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Pharmacology > CHF > Flashcards

CHF Flashcards

1
Q

Systolic Heart Failure

A

Ventricles cant generate enough SV- decreases CO, and Drop-in BP

CO = HR X SV,

SV inverse to Afterload- decrease Diastolic pressure

Decrease EF

Flappy, Dilated and Compliant myocardium

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2
Q

Decrease in Contractility in SHF

A

MI- Anterior/Lateral

Dilated CardioMyopathy - (Flappy Heart)

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3
Q

Increase in Preload with Decrease Contractility SHF

A

Mitral and Aortic Regurgitation

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4
Q

Other SHF conditions

A

Tachyarrythmias and Bradyarrythmias

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5
Q

Diastolic Heart Failure

A

EF maybe normal (preserved)- decreased filling/preload and increase in Afterload

Stiff, Fibrotic, Non-compliant myocardium

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6
Q

Decrease PReload DHF

A

MI,
Restrictive CM,
Constrictive Pericarditis

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7
Q

Increased Afterload

A

Hypertension,
Aortic stenosis,
Coarctation of Aorta (Narrowing of aorta)
Hypertrophic Constrictive Cardiomyopathy- Congenital (Thick myocardium)

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8
Q

What leads to RHF

A

LHF

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9
Q

Increase Afterload RHF

A

Pulmonary stenosis
Pulmonary hypertension
Pul. Embol
Cor. Pulmonale- COPD V/Q= <0.8

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10
Q

Increase in Preload RHF

A

Tricuspid and Pumonary Regurg (Not common)- common in IV drug users- Staph infection-infection of valves

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11
Q

Decrease in contractility

A

Inferior MI, Myocarditis

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12
Q

High Output HF is due to

A

underlying CVD

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13
Q

Symptoms of HOHF

A 
Severe Anemia (hypoxia)
Wet Beri-Beri (Thiamine deficiency- Alcoholics, CN6 palsy, Deficiency of PDH)
Thyrotoxicosis
Pregnancy (Volume overload)
AV Fistula (hemodialysis complication)
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14
Q

Lactic acid accumulation in Myocardium

A

Vasodilation causes AV shunting (Fast shifting of blood from Atria to ventricle)

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15
Q

Receptors in Carotid sinus for BP

A

BAroreceptors

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16
Q

Detects low CO

A

receptors- LBP- Medulla- CArd. Acc Center- SNS- Increases Contractility (B1 receptors) inc. SV, HR

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17
Q

SNS effects

A

Sends fibers to Venous and arterial system- release epi. (a1 receptors)- Constricts Arterial Smooth muscle- Inc TPR= Increase BP

Constriction of V Smooth Muslce- Inc Venous return = Inc Preload = Inc SV=
Inc. CO = Inc- BP

a1 receptor in kidney = dec. GFR= inc Fluid retention= Inc Preload = Inc SV -= Inc CO = Inc BP

JG cells- b1 recep- inc. Renin= ACE in lungs (with angiotensinogen in Liver)= AT 2

Beta blockers helpful

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18
Q

Functions of AT2

A

Stim Post pituitary= ADH prod = Water retention= inc. BV = Inc Preload = Inc. SV= Inc Co= Inc BP

Vasoconstriction of arterioles= Inc TPR = Inc BP

Adrenal Gland (Zona G)- Secretes Aldosterone= Increase Na reabsorption in DCT and H20 Reabsorption= Inc BV = Inc Preload = Inc. SV= Inc Co= Inc BP

ACE inhibtors helpful

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19
Q

CHF symptoms

A

Pulmonary veins have a lot of blood- Inc pressure in Pulmonary veins= Leaking fluids- Pulmonary Edema (inc pressure in P. capillaries)= Hypoxemia

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20
Q

Symptoms of hypoxemia

A

Dyspnea
Cough (Dry)
Orthopnea (difficulty breathing when lying flat)
Paroxysmal Nocturnal Dyspnea- (Difficulty breathing)
Crackles in lungs (Rales) inspiration

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21
Q

Accumulating of Blood in Sup. Vena Cava

A

Inc Internal Jug Vein Pressure= Jug Vein Distention

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22
Q

Accumulation of blood into inf Vena Cava

A

inc Pressure due to pressure on liver, Decrease perfusion of Liver

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23
Q

Hepato-jug Reflex

A

> /= 3cm Inc in JVD

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24
Q

increased pressure in the liver and spleen due to accumulation causes

A

hepato-spleno-megaly and ascites

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25
Q

Accumulation of blood in GIT

A

Ascites- Nausea and abd. pain and

obstruction- dull precursive abdomen- Fluid wave test

26
Q

Accumulation of blood in LE

A

Calf Edema- Pitting (Bilateral edema)

27
Q

Decreased perfusion of extremities

A

Cold, Clammy, pale, Diaphoretic

28
Q

Heart Sounds in CHF

A

Sys HF- S3

Dias. HF- S4

29
Q

Diagnostic clues for HF

A

CXR
BNP >400pg
Echo
Cardiac Catheterization

30
Q

Classes of NYHA CHF

A

1- Extreme exertion
2- Mod. ex
3- Mild
4- At rest (Emergency)

31
Q

What should be treated first regardless of Class of HF

A

Underlying disease

Restrict Na+(<2g/day and H2O (<2L/day) intake

32
Q

RAAS

A

Decrease perfusion of Kidneys = Stim. JG cells = Release Renin = Angiotensinogen to AT1 ACE converts to AT2

33
Q

Problems with AT2

A

Vasoconstriction- Decrease lumen diameter- inc TPR (Afterload inc)- Inc BP

Ant Pitutary- ADH- Dec Urine output- Inc. Water reabsorp.= inc. Bp= inc. EDV = Inc. Preload

Adremal gland= Aldosterone= inc NA and Water reabsorption= Inc BV= Inc EDV = Inc Preload

34
Q

Class 1 drugs

A

ACE inhibitors- Inhibit ACE which decreases AT2 and reduces stress

Captopril
Enalapril
Lisinopril
Benazepril

35
Q

What if the patient cannot tolerate ACE inhibitors- Dry cough and angioedema Class 1

A

ARBs (AT2 Receptor blockers)-
Lazartan
Valsartan
Candesartan

36
Q

Class 3 Drugs

A

Aldosterone antagonist-

Spirnolactone
Eplerenone

Dec Remodelling, K+ sparing

37
Q

Class 3 drug that can be used if normal fail

A

Entresto

38
Q

MOA of Entresto

A

HF= Inc BNP = Blocks AT2 actions decrease afterload

Problems- Neprilysin- Breaks down BNP
Neprilysin Inhib to prevent breakdown

39
Q

Neprilysin Inhibitors to inc BNP and increase action

A

Sacubatril + ARB (Valsartan) = Entresto

40
Q

SNS effects

A

b1 receptors Dec CO= inc. SNS= inc. HR (b1 receptors on SA node and Myocardium = Inc BP= inc Contractility= inc CO = inc BP= inc O2 demand

a1 on renal arterioles= inc. renin and vasoconstriction= inc TPR= Inc BP and in Afterload

41
Q

Class 1 SNS drugs

A

ACE inhib and ARb cant tolerate, give b-blockers

Metoprolol- b1 only selective

Carvedilol- both a1 and b1 activity

negative chronotropic (dec HR) and neg Ionotropic (dec Contractility) negative renin release

42
Q

Where are BEta blockers contraindicated

A

Decompensated HF

43
Q

Class 4 SNS drugs for contractility (last-ditch effort to save patient)

A

Digoxin (+ve inotrope, -ve Chronotropic)

44
Q

Dobutamine class 4

A

Decomp. HF

Cardiogenic shock

45
Q

Class 2 (Diuretics) for edema

A

Loop- Furosemide (Lasix)

Thiazide- Hydrochlorothiazide & metolazone)

46
Q

Metolazone

A

significant edema start at 2mg Furosemide sometimes add Metolazone to pull out more water and not inc. Furosemide Dosage

47
Q

loop diuretics MOA-

A

Act on Loop- inhibit Na+/K+ cotransporter

Increase buildup of Na, k and H2O= Increase urination (25%) Decreases EDV= Dec Preload

48
Q

Thiazide MOA

A

Inhib Na/Cl transporter- dec. reabsorption (10-15% GFR) inc. Urine output= Dec.BV= Dec. EDV= Dec Preload= Dec Stress

49
Q

Class 3 Drugs

A

Hydralazine
Isosorbide Dinitrate

Only use when ACE1 and ARBS fail

50
Q

MOA of Hydralazine

A

Hydralazine= well-tolerated in African American patients, safe for pregnancy

Acts on art. SM= Inc NO= inc Guanylyl Cyclase- GTP to cGMP- with Protein kinase- Promotes inhibits Ca entry and relax smooth muscle

51
Q

MOA of ISD

A

Acts on art. SM= Inc NO= inc Guanylyl Cyclase- GTP to cGMP- with Protein kinase- Promotes inhibits Ca entry and relax smooth muscle

52
Q

The difference in ISD and Hydralazine

A

Arterial relaxation= dec. TPR, Dec. Afterload in Hydralazine

ISD- relaxation of venous system= Dec. right Venous return, Dec EDV = Dec. Preload= Dec. Stress

53
Q

Decomp. HF

A 
L- lasix- Edema
M- Morphine
N- Nitrates (hydralazine, ISD- dec. AL and Chest pain)
O- OXygenation- BIPAP, CPAP
P- position- Decrease fluid by gravity
54
Q

Ivabradine

A

HCn channel Blocker
used in patients on b blockers or contraindicated on b blocker

Inc. SV= Slow Heartrate

6hr half-life 2 times a day

side eff- 
bradycardia
no eff. on rate control in a-fib
luminous phenomena in eye
Contraindicated in pregnancy, adv. Heart blocks and 3A4 inhibtors
55
Q

Adverse effects of ACE inhibitors

A 
Postural hypertension
Renal insuffeciency
Hyperkalemia- monitor K+ while using simultaneously with Spirnolactone
Creatinine increase
Teratogen
56
Q

Adverse effects of ARBs

A

similar to ACE inhibtor

hoewever, lo effects on Cough and angioedema

57
Q

Thiazide Diuretics Adv. Effects

A 
Hypokalemia
Hyponatremia
Hypomagnesemia
Hyperuricemia
Hypovolemia
Hypercalcemia
Hyperglycemia
58
Q

Loop Diuretics Adv. effects

A 
Acute Hypovolemia\
hypokalemia
Hypomagnesemia
Ototoxicity- hearing loss
Hyperuricemia
59
Q

K+ Sparing Diruretics Adv. Eff

A

Hyperkalemia

Gynecomastia

60
Q

Adv Effects of Neprilysin inhib

A

Same as ARB and ACE

61
Q

Adv. Effects of Digoxin

A 
narrow TI
Anorexia
Nausea
Emesis
Blurred vision
Arrhythmias due to Na+/K+ ATPase inhibition
Hypokalemia
inhibitors of P-gp Clarithromycin, Verapamil, and Amiodarone can cause worse side effects to digoxin as they act on P-gp

Pharmacology (19 decks)

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