Ch 48: Drugs for Heart Failure Flashcards
Of those patients who have heart failure, __% are likely to die within 1 year, and __% within 5 years.
20%; 50%
p. 517
As a rule of heart failure, cardiac remodeling ________ development of symptoms.
precedes
p. 517
What 3 symptoms of HF demonstrate inadequate tissue perfusion?
fatigue, shortness of breath, exercise intolerance
p. 517
What 3 symptoms of HF demonstrate volume overload?
[central] venous distention, peripheral edema, pulmonary edema
(p. 517)
Cardiac dilation results from a combination of…
…increased venous pressure, and reduced contractile force.
p. 518
As arterial BP falls as a result of HF, the baroreceptor reflex kicks in. What are the 4 compensatory events which occur as a result?
Increased HR
Increased contractility
Increased venous tone
Increased arteriolar tone
(p. 518)
In a patient hospitalized for HF, the lower the BNP level…
…the greater the chances of long-term survival.
p. 519
For routine therapy, heart failure is treated with 3 types of drugs:
1) diuretics
2) agents that inhibit the RAAS
3) beta blockers
(p. 519)
When selecting a diuretic for a patient with HF, caution should be used. Because ACE inhibitors and ARBs carry a risk of hyperkalemia, these drugs should not be combined with a…
…potassium-sparing diuretic.
p. 520
Spironolactone prolongs survival in HF patients primarily by blocking ___________ _________, not by causing ________.
aldosterone receptors
diuresis
(p. 520)
In the absence of specific contraindications, all patients with HF should receive…
…an ACE inhibitor.
p. 520
How do ACE inhibitors help to treat HF?
They block production of ____________, decrease release of ___________, and suppress degradation of ______. As a result they improve hemodynamics and favorably alter _______ __________.
angiotensin II
aldosterone
kinins
cardiac remodeling
(p. 520)
Why are the ARBs’ effects on cardiac remodeling less favorable than those of ACE inhibitors?
Because ARBs do not increase levels of kinins.
p. 521
Current guidelines recommend adding an aldosterone antagonist to standard HF therapy, but only in patients with persistent symptoms despite treatment with an ___ _________ and ____ _______.
ACE inhibitor and a beta blocker
p. 521
The mechanism underlying the benefit behind beta blocker use in heart failure is uncertain. What are some likely possibilities?
protecting the heart from excessive sympathetic stimulation and protecting against dysrhythmias
(p. 522)
What 2 sympathomimetic drugs are used to treat heart failure?
dopamine and dobutamine
p. 522
What kind of drug is milrinone?
a phosphodiesterase inhibitor
p. 523
What is the danger of using inotropes too aggressively?
Inotropes can induce dysrhythmias and cause myocardial ischemia from increased metabolic demand.
(p. 523)
What is BiDil and why is it special?
It is a fixed dose combination of hydralazine and isosorbide dinitrate. It is used to treat HF in African Americans, making it the first medication approved for a specific ethnic group.
(p. 523)
Digoxin increases myocardial contractility by inhibiting…
Inhibition of this enzyme…
…the enzyme known as Na-K-ATPase.
…promotes calcium accumulation within myocytes. The calcium augments contractile force.
(p. 524)
During treatment with digoxin, if potassium levels are high, it causes…
A potassium level that is too low can cause…
…a reduction in the therapeutic response.
…toxicity.
(p. 525)
Although digoxin can produce substantial improvement in HF symptoms, [research shows that]…
…it does not prolong life.
p. 525
By inhibiting the Na-K-ATPase in vagal afferent fibers, digoxin…
…decreases sympathetic outflow from the CNS by increasing the sensitivity of cardiac baroreceptors.
(p. 525)
What is the optimal therapeutic range for digoxin levels?
- 5 - 0.8 ng/mL
p. 526
Digoxin is eliminated primarily by…
…renal excretion.
p. 528
All patients with Stage C HF should receive…
…an ACE inhibitor.
p. 529
For patients who cannot tolerate ACE inhibitors or ARBs…
…substitution of isosorbide dinitrate (ISDN)/ hydralazine is considered reasonable.
(p. 529)
