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NAPLEX > Chapter 31: Chronic Heart Failure > Flashcards

Chapter 31: Chronic Heart Failure Flashcards

1
Q

ACC/AHA Staging System (A)

A

A- at risk for development but without disease symptoms, structural heart disease or elevated biomarkers

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2
Q

ACC/AHA Staging System (B)

A

B- Pre-HF; structural heart disease, abnormal cardiac fx, elevated biomarkers, with without signs and symptoms

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3
Q

ACC/AHA Staging System (C)

A

CLINICAL DIAGNOSIS OF HF

C- structural and/or functional cardiac abnormality w/prior or current symptoms of HF

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4
Q

ACC/AHA Staging System (D)

A

D- advanced HF with severe symptoms, symptoms at rest or recurrent hospitalizations despite maximal tx

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5
Q

NYHA Functional Class (I)

A

I- no limitations of physical activity. Ordinary physical activity does not cause symptoms

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6
Q

NYHA Functional Class (II)

A

II- slight limitation of physical activity. Comfortable at rest but ordinary physical activity (walking up stairs) results in symptoms of HF

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7
Q

NYHA Functional Class (III)

A

III- marked limitation of physical activity. Comfortable at rest but minimal exertion (dressing) causes HF symptoms

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8
Q

NYHA Functional Class (IV)

A

IV- unable to carry on any physical activity without symptoms of HF or symptoms of HF at rest (SOB while sitting)

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9
Q

Labs/Bio-markers

A

Increased BNP
Increased NT-proBNP
Used to determine between cardiac and non-cardiac causes of dyspnea

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10
Q

Left-Sided Signs and Symptoms

A
  • Orthopnea
  • Paroxysmal nocturnal dyspnea (PND)
  • Bibasilar rales (crackling lung sounds)
  • S3 gallop
  • Hypoperfusion (renal impairment and cool extremities)
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11
Q

General Signs and Symptoms

A
  • Dyspnea
  • Cough
  • Fatigue, weakness
  • Reduced exercise capacity
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12
Q

Right Sided Signs and Symptoms

A
  • Peripheral edema
  • Ascites
  • Jugular venous distention
  • Hepatojugular reflux (neck vein distention from pressure placed on the abdomen)
  • Hepatomegaly (enlarged liver due to fluid congestion)
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13
Q

Cardiac Output (CO)

A

Is the volume of blood pumped by the heart in 1 minute
is determined by HR and SV
CO= HR x SV

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14
Q

Stroke Volume (SV)

A

The volume of blood ejected from the left ventricle during 1 complete heartbeat.
SV depends on preload, afterload, and contractility

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15
Q

Drugs that cause or worsen HF

A

Drug Information NATION
D- DPP4i’s (alogliptin, saxagliptin)
I- Immunosuppressants (TNF inhibitors [adalimumab, enteracept] and interferons
N- Non-DHP CCBs (dilt and verapamil in systolic HF)
A- Antiarrhythmics (Class I agents [quinidine, flecainide] and dronedarone
T- TZDs (increased risk of edema)
I- Itraconazole
O- Oncology drugs (anthracyclines; doxorubicin, daunorubicin)
N- NSAIDs (excluding celecoxib)

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16
Q

Initial Medications (recommended in all patients without CIs)

A
  • ACEi, ARB, or ARNI: decreased mortality in HFrEF, ARNI preferred
  • BBs: controlling HR and reducing arrhythmia risk, decreasing mortality
  • Loop diuretics: reduce blood volume which reduces edema and congestion
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17
Q

Secondary Medications (add-on in select patients)

A
  • Aldosterone receptor antagonists (ARAs): decrease morbidity and mortality in NYHA class II-IV, added diuresis
  • SGLT2i’s: decease morbidity and mortality in NYHA class II-IV must meet eGFR criterria
  • Hydralazine and nitrates (Bidil): decrease morbidity and mortality in black patients with NYHA class III-IV when added to ace/arb and bb, or other patients who cannot tolerate ace/arb
  • Ivabradine (Corlanor): decrease risk of hospitalization in patients with stable NYHA class II-III
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18
Q

Additional Medications

A
  • Digoxin: provides small increase in CO, improves symptoms and decreases cardiac hospitalizations
  • Vericiguat (soluble guanylate cyclase stimulator): decrease risk of hospitalizations and CV death after HF hospitalization or need for IV diuretics (not yet included in tx guidelines)
19
Q

Loop diuretics dose conversion

A 
"Fat Tina Bought Eggs"
F-furosemide 40 =
T- torsemide 20mg =
B- bumetanide 1mg =
E- ethacrynic acid 50mg
20
Q

Furosemide IV:PO ratio

A

1:2

furosemide 20mg IV: furosemide 40mg PO

21
Q

Target Dose for Enalapril

A

Enalapril 10-20mg po bid

22
Q

Target Dose for Lisinopril

A

Lisinopril 20-40mg qd

23
Q

Target Dose for Quinapril

A

Quinapril 20mg bid

24
Q

Target Dose for Ramipril

A

Ramipril 10mg qd

25
Q

Target Dose for Losartan

A

Losartan 50-150mg qd

26
Q

Target Dose for Valsartan

A

Valsartan 160mg bid

27
Q

Target Dose of Entresto

A

Entresto 200mg bid (97 sacubitril+103mg valsartan)

28
Q

Target Dose of Metoprolol Succinate

A

Metoprolol Succinate 200mg qd

29
Q

Target Dose of Carvedilol

A

Carvedilol IR <=85kg 25mg bid; >=85kg 50mg bid

Carvedilol ER 80mg qd

30
Q

Target Dose of Spironolactone

A

Spironolactone 25mg qd or bid

31
Q

Dapagliflozin eGFR

A

Do not initiate in eGFR <30

farxiga

32
Q

Empagliflozin eGFR

A

Do not initiate in eGFR <20

jardiance

33
Q

Digoxin MOA

A

Inhibits NA-K-ATPase pump causing a positive inotropic effect (increases CO) and exerts a parasympathetic effect, which causes negative chronotropy (decreasaed HR)

34
Q

Digoxin typical dose and therapeutic range

A

0.125 to 0.25mg qd
CrCl <50 decrease dose or frequency
Therapeutic range: 0.5 to 0.9

35
Q

Digoxin toxicity symptoms

A

Initial: N/V, loss of appetite and bradycardia
Severe: blurred/double vision, greenish-yellow halo around lights or objects

36
Q

Ivabradine MOA

A 
Belongs to a class of drugs known as hyperpolarization-activated cyclic nucleotide-gated channel blocker. 
It disrupts the "funny" current in the sinoatrial node resulting in decreased rate of firing and ultimately decreased HR
37
Q

Ivabradine warnings and SE

A

Target HR between 50-50 bpm
Warnings: Bradycardia which can increase risk of GT prolongation and ventricular arrhythmias
SE: bradycardia, HTN, afib

38
Q

Vericiguat MOA

A

Is a soluble guanylate cyclase stimulator which increases cyclic GMP and leads to smooth muscle relaxation and vasodilation.

39
Q

Potassium chloride oral solution strengths

A

10% (20meq/15ml)

20% (40meq/15ml)

40
Q

Potassium ER capsules

A

-Mico-k and Klor-con sprinkle: can sprinkle capsule contents on a small amount of applesauce or pudding

41
Q

Potassium ER tabs

A
  • klor-con, k-tab: swallow whole, do not crush, cut or suck on tab
  • Klor-con M: if difficult to swallow can be cut in half and dissolved in water
42
Q

Oral Packet

A

Dissolve contents in water and drink immediately

43
Q

Oral Solution

A

Mix 15ml with 6oz of water

NAPLEX (45 decks)

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