone secretion from adrenal cortex that acts on the renal tubules to excrete sodium which works on water and decreases fluid volume. This also means that they retain potassium making risk for hyper -k

23
Q

what part of ACE helps with cardiac remodaling

A

decrease kinin degradation and decrease release of aldosterone

24
Q

adverse effects of ACE

A

hyperkalemia (secondary to aldosterone release)
intractable cough and angioedema (secondary to decrease kinin degradation), renal fauilure in patients with bilat renal artery stenosis.

25
Q

Can you use ACE in pregnancy if you are already on an ACE prior to becoming pregnant

A

no

26
Q

What do ARBS help with

A 
improve LV Ejection fraction
reduce HF symptoms
increase exercise tolerance
decrease hospitalization
enhance quality of life
reduce mortality
27
Q

How do ARBS do with cardiac remodaling

A

Not near as good as ACE bc the ARBS dont block degradation of kinin

28
Q

what is Sacubitril/valsartan (Entresto)

A

Sacubitril is a new class of drug called Angiotensin receptor nephrilysin inhibitor (ANRI)

increases BNP and suppresses the neg effects of the RAAS. This is approved for pt with stage II -IV HF and in place of an ACE or ARB

study shows superior to enalapril
similar to ARB,

29
Q

side effects of Sacubitril/valsartan (Entresto)

A

angioedema, hyperkalemia and hypotension

30
Q

Can you use Sacubitril/valsartan (Entresto) in Pregnancy

A

no

31
Q

Signs of dig tox

A

visual disturbances

altered HR or rhythm

32
Q

what population does dig shorten life span

A

women

33
Q 
what class does 
spironolactone (Aldactone) 
Eplerenone (Inspra)
fall into
A

Aldosterone antagonists

34
Q

major adverse effect of aldosterone antagonists

A

hyper K

gynecomastia in men for spironolactone but not Eplerenone

35
Q

management of Stage A HF

A

directed at reducing risk
ACE or ARB to control HTN, Hyperlipidemia, DM, atherosclerosis

statin for atherosclerosis

lifestyle mods
cease smoking and excessive alcohol abuse which can suppress contractility

no evidence of exercise preventing development of HF - but exercise has other health benefits

36
Q

Stage B HF management

A

no signs or symptoms of HF but have structural heart disease associated with development of HF (LV hypertrophy or fibrosis, LV dilation, or hypocontractility, valvular heart disease and previous MI.

goal is to prevent development of symptoms

ACE plus B Blocker for pt with reduced Ejection fraction, history of Mi or both.

if ACE cant be used -> ARB

37
Q

Stage c HF management

A

symptoms of dyspnea, fatigue, peripheral edema, distension of jugular veins.

ACE/ARB
Statin
B Blocker
Diuretic - loop or thiazide
if kidney impaired - no spironolactone (aldosterone antagonist) add to loop or thiazide if no kidney impairment
Digoxin if nothing else is working

Adding isorbide dinitrate/hydralazine (Bidil) (African American population)

38
Q

goals of HF management

A

relief of pulmonary and peripheral congestive symptoms

improvement of functional capacity and quality of life

slowing cardiac remodeling and progression of LV dysfunction

prolonging life

39
Q

approved B blockers for HF

A

Carvedilol
metoprolol xl
bisoprolol

40
Q

in stage C HF what drugs to avoid

A

CCBS
NSAIDS
antidysrhythmics

41
Q

what lab value is indicative of improvement in HF

A

lower BNP

42
Q

Stage D HF management

A

advanced structural heart disease
marked symptoms at rest despite treatment

repeated and prolonged hospitalization is common

heart transplant for eligible

LV mechanical assist device can be used as a bridge to transplant

fluid retention loop combined with a thiazide

IV diuretics may be necessary

B-Blockers can make HF worse
ACES may induce profound hypotension or renal failure

end of life care

43
Q

what drug class is Digoxin

A

Cardiac glycoside

44
Q

what does the HR need to be above to give Digoxin

A

> 50

45
Q

What drug classes are first line for HF

A

Agents that inhibit RAAS
B Blockers
Diuretics

46
Q

what does Digoxin

A

decreases heart rate
modulates neurohormonal system
Positive inotropic effects (increases contractility)

47
Q

What drugs are contraindicated with Digoxin

A

Quinidine
Amiodarone
Verapamil

48
Q

What antidysrhythmic are approved to use in conjunction with Digoxin

A

Lidocaine

Phenytoin

49
Q

hyperkalemia and Digoxin

A

can impair therapeutic effects of Digoxin

50
Q

Hypokalemia and Digoxin

A

can cause dig toxicity

51
Q

pt who takes Digoxin has increased cardiac output which helps how

A

1) Sympathetic tone declines (affects baroreceptor reflex)
a) reduces HR (allows for more complete ventricular filling)
b) afterload is reduced (due to reduced arteriolar constriction) and allows for more complete ventricular emptying
2) urine production increases
a) reduces blood volume
b) reduces cardiac distention, pulmonary congestion and peripheral edema
3) Renin release declines
a) reduces afterload
b) reduces venous pressure

summary
cardiac output improves
heart rate decreases
constriction of arterioles and veins
water retention reverses
blood volume declines
peripheral and pulmonary edema decrease
water weight lost
exercise tolerance improves 
fatigue reduced
52
Q

Side effects of Digoxin

A

anorexia, n/v

fatigue

visual disturbances (blurred vision, yellow tinge to vision, halos)

all can be signs of tox

Pharm 2 Exam (18 decks)

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