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Pharm Midterm 1 > CHF > Flashcards

CHF Flashcards

1
Q

What is Stage A in CHF

A

High risk of HF

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2
Q

What is Stage B in CHF

A

ASx HF

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3
Q

What is Stage C in CHF

A

Symptomatic HF

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4
Q

What is Stage D in CHF

A

Refractory end-stage HF

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5
Q

What do you give in Stage A

A

ACEI

ARBs

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6
Q

What do you give in Stage B

A

ACEIs/ARBs or Beta blockers

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7
Q

What do you give in Stage C

A

AceIs/ARBs AND Beta blockers

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8
Q

What do you give in Stage D

A

End of life care

Extraordinary measures

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9
Q

Most common cause of HF in USA

A

CAD and HTN

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10
Q

Sx in HF

A

Decreased exercise tolerance
Dyspnea
Peripheral/pulm edema
Cardiomegaly

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11
Q

What is seen in Systolic failure

A

Reduced contractility and EF

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12
Q

What is seen in Diastolic failure

A

Stiffening (less relaxation)

Reduced CO, but normal EF

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13
Q

What is seen in CHF

A

Abnormal BV and IF fluid increase
Dyspnea
Peripheral edema

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14
Q

Physiological compensation in CHF

A

Activation of SNS, RAAS

Tissue remodelling

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15
Q

4 Factors affecting cardiac performance

A

Preload
Afterload
Contractility
HR

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16
Q

What is preload

A

Stretching of myocardial muscles to increase contractility

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17
Q

What is afterload

A

Force against which the ventricles act

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18
Q

What is contractility directly related to

A

Ca concentration

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19
Q

Drugs for systolic failure

A 
Diuretics
Spironolactone
ACEIs
ARBs
Direct vasodilators
Beta blocers
Inotropic agents
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20
Q

Drugs for diastolic failure

A

Diuretics
Ca channel blockers
Beta blockers

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21
Q

What do you never give in diastolic failure

A

+ve Inotropic agents

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22
Q

DOC in heart failure

A

ACEIs

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23
Q

Teratogenic so contraindicated in pregnancy

A

ACEIs

ARBs

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24
Q

Reduce HF Sx and Hospital time

A

DIgoxin

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25
Q

Increase exercise tolerance

A

Digoxin

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26
Q

Does NOT increase survival

A

Digoxin

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27
Q

What Thiazides are used in CHF

A

Chlorthalidon
Hydrochlorothiazide
Metolazone

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28
Q

What Loops are used in CHF

A

Ethacrynic acid
Furosemide
Torsemide

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29
Q

What Aldosterone antagonists are used in CHF

A

Spironolactone

Eplerenone

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30
Q

What ACEIs are used in CHF

A

Captopril
Enalapril
Lisinopril

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31
Q

What ARBs are used in CHF

A

Candesartan

Valsartan

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32
Q

What direct vasodilators are used in CHF

A

Hydralazine

NItrates (Isosorbide Dinitrate)

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33
Q

What beta blockers are used in CHF

A

Carvedilol

Metoprolol

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34
Q

What is the cardiac glycoside used

A

Digoxin

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35
Q

What are the Inotropic agents used in CHF

A 
Digoxin
Milrinone
Inamrinone
DA
Dobutamine
Glucagon
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36
Q

Which are more effective, loops or thiazides in CHF

A

Loops

37
Q

When do you give thiazide over loop in CHF

A

Hypertensive heart disease with congestive sx

38
Q

How do loops and thiazides treat CHF

A

Relieve pulm congestion and peripheral edema
Decrease orthopnia
Decrease VR and preload and afterload

39
Q

What do you combine aldosterone antagonists to reduce mortality and morbidity of sever HF

A

ACEIs

40
Q

How do aldosterone antagonists treat CHF

A

Prevent Na retention, K loss and mycardial hypertrophy

41
Q

When do you give Aldosterone antagonists

A

Advanced HF

LV dysfunction post MI

42
Q

When are aldosterone antagonists contraindicated

A

Pts on K supplements

43
Q

GI AE of aldosterone antagonists

A

Gastritis

PUD

44
Q

Endocrine AE of aldosterone antagonists

A

Gynecomastia
Decreased libido
Mestrual irregularities

45
Q

Metabolic AE of aldosterone antagonists

A

Hyperkalemia

46
Q

CNS AE of aldosterone antagonists

A

Lethargy

Confusion

47
Q

Which ARB is used for HTN vs CHF

A

HTN - Lorsartan

CHF - Candesartan

48
Q

How do ARBs act in CHF

A

Block AT-I receptor

No effect on bradykinin

49
Q

Effects of ACEIs in CHF

A

Decrease PVR, BP, afterload, preload, Na/H2O retention, long term remodelling
Increase CO

50
Q

When do you give ACEIs in CHF

A

Symptomatic HF

Asymptomatic HF with decreased LV EF or Hx of MI

51
Q

Which high risk groups can you give ACEIs to

A

Diabetes
HTN
Atherosclerosis
Obesity

52
Q

When do you give ARBs

A

Intolerant to ACEIs

Cough/Angioedema

53
Q

AE of ACEIs/ARBs

A 
Dry cough (NOT ARBs)
Hypotension
Renal insufficiency
Hyperkalemia
Angioedema
54
Q

What vessels does Hydralazine dilate

A

Arterioles

55
Q

What vessels do nitrates dilate

A

Venules

56
Q

When do you give direct vasodilators

A

Intolerant to ACEIs or beta blockers

Adjuvant in Black with advanced HF

57
Q

AE of Hydralazine

A

Lupus-like
Tachycardia
Peripheral neuritis

58
Q

How do beta blockers affect CHF

A

Reverse remodelling

59
Q

How do beta blockers act

A

Decrease HR and RAAS

Protect cardiac muscle from NE

60
Q

When do you give beta blockers in CHF

A

Stage B and C with ACEI

61
Q

What can initial beta blocker tx cause

A

Fluid retention

62
Q

Cautious use of beta blockers in whom

A

Asthma

Severe bradycardia

63
Q

Has a narrow therapeutic window

A

Digoxin

64
Q

Which CHF drug is +ve inotropic and -ve chronotropic

A

Digoxin

65
Q

When is Digoxin indicated

A

HF with A-fib

Give with ACEI and beta blocker

66
Q

How does Digoxin act

A

Inhibit Na/K ATPase
Indirect Na/Ca exchange inhibition
Increase Ca
Increase contractility

67
Q

Effect of Digoxin on HR

A

Reduces via decreased SNS, RAAS, PVR

68
Q

How does Digoxin increase refractory period

A

Decrease conduction through AV node

69
Q

Where does Digoxin accumulate

A

Muscle (high Vd)

70
Q

Does Digoxin need a loading dose?

A

Yes

71
Q

What can precipitate Digoxin toxicity

A

Hypokalemia

72
Q

How does Digoxin cause Hypokalemia

A

Competes with K for binding on ATPase

73
Q

Digoxin toxicity Sx

A

Atrial arrhythmias
Altered color perception
Halos on dark objects

74
Q

How do you treat Digoxin toxicity

A

Withdraw/Reduce

Digitalis Abs

75
Q

Tx for Digoxin tox with V-tach

A

Lidocaine and Mg or increase K

76
Q

Contraindications of Digoxin

A

Diastolic/Right HF
Uncontrolled HTN
Bradyarrhythmias

77
Q

What do you NEVER coadmin with Digoxin and why

A

Quinidine
Verapamil
Amiodarone
Compete with kidney excretion (Increase levels of digoxin in body)

78
Q

PDE3 inhibitor for short term increase in CO

A

Milrinone

Inamrinone

79
Q

Can increase AV conduction

A

Milrinone

Inamrinone

80
Q

+ve inotropic, increase CO and decrease preload and afterload

A

Milrinone

Inamrinone

81
Q

When do you give DA in CHF

A

Tx for shock after volume replacement

82
Q

What is the effect of an intermediate dose of DA

A

Dopaminergic and beta 1 receptors

Increase force and rate of contraction and renal vasodilation

83
Q

What is the effect of an lowdose of DA

A

D1 only

Dilate renal and mesenteric BVs

84
Q

What is the effect of an high dose of DA

A

Alpha 1 only

Vasoconstriction (no good)

85
Q

What is used in short term management of pts with cardiac decompensation

A

Dobutamine

86
Q

How does dobutamine work

A

+ve inotropic, vasodilation

Increase contraction

87
Q

What does Dobutamine not affect

A

HR

88
Q

When do you give Glucagon

A

Acute cardiac dysfunction from beta blocker OD

89
Q

How does glucagon work

A 
Increase contractility (not beta)
Inotropic and chronotropic

Pharm Midterm 1 (36 decks)

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